Comparison of the collagen haemostat Sangustop(R) versus a carrier-bound fibrin sealant during liver resection; ESSCALIVER-study

Background: Haemostasis in liver surgery remains a challenge despite improved resection techniques. Oozing from blood vessels too small to be ligated necessitate a treatment with haemostats in order to prevent complications attributed to bleeding. There is good evidence from randomised trials for the efficacy of fibrin sealants, on their own or in combination with a carrier material. A new haemostatic device is Sangustop(R). It is a collagen based material without any coagulation factors. Pre-clinical data for Sangustop(R) showed superior haemostatic effect. This present study aims to show that in the clinical situation Sangustop(R) is not inferior to a carrier-bound fibrin sealant (Tachosil(R)) as a haemostatic treatment in hepatic resection. Methods: This is a multi-centre, patient-blinded, intra-operatively randomised controlled trial. A total of 126 patients planned for an elective liver resection will be enrolled in eight surgical centres. The primary objective of this study is to show the non-inferiority of Sangustop(R) versus a carrier-bound fibrin sealant (Tachosil(R)) in achieving haemostasis after hepatic resection. The surgical intervention is standardised with regard to devices and techniques used for resection and primary haemostasis. Patients will be followed-up for three months for complications and adverse events. Discussion: This randomised controlled trial (ESSCALIVER) aims to compare the new collagen haemostat Sangustop(R) with a carrier-bound fibrin sealant which can be seen as a "gold standard" in hepatic and other visceral organ surgery. If non-inferiority is shown other criteria than the haemostatic efficacy (e.g. costs, adverse events rate) may be considered for the choice of the most appropriate treatment. Trial Registration: NCT0091861

Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review

Background: It is important that people with SMI receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly used to assist healthcare delivery (‘telehealth’) , providing service users with immediate real-time information to improve the management of chronic health conditions. Telehealth has been found to be successful in improving management and symptoms across a number of health conditions, whilst also being acceptable to users. Initial findings suggest technology could improve quality of life in people with SMI. Objectives: This systematic review aimed to identify the variety of uses and efficacy of teleheal th technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, AMED, He alth Techno logy Assessment, CINAHL plus and NHS EED ) for randomised controlled trials (RCTs) evaluating telehealth for adults with SMI , published in English. Additional literature was identified by searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: The search identified 31 eligible articles, describing 29 trials. The included studies evaluated the use of computers to deliver cognitive rehabilitation (1 5 trials), patient education (3 trials), online self- management interventions (2 trials), and to support consultations (1 trial). Virtual reality (VR) was used to simulate work and social sit uations (2 trials ) and to deliver cognitive training (1 trial). Telephones were used to prompt medication use (3 trials ) and report SMI symptoms to healthcare teams (1 trial ). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective for improving medication adherence and reducing symptom severity and inpatient days. Computer assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. Few studies evaluated the 3 use of remote medication telemonitoring, VR, online self-management and computer -mediated consultations, suggesting these are novel technologies for managing SMI, although all were found effective for improving psycho social and behavioural outcomes. The results of this review should be taken in the context of varied quality in study design, with only five studies demonstrating a low risk of bias. Conclusions : A growing variety of telehealth technologies are used to support SMI. Specific types of technology have been found to be effective for som e outcomes, for example telephone prompts for medication adherence, while other types of telehealth had no benefit over traditional methods and were less acceptable to patients. Few studies found benefits for telehealth on quality of life, except for novel technologies with a limited number of trials. Further research is warranted to establish the full potential benefits of telehealth for improving quality of life in SMI, acceptability from the service user perspective, and cost-effectivenes

Airborne laser scanning reveals uniform responses of forest structure to moose (Alces alces) across the boreal forest biome

1. The moose Alces alces is the largest herbivore in the boreal forest biome, where it can have dramatic impacts on ecosystem structure and dynamics. Despite the importance of the boreal forest biome in global carbon cycling, the impacts of moose have only been studied in disparate regional exclosure experiments, leading to calls for common analyses across a biome-wide network of moose exclosures. 2. In this study, we use airborne laser scanning (ALS) to analyse forest canopy re-sponses to moose across 100 paired exclosure-control experimental plots dis-tributed across the boreal biome, including sites in the United States (Isle Royale), Canada (Quebec, Newfoundland), Norway, Sweden and Finland. 3. We test the hypotheses that canopy height, vertical complexity and above- ground biomass (AGB) are all reduced by moose and that the impacts vary with moose density, productivity, temperature and pulse disturbances such as logging and insect outbreaks. 4. We find a surprising convergence in forest canopy response to moose. Moose had negative impacts on canopy height, complexity and AGB as expected. The responses of canopy complexity and AGB were consistent across regions and did not vary along environmental gradients. The difference in canopy height be-tween exclosures and open plots was on average 6 cm per year since the start of exclosure treatment (±2.1 SD). This rate increased with temperature, but only when moose density was high. 5. The difference in AGB between moose exclosures and open plots was 0.306 Mg ha−1 year−1 (±0.079). In browsed plots, stand AGB was 32% of that in the exclosures, a difference of 2.09 Mg ha−1. The uniform response allows scaling of the estimate to a biome-wide impact of moose of the loss of 448 (±115) Tg per year, or 224 Tg of carbon. 6. Synthesis: Analysis of ALS data from distributed exclosure experiments identified a largely uniform response of forest canopies to moose across regions, facilitat-ing scaling of moose impacts across the whole biome. This is an important step towards incorporating the effect of the largest boreal herbivore on the carbon cycling of one of the world's largest terrestrial biomes.publishedVersio

