A move towards more compact and climate-resilient cities is being encouraged around the world. As part of these plans, there is a need to manage the potential conflict between increasing urban densities and the extent of tree canopy in cities. Reductions in tree canopy are a major contributor to the urban heat island (UHI) effect, which will act to reduce rather than increase climate resilience in many cities. A systems thinking approach called Collaborative Conceptual Modelling was used to study the interaction between urban infill, tree canopy, and human health in Perth, Australia. The results indicated that under current planning policies and development practices, the behaviour of the system is dominated by the drive towards higher housing densities. While this may result in the attainment of urban infill targets, it is likely to lead to a reduction in tree canopy, higher temperatures, and a decrease in a range of other benefits provided by trees. Recommended actions to overcome this behaviour were determined by the identification of leverage points in the system. These included a shift to a sustainable development paradigm that places greater value on the environmental and social benefits provided by trees and a greater emphasis on a climate-resilient future. Market and legislative mechanisms should be integrated into the city’s greening strategy and development plans to ensure the protection of existing trees and the inclusion of new trees on public and private land.

Objective: To identify the accuracy of diagnosing postpartum diabetes and glucose intolerance using antepartum glycosylated hemoglobin (HbA 1c ) and fasting glucose values. Study Design: A retrospective Hawaiian cohort of women with gestational diabetes during 2004-2011 were evaluated. Antepartum HbA 1c and postpartum 75-g glucose tolerance tests were obtained. Results: An antepartum HbA 1c value of ≥ 6.5% had a 45.7% sensitivity, a 96% specificity and a 40% positive predictive value (PPV) for predicting postpartum diabetes. An antepartum HbA 1c value of ≥ 6.5% had a 6.6% sensitivity, a 94.2% specificity and a 27% PPV for predicting postpartum impaired glucose tolerance. An antepartum HbA 1c value of ≥ 6.5% had a 10.3% sensitivity, a 95.7% specificity and a 33.3% PPV for predicting postpartum impaired fasting glucoses. Conclusion:We could not demonstrate a clinically useful PPV for diagnosing postpartum diabetes or glucose intolerance using an antepartum elevated HbA 1c value of ≥ 6.5% or a fasting glucose level of ≥ 90 mg/dL.

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