68 research outputs found
Recent Widespread Tree Growth Decline Despite Increasing Atmospheric CO2
Background: The synergetic effects of recent rising atmospheric CO2 and temperature are expected to favor tree growth in boreal and temperate forests. However, recent dendrochronological studies have shown site-specific unprecedented growth enhancements or declines. The question of whether either of these trends is caused by changes in the atmosphere remains unanswered because dendrochronology alone has not been able to clarify the physiological basis of such trends. Methodology/Principal Findings: Here we combined standard dendrochronological methods with carbon isotopic analysis to investigate whether atmospheric changes enhanced water use efficiency (WUE) and growth of two deciduous and two coniferous tree species along a 9u latitudinal gradient across temperate and boreal forests in Ontario, Canada. Our results show that although trees have had around 53 % increases in WUE over the past century, growth decline (measured as a decrease in basal area increment â BAI) has been the prevalent response in recent decades irrespective of species identity and latitude. Since the 1950s, tree BAI was predominantly negatively correlated with warmer climates and/or positively correlated with precipitation, suggesting warming induced water stress. However, where growth declines were not explained by climate, WUE and BAI were linearly and positively correlated, showing that declines are not always attributable to warming induced stress and additional stressors may exist. Conclusions: Our results show an unexpected widespread tree growth decline in temperate and boreal forests due t
VARICEAL BLEEDING: UPDATE OF RECOMMENDATIONS FROM THE BRAZILIAN ASSOCIATION OF HEPATOLOGY
A Hybrid computer simulation of the Beale Free Piston cycle engine
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P80â Ultrasound practice is heterogeneous and failing to highlight clinically significant liver disease
Introduction Abdominal ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient âabnormal LFTâ US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication âabnormal LFTsâ 04-17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported â this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery - on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. of the 281 scans reporting âfatty liverâ, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 15% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the word âcirrhosisâ was mentioned in only 5 of these scans (11%) and referral to Gastroenterology recommended in only 1 - meaning at least 884 missed opportunities to diagnose cirrhosis/year.The results suggest a crude incidence of fatty liver of 141/100,000/year and a crude incidence of cirrhosis of 22/100,000/year; however there was significant variability across Health Boards (range 0-381 and 0-62/100,000/year, respectively). The crude incidence did not relate to the reported crude prevalence of type 2 diabetes mellitus or alcohol related mortality rate, and instead increased with the number of scans performed/100,000 population.Conclusions US practice is heterogeneous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways
P80â Ultrasound practice is heterogeneous and failing to highlight clinically significant liver disease
Introduction Abdominal ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient âabnormal LFTâ US, and its efficacy in the risk stratification of liver disease.Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication âabnormal LFTsâ 04-17/10/21.Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.There was significant variability in descriptive terminology and parameters reported â this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery - on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. of the 281 scans reporting âfatty liverâ, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 15% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the word âcirrhosisâ was mentioned in only 5 of these scans (11%) and referral to Gastroenterology recommended in only 1 - meaning at least 884 missed opportunities to diagnose cirrhosis/year.The results suggest a crude incidence of fatty liver of 141/100,000/year and a crude incidence of cirrhosis of 22/100,000/year; however there was significant variability across Health Boards (range 0-381 and 0-62/100,000/year, respectively). The crude incidence did not relate to the reported crude prevalence of type 2 diabetes mellitus or alcohol related mortality rate, and instead increased with the number of scans performed/100,000 population.Conclusions US practice is heterogeneous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways
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