Individualizing fortification of human milk using real time human milk analysis

OBJECTIVE

To use real-time human milk macronutrient analysis to calculate final composition following fortification.

STUDY DESIGN

Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to PHM. Four milk sample profiles were selected to demonstrate individualized fortification results.

RESULTS

Lactose was similar in PHM and DHM. Protein in PHM showed the expected decline as lactation progressed. DHM protein was significantly lower vs. PHM. Fat was highly variable and lowest in DHM. Using standard fortification protocols, not all fortified milks met targets for protein and energy. Individualized fortification resulted in milks closer to target recommendations.

CONCLUSIONS

Real-time analysis of HM provides assessment of the macronutrient content of the milk and can guide fortification. Individualized protocols, based on actual milk macronutrient profiles, may need to be considered to avoid unexpected nutrient content.

Markedly divergent estimates of Amazon forest carbon density from ground plots and satellites

AIM

The accurate mapping of forest carbon stocks is essential for understanding the global carbon cycle, for assessing emissions from deforestation, and for rational land-use planning. Remote sensing (RS) is currently the key tool for this purpose, but RS does not estimate vegetation biomass directly, and thus may miss significant spatial variations in forest structure. We test the stated accuracy of pantropical carbon maps using a large independent field dataset.

LOCATION

Tropical forests of the Amazon basin. The permanent archive of the field plot data can be accessed at: http://dx.doi.org/10.5521/FORESTPLOTS.NET/2014_1.

METHODS

Two recent pantropical RS maps of vegetation carbon are compared to a unique ground-plot dataset, involving tree measurements in 413 large inventory plots located in nine countries. The RS maps were compared directly to field plots, and kriging of the field data was used to allow area-based comparisons.

RESULTS

The two RS carbon maps fail to capture the main gradient in Amazon forest carbon detected using 413 ground plots, from the densely wooded tall forests of the north-east, to the light-wooded, shorter forests of the south-west. The differences between plots and RS maps far exceed the uncertainties given in these studies, with whole regions over- or under-estimated by > 25%, whereas regional uncertainties for the maps were reported to be < 5%.

MAIN CONCLUSIONS

Pantropical biomass maps are widely used by governments and by projects aiming to reduce deforestation using carbon offsets, but may have significant regional biases. Carbon-mapping techniques must be revised to account for the known ecological variation in tree wood density and allometry to create maps suitable for carbon accounting. The use of single relationships between tree canopy height and above-ground biomass inevitably yields large, spatially correlated errors. This presents a significant challenge to both the forest conservation and remote sensing communities, because neither wood density nor species assemblages can be reliably mapped from space.

Mixed-forest species establishment in a monodominant forest in central Africa: implications for tropical forest invasibility

Background

Traits of non-dominant mixed-forest tree species and their synergies for successful co-occurrence in monodominant Gilbertiodendron dewevrei forest have not yet been investigated. Here we compared the tree species diversity of the monodominant forest with its adjacent mixed forest and then determined which fitness proxies and life history traits of the mixed-forest tree species were most associated with successful co-existence in the monodominant forest.

Methodology/Principal Findings

We sampled all trees (diameter in breast height [dbh]≥10 cm) within 6×1 ha topographically homogenous areas of intact central African forest in SE Cameroon, three independent patches of G. dewevrei-dominated forest and three adjacent areas (450–800 m apart). Monodominant G. dewevrei forest had lower sample-controlled species richness, species density and population density than its adjacent mixed forest in terms of stems with dbh≥10 cm. Analysis of a suite of population-level characteristics, such as relative abundance and geographical distribution, and traits such as wood density, height, diameter at breast height, fruit/seed dispersal mechanism and light requirement–revealed after controlling for phylogeny, species that co-occur with G. dewevrei tend to have higher abundance in adjacent mixed forest, higher wood density and a lower light requirement.

Conclusions/Significance

Our results suggest that certain traits (wood density and light requirement) and population-level characteristics (relative abundance) may increase the invasibility of a tree species into a tropical closed-canopy system. Such knowledge may assist in the pre-emptive identification of invasive tree species.

Quantifying and understanding carbon storage and sequestration within the Eastern Arc Mountains of Tanzania, a tropical biodiversity hotspot

BACKGROUND

The carbon stored in vegetation varies across tropical landscapes due to a complex mix of climatic and edaphic variables, as well as direct human interventions such as deforestation and forest degradation. Mapping and monitoring this variation is essential if policy developments such as REDD+ (Reducing Emissions from Deforestation and Forest Degradation) are to be known to have succeeded or failed.