Tree spatial pattern within the forest–tundra ecotone: a comparison of sites across Canada

Accepted VersionAlthough many studies have focused on factors influencing treeline advance with climate change, less consideration has been given to potential changes in tree spatial pattern across the forest–tundra ecotone. We investigated trends in spatial pattern across the forest–tundra ecotone and geographical variation in the Yukon, Manitoba, and Labrador, Canada. Tree cover was measured in contiguous quadrats along transects up to 100 m long located in Forest, Ecotone, and Tundra sections across the forest–tundra transition. Spatial patterns were analyzed using new local variance to estimate patch size and wavelet analysis to determine the scale and amount of aggregation. Compared with the Forest, tree cover in the Ecotone was less aggregated at most sites, with fewer smaller patches of trees. We found evidence that shorter trees may be clumped at some sites, perhaps due to shelter from the wind, and we found little support for regular spacing that would indicate competition. With climate change, trees in the Ecotone will likely become more aggregated as patches enlarge and new patches establish. However, results were site-specific, varying with aspect and the presence of krummholz (stunted trees); therefore, strategies for adaptation of communities to climate change in Canada’s subarctic forest would need to reflect these differences

Plant traits poorly predict winner and loser shrub species in a warming tundra biome

Climate change is leading to species redistributions. In the tundra biome, shrubs are generally expanding, but not all tundra shrub species will benefit from warming. Winner and loser species, and the characteristics that may determine success or failure, have not yet been fully identified. Here, we investigate whether past abundance changes, current range sizes and projected range shifts derived from species distribution models are related to plant trait values and intraspecific trait variation. We combined 17,921 trait records with observed past and modelled future distributions from 62 tundra shrub species across three continents. We found that species with greater variation in seed mass and specific leaf area had larger projected range shifts, and projected winner species had greater seed mass values. However, trait values and variation were not consistently related to current and projected ranges, nor to past abundance change. Overall, our findings indicate that abundance change and range shifts will not lead to directional modifications in shrub trait composition, since winner and loser species share relatively similar trait spaces

Circum-Arctic distribution of chemical anti-herbivore compounds suggests biome-wide trade-off in defence strategies in Arctic shrubs

Spatial variation in plant chemical defence towards herbivores can help us understand variation in herbivore top-down control of shrubs in the Arctic and possibly also shrub responses to global warming. Less defended, non-resinous shrubs could be more influenced by herbivores than more defended, resinous shrubs. However, sparse field measurements limit our current understanding of how much of the circum-Arctic variation in defence compounds is explained by taxa or defence functional groups (resinous/non-resinous). We measured circum-Arctic chemical defence and leaf digestibility in resinous (Betula glandulosa, B. nana ssp. exilis) and non-resinous (B. nana ssp. nana, B. pumila) shrub birches to see how they vary among and within taxa and functional groups. Using liquid chromatography-mass spectrometry (LC-MS) metabolomic analyses and in vitro leaf digestibility via incubation in cattle rumen fluid, we analysed defence composition and leaf digestibility in 128 samples from 44 tundra locations. We found biogeographical patterns in anti-herbivore defence where mean leaf triterpene concentrations and twig resin gland density were greater in resinous taxa and mean concentrations of condensing tannins were greater in non-resinous taxa. This indicates a biome-wide trade-off between triterpene- or tannin-dominated defences. However, we also found variations in chemical defence composition and resin gland density both within and among functional groups (resinous/non-resinous) and taxa, suggesting these categorisations only partly predict chemical herbivore defence. Complex tannins were the only defence compounds negatively related to in vitro digestibility, identifying this previously neglected tannin group as having a potential key role in birch anti-herbivore defence. We conclude that circum-Arctic variation in birch anti-herbivore defence can be partly derived from biogeographical distributions of birch taxa, although our detailed mapping of plant defence provides more information on this variation and can be used for better predictions of herbivore effects on Arctic vegetation

Climate sensitivity of shrub growth across the tundra biome

The tundra biome is experiencing rapid temperature increases that have been linked to a shift in tundra vegetation composition towards greater shrub dominance. Shrub expansion can amplify warming by altering the surface albedo, energy and water balance, and permafrost temperatures. To account for these feedbacks, global climate models must include realistic projections of vegetation dynamics, and in particular tundra shrub expansion, yet the mechanisms driving shrub expansion remain poorly understood. Dendroecological data consisting of multi-decadal time series of annual growth of shrub species provide a previously untapped resource to explore climate-growth relationships across the tundra biome. We analysed a dataset of approximately 42,000 annual growth records from 1821 individuals, comprising 25 species from eight genera, from 37 arctic and alpine sites. Our analyses demonstrate that the sensitivity of shrub growth to climate was (1) heterogeneous across the tundra biome, (2) greater at sites with higher soil moisture and (3) strongest for taller shrub species growing at the northern or upper elevational edge of their range. Across latitudinal gradients in the Arctic, climate sensitivity of growth was greatest at the boundary between low- and high-arctic vegetation zones, where permafrost conditions are changing and the majority of the global permafrost soil carbon pool is stored. Thus, in order to more accurately estimate feedbacks among shrub change, albedo, permafrost thaw, carbon storage and climate, the observed variation in climate-growth relationships of shrub species across the tundra biome will need to be incorporated into earth system models.JRC.H.3-Forest Resources and Climat

Traditional plant functional groups explain variation in economic but not size-related traits across the tundra biome

Aim Plant functional groups are widely used in community ecology and earth system modelling to describe trait variation within and across plant communities. However, this approach rests on the assumption that functional groups explain a large proportion of trait variation among species. We test whether four commonly used plant functional groups represent variation in six ecologically important plant traits. Location Tundra biome. Time period Data collected between 1964 and 2016. Major taxa studied 295 tundra vascular plant species. Methods We compiled a database of six plant traits (plant height, leaf area, specific leaf area, leaf dry matter content, leaf nitrogen, seed mass) for tundra species. We examined the variation in species-level trait expression explained by four traditional functional groups (evergreen shrubs, deciduous shrubs, graminoids, forbs), and whether variation explained was dependent upon the traits included in analysis. We further compared the explanatory power and species composition of functional groups to alternative classifications generated using post hoc clustering of species-level traits. Results Traditional functional groups explained significant differences in trait expression, particularly amongst traits associated with resource economics, which were consistent across sites and at the biome scale. However, functional groups explained 19% of overall trait variation and poorly represented differences in traits associated with plant size. Post hoc classification of species did not correspond well with traditional functional groups, and explained twice as much variation in species-level trait expression. Main conclusions Traditional functional groups only coarsely represent variation in well-measured traits within tundra plant communities, and better explain resource economic traits than size-related traits. We recommend caution when using functional group approaches to predict tundra vegetation change, or ecosystem functions relating to plant size, such as albedo or carbon storage. We argue that alternative classifications or direct use of specific plant traits could provide new insights for ecological prediction and modelling.Peer reviewe

Circum-Arctic distribution of chemical anti-herbivore compounds suggests biome-wide trade-off in defence strategies in Arctic shrubs

Spatial variation in plant chemical defence towards herbivores can help us understand variation in herbivore top-down control of shrubs in the Arctic and possibly also shrub responses to global warming. Less defended, non-resinous shrubs could be more influenced by herbivores than more defended, resinous shrubs. However, sparse field measurements limit our current understanding of how much of the circum-Arctic variation in defence compounds is explained by taxa or defence functional groups (resinous/non-resinous). We measured circum-Arctic chemical defence and leaf digestibility in resinous (Betula glandulosa, B. nana ssp. exilis) and non-resinous (B. nana ssp. nana, B. pumila) shrub birches to see how they vary among and within taxa and functional groups. Using liquid chromatography-mass spectrometry (LC-MS) metabolomic analyses and in vitro leaf digestibility via incubation in cattle rumen fluid, we analysed defence composition and leaf digestibility in 128 samples from 44 tundra locations. We found biogeographical patterns in anti-herbivore defence where mean leaf triterpene concentrations and twig resin gland density were greater in resinous taxa and mean concentrations of condensing tannins were greater in non-resinous taxa. This indicates a biome-wide trade-off between triterpene- or tannin-dominated defences. However, we also found variations in chemical defence composition and resin gland density both within and among functional groups (resinous/non-resinous) and taxa, suggesting these categorisations only partly predict chemical herbivore defence. Complex tannins were the only defence compounds negatively related to in vitro digestibility, identifying this previously neglected tannin group as having a potential key role in birch anti-herbivore defence. We conclude that circum-Arctic variation in birch anti-herbivore defence can be partly derived from biogeographical distributions of birch taxa, although our detailed mapping of plant defence provides more information on this variation and can be used for better predictions of herbivore effects on Arctic vegetation.Peer reviewe