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Rationale: Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH).Objectives: To investigate epidemiology, risk factors, right ventricular function, and outcomes in patients with chronic heart failure and Cpc-PH.Methods: The study population was identified from a retrospective chart review of a clinical database of 3,107 stable patients who underwent first diagnostic right heart catheterization and from a prospective cohort of 800 consecutive patients at a national university-affiliated tertiary center.Measurements and Main Results: The retrospective cohort had 664 patients with systolic heart failure (SHF) and 399 patients with diastolic heart failure (DHF), 12% of whom were classified as Cpc-PH. The prospective cohort had 172 patients with SHF (14% Cpc-PH) and 219 patients with DHF (12% Cpc-PH). Chronic obstructive pulmonary disease (P = 0.034) and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (P = 0.015) predicted Cpc-PH in SHF. Younger age (P = 0.004), valvular heart disease (P = 0.046), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio predicted Cpc-PH in DHF (P = 0.016). Right ventricular-pulmonary vascular coupling was worse in Cpc-PH patients (end-systolic elastance to effective arterial elastance [Ees/Ea]: SHF: 1.05 ± 0.25; P = 0.002; DHF: 1.17 ± 0.27; P = 0.027) than in those with isolated post-capillary PH (Ees/Ea: SHF: 1.52 ± 0.51; DHF: 1.45 ± 0.29).Conclusions: Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes. [ABSTRACT FROM AUTHOR]

Roadkill is a worldwide issue that can cause local population extinctions. In Australia numerous species are affected, however the bare-nosed wombat (Vombatus ursinus) is particularly vulnerable due to its preference for disturbed habitats. Collisions with motor vehicles causes significant damage to the vehicle and sometimes the driver, as well as wounding or killing the wombat. Virtual fences are light and sound-based devices, originally developed in Austria that can be used to reduce roadkill through mitigation. They have had mixed results. In this study a virtual fence was installed along a 1.5 km stretch of road in semi-rural NSW, Australia, with the aim of reducing wombat roadkill through the use of this form of mitigation strategy. The number of roadkilled wombats was counted before and after the fence was installed in March 2020. Prior to the fence being installed 23 wombats were killed and after the fence was installed six wombats were killed. Along Old Bega Road, outside of the fenced area 64 wombats were killed pre-fence installation and 17 post fence installation. Bare-nosed wombats are semi-fossorial ecosystem engineers with an important role in the ecosystem and despite being listed as Least Concern are readily impacted by roadkill. Virtual fencing implemented in regions that have high wombat roadkill rates may aid in reducing road deaths and species conservation. However, we recommend that more research is required to assess virtual fencing, as a roadkill mitigation strategy, including an investigation into a larger number of species in a range of different habitats. • Vehicles often fatally strike animals and in Australia this includes the wombat. • Roadkills might be reduced if wombats were warned of approaching vehicles. • We used virtual fencing to warn wombats as vehicles approach in a high-risk location. • We compared roadkill rates before and after the installation of the virtual fencing. • Mortality was marginally reduced after system installation. [ABSTRACT FROM AUTHOR]