RESULTS

We produce a map of carbon storage across the watershed of the Tanzanian Eastern Arc Mountains (33.9 million ha) using 1,611 forest inventory plots, and correlations with associated climate, soil and disturbance data. As expected, tropical forest stores more carbon per hectare (182 Mg C ha(-1)) than woody savanna (51 Mg C ha(-1)). However, woody savanna is the largest aggregate carbon store, with 0.49 Pg C over 9.6 million ha. We estimate the whole landscape stores 1.3 Pg C, significantly higher than most previous estimates for the region. The 95% Confidence Interval for this method (0.9 to 3.2 Pg C) is larger than simpler look-up table methods (1.5 to 1.6 Pg C), suggesting simpler methods may underestimate uncertainty. Using a small number of inventory plots with two censuses (n = 43) to assess changes in carbon storage, and applying the same mapping procedures, we found that carbon storage in the tree-dominated ecosystems has decreased, though not significantly, at a mean rate of 1.47 Mg C ha(-1) yr(-1) (c. 2% of the stocks of carbon per year).

CONCLUSIONS

The most influential variables on carbon storage in the region are anthropogenic, particularly historical logging, as noted by the largest coefficient of explanatory variable on the response variable. Of the non-anthropogenic factors, a negative correlation with air temperature and a positive correlation with water availability dominate, having smaller p-values than historical logging but also smaller influence. High carbon storage is typically found far from the commercial capital, in locations with a low monthly temperature range, without a strong dry season, and in areas that have not suffered from historical logging. The results imply that policy interventions could retain carbon stored in vegetation and likely successfully slow or reverse carbon emissions.

Fast demographic traits promote high diversification rates of Amazonian trees

The Amazon rain forest sustains the world's highest tree diversity, but it remains unclear why some clades of trees are hyperdiverse, whereas others are not. Using dated phylogenies, estimates of current species richness and trait and demographic data from a large network of forest plots, we show that fast demographic traits – short turnover times – are associated with high diversification rates across 51 clades of canopy trees. This relationship is robust to assuming that diversification rates are either constant or decline over time, and occurs in a wide range of Neotropical tree lineages. This finding reveals the crucial role of intrinsic, ecological variation among clades for understanding the origin of the remarkable diversity of Amazonian trees and forests.

Foliar trait contrasts between African forest and savanna trees: genetic versus environmental effects

Variations in leaf mass per unit area (Ma) and foliar concentrations of N, P, C, K, Mg and Ca were determined for 365 trees growing in 23 plots along a West African precipitation gradient ranging from 0.29 to 1.62m a-1. Contrary to previous studies, no marked increase in Ma with declining precipitation was observed, but savanna tree foliar [N] tended to be higher at the drier sites (mass basis). Generally, Ma was slightly higher and [N] slightly lower for forest vs savanna trees with most of this difference attributable to differences in soil chemistry. No systematic variations in [P], [Mg] and [Ca] with precipitation or between trees of forest vs savanna stands were observed. We did, however, find a marked increase in foliar [K] of savanna trees as precipitation declined, with savanna trees also having a significantly lower [K] than those of nearby forest. These differences were not related to differences in soil nutrient status and were accompanied by systematic changes in [C] of opposite sign. We suggest an important but as yet unidentified role for K in the adaption of savanna species to periods of limited water availability; with foliar [K] being also an important factor differentiating tree species adapted to forest vs savanna soils within the 'zone of transition' of Western Africa.

Predictive systems ecology

Human societies, and their well-being, depend to a significant extent on the state of the ecosystems that surround them. These ecosystems are changing rapidly usually in response to anthropogenic changes in the environment. To determine the likely impact of environmental change on ecosystems and the best ways to manage them, it would be desirable to be able to predict their future states. We present a proposal to develop the paradigm of predictive systems ecology, explicitly to understand and predict the properties and behaviour of ecological systems. We discuss the necessary and desirable features of predictive systems ecology models. There are places where predictive systems ecology is already being practised and we summarize a range of terrestrial and marine examples. Significant challenges remain but we suggest that ecology would benefit both as a scientific discipline and increase its impact in society if it were to embrace the need to become more predictive.

African rainforests: past, present and future

The rainforests are the great green heart of Africa, and present a unique combination of ecological, climatic and human interactions. In this synthesis paper, we review the past and present state processes of change in African rainforests, and explore the challenges and opportunities for maintaining a viable future for these biomes. We draw in particular on the insights and new analyses emerging from the Theme Issue on 'African rainforests: past, present and future' of Philosophical Transactions of the Royal Society B. A combination of features characterize the African rainforest biome, including a history of climate variation; forest expansion and retreat; a long history of human interaction with the biome; a relatively low plant species diversity but large tree biomass; a historically exceptionally high animal biomass that is now being severely hunted down; the dominance of selective logging; small-scale farming and bushmeat hunting as the major forms of direct human pressure; and, in Central Africa, the particular context of mineral- and oil-driven economies that have resulted in unusually low rates of deforestation and agricultural activity. We conclude by discussing how this combination of factors influences the prospects for African forests in the twenty-first century.

Above-ground biomass and structure of 260 African tropical forests

We report above-ground biomass (AGB), basal area, stem density and wood mass density estimates from 260 sample plots (mean size: 1.2 ha) in intact closed-canopy tropical forests across 12 African countries. Mean AGB is 395.7 Mg dry mass ha⁻¹ (95% CI: 14.3), substantially higher than Amazonian values, with the Congo Basin and contiguous forest region attaining AGB values (429 Mg ha⁻¹) similar to those of Bornean forests, and significantly greater than East or West African forests. AGB therefore appears generally higher in palaeo- compared with neotropical forests. However, mean stem density is low (426 ± 11 stems ha⁻¹ greater than or equal to 100 mm diameter) compared with both Amazonian and Bornean forests (cf. approx. 600) and is the signature structural feature of African tropical forests. While spatial autocorrelation complicates analyses, AGB shows a positive relationship with rainfall in the driest nine months of the year, and an opposite association with the wettest three months of the year; a negative relationship with temperature; positive relationship with clay-rich soils; and negative relationships with C : N ratio (suggesting a positive soil phosphorus-AGB relationship), and soil fertility computed as the sum of base cations. The results indicate that AGB is mediated by both climate and soils, and suggest that the AGB of African closed-canopy tropical forests may be particularly sensitive to future precipitation and temperature changes.

Neogene origins and implied warmth tolerance of Amazon tree species

Tropical rain forest has been a persistent feature in South America for at least 55 million years. The future of the contemporary Amazon forest is uncertain, however, as the region is entering conditions with no past analogue, combining rapidly increasing air temperatures, high atmospheric carbon dioxide concentrations, possible extreme droughts, and extensive removal and modification by humans. Given the long-term Cenozoic cooling trend, it is unknown whether Amazon forests can tolerate air temperature increases, with suggestions that lowland forests lack warm-adapted taxa, leading to inevitable species losses. In response to this uncertainty, we posit a simple hypothesis: the older the age of a species prior to the Pleistocene, the warmer the climate it has previously survived, with Pliocene (2.6–5 Ma) and late-Miocene (8–10 Ma) air temperature across Amazonia being similar to 2100 temperature projections under low and high carbon emission scenarios, respectively. Using comparative phylogeographic analyses, we show that 9 of 12 widespread Amazon tree species have Pliocene or earlier lineages (>2.6 Ma), with seven dating from the Miocene (>5.6 Ma) and three >8 Ma. The remarkably old age of these species suggest that Amazon forests passed through warmth similar to 2100 levels and that, in the absence of other major environmental changes, near-term high temperature-induced mass species extinction is unlikely.

Towards regional, error-bounded landscape carbon storage estimates for data-deficient areas of the world

Monitoring landscape carbon storage is critical for supporting and validating climate change mitigation policies. These may be aimed at reducing deforestation and degradation, or increasing terrestrial carbon storage at local, regional and global levels. However, due to data-deficiencies, default global carbon storage values for given land cover types such as 'lowland tropical forest' are often used, termed 'Tier 1 type' analyses by the Intergovernmental Panel on Climate Change (IPCC). Such estimates may be erroneous when used at regional scales. Furthermore uncertainty assessments are rarely provided leading to estimates of land cover change carbon fluxes of unknown precision which may undermine efforts to properly evaluate land cover policies aimed at altering land cover dynamics. Here, we present a repeatable method to estimate carbon storage values and associated 95% confidence intervals (CI) for all five IPCC carbon pools (aboveground live carbon, litter, coarse woody debris, belowground live carbon and soil carbon) for data-deficient regions, using a combination of existing inventory data and systematic literature searches, weighted to ensure the final values are regionally specific. The method meets the IPCC 'Tier 2' reporting standard. We use this method to estimate carbon storage over an area of33.9 million hectares of eastern Tanzania, reporting values for 30 land cover types. We estimate that this area stored 6.33 (5.92-6.74) Pg C in the year 2000. Carbon storage estimates for the same study area extracted from five published Africa-wide or global studies show a mean carbon storage value of ∼50% of that reported using our regional values, with four of the five studies reporting lower carbon storage values. This suggests that carbon storage may have been underestimated for this region of Africa. Our study demonstrates the importance of obtaining regionally appropriate carbon storage estimates, and shows how such values can be produced for a relatively low investment.

Drought-induced shifts in the floristic and functional composition of tropical forests in Ghana

The future of tropical forests under global environmental change is uncertain, with biodiversity and carbon stocks at risk if precipitation regimes alter. Here, we assess changes in plant functional composition and biomass in 19 plots from a variety of forest types during two decades of long-term drought in Ghana. We find a consistent increase in dry forest, deciduous, canopy species with intermediate light demand and a concomitant decrease in wet forest, evergreen, sub-canopy and shade-tolerant species. These changes in composition are accompanied by an increase in above-ground biomass. Our results indicate that by altering composition in favour of drought-tolerant species, the biomass stocks of these forests may be more resilient to longer term drought than short-term studies of severe individual droughts suggest.

Mapping socio-economic scenarios of land cover change: a GIS method to enable ecosystem service modelling

We present a GIS method to interpret qualitatively expressed socio-economic scenarios in quantitative map-based terms. (i) We built scenarios using local stakeholders and experts to define how major land cover classes may change under different sets of drivers; (ii) we formalized these as spatially explicit rules, for example agriculture can only occur on certain soil types; (iii) we created a future land cover map which can then be used to model ecosystem services. We illustrate this for carbon storage in the Eastern Arc Mountains of Tanzania using two scenarios: the first based on sustainable development, the second based on 'business as usual' with continued forest-woodland degradation and poor protection of existing forest reserves. Between 2000 and 2025 4% of carbon stocks were lost under the first scenario compared to a loss of 41% of carbon stocks under the second scenario. Quantifying the impacts of differing future scenarios using the method we document here will be important if payments for ecosystem services are to be used to change policy in order to maintain critical ecosystem services.

Soil does not explain monodominance in a Central African tropical forest

BACKGROUND

Soil characteristics have been hypothesised as one of the possible mechanisms leading to monodominance of Gilbertiodendron dewerei in some areas of Central Africa where higher-diversity forest would be expected. However, the differences in soil characteristics between the G. dewevrei-dominated forest and its adjacent mixed forest are still poorly understood. Here we present the soil characteristics of the G. dewevrei forest and quantify whether soil physical and chemical properties in this monodominant forest are significantly different from the adjacent mixed forest.

METHODOLOGY/PRINCIPAL FINDINGS

We sampled top soil (0-5, 5-10, 10-20, 20-30 cm) and subsoil (150-200 cm) using an augur in 6 × 1 ha areas of intact central Africa forest in SE Cameroon, three independent patches of G. dewevrei-dominated forest and three adjacent areas (450-800 m apart), all chosen to be topographically homogeneous. Analysis--subjected to Bonferroni correction procedure--revealed no significant differences between the monodominant and mixed forests in terms of soil texture, median particle size, bulk density, pH, carbon (C) content, nitrogen (N) content, C:N ratio, C:total NaOH-extractable P ratio and concentrations of labile phosphorous (P), inorganic NaOH-extractable P, total NaOH-extractable P, aluminium, barium, calcium, copper, iron, magnesium, manganese, molybdenum, nickel, potassium, selenium, silicon, sodium and zinc. Prior to Bonferroni correction procedure, there was a significant lower level of silicon concentration found in the monodominant than mixed forest deep soil; and a significant lower level of nickel concentration in the monodominant than mixed forest top soil. Nevertheless, these were likely to be the results of multiple tests of significance.

CONCLUSIONS/SIGNIFICANCE

Our results do not provide clear evidence of soil mediation for the location of monodominant forests in relation to adjacent mixed forests. It is also likely that G. dewevrei does not influence soil chemistry in the monodominant forests.

Drought-mortality relationships for tropical forests

*The rich ecology of tropical forests is intimately tied to their moisture status. Multi-site syntheses can provide a macro-scale view of these linkages and their susceptibility to changing climates. Here, we report pan-tropical and regional-scale analyses of tree vulnerability to drought. *We assembled available data on tropical forest tree stem mortality before, during, and after recent drought events, from 119 monitoring plots in 10 countries concentrated in Amazonia and Borneo. *In most sites, larger trees are disproportionately at risk. At least within Amazonia, low wood density trees are also at greater risk of drought-associated mortality, independent of size. For comparable drought intensities, trees in Borneo are more vulnerable than trees in the Amazon. There is some evidence for lagged impacts of drought, with mortality rates remaining elevated 2 yr after the meteorological event is over. *These findings indicate that repeated droughts would shift the functional composition of tropical forests toward smaller, denser-wooded trees. At very high drought intensities, the linear relationship between tree mortality and moisture stress apparently breaks down, suggesting the existence of moisture stress thresholds beyond which some tropical forests would suffer catastrophic tree mortality.

Are the dynamics of tropical forests dominated by large and rare disturbance events?

A recent Ecology Letters paper of Fisher et al. (2008) utilized a modelling framework to investigate disturbance effects on forest biomass dynamics. But it contains serious methodological and conceptual errors. Associated conclusions are unlikely to be correct.

Early amino acids and the metabolic response of ELBW infants (< or = 1000 g) in three time periods

OBJECTIVE

To evaluate early amino-acid (AA) administration in extremely low birth weight (ELBW) infants over three time periods, beginning with the initiation of this strategy.

STUDY DESIGN

This was a retrospective study of ELBW infants between 2000 and 2007. Nutritional intake and laboratory results were monitored during the first 5 days of life. Growth rates and complications were followed until discharge.

RESULT

Infants were similar in birth weight (BW), gestational age (GA) and severity of illness. The age at initiation of AA decreased significantly over time. Age at weight nadir, return to BW and percent postnatal weight loss decreased in epoch 3. There were modest increases in blood urea nitrogen (BUN), but no significant metabolic disturbances were observed. Cholestasis was more prevalent in epoch 2.

CONCLUSION

AA administration within the first hours of life appears to be safe and beneficial for ELBW infants. Absent signs of renal dysfunction, a modest rise in BUN is consistent with the neonate's utilization of AAs for energy.

Towards a worldwide wood economics spectrum

Wood performs several essential functions in plants, including mechanically supporting aboveground tissue, storing water and other resources, and transporting sap. Woody tissues are likely to face physiological, structural and defensive trade-offs. How a plant optimizes among these competing functions can have major ecological implications, which have been under-appreciated by ecologists compared to the focus they have given to leaf function. To draw together our current understanding of wood function, we identify and collate data on the major wood functional traits, including the largest wood density database to date (8412 taxa), mechanical strength measures and anatomical features, as well as clade-specific features such as secondary chemistry. We then show how wood traits are related to one another, highlighting functional trade-offs, and to ecological and demographic plant features (growth form, growth rate, latitude, ecological setting). We suggest that, similar to the manifold that tree species leaf traits cluster around the 'leaf economics spectrum', a similar 'wood economics spectrum' may be defined. We then discuss the biogeography, evolution and biogeochemistry of the spectrum, and conclude by pointing out the major gaps in our current knowledge of wood functional traits.

Drought sensitivity of the Amazon rainforest

Amazon forests are a key but poorly understood component of the global carbon cycle. If, as anticipated, they dry this century, they might accelerate climate change through carbon losses and changed surface energy balances. We used records from multiple long-term monitoring plots across Amazonia to assess forest responses to the intense 2005 drought, a possible analog of future events. Affected forest lost biomass, reversing a large long-term carbon sink, with the greatest impacts observed where the dry season was unusually intense. Relative to pre-2005 conditions, forest subjected to a 100-millimeter increase in water deficit lost 5.3 megagrams of aboveground biomass of carbon per hectare. The drought had a total biomass carbon impact of 1.2 to 1.6 petagrams (1.2 x 10(15) to 1.6 x 10(15) grams). Amazon forests therefore appear vulnerable to increasing moisture stress, with the potential for large carbon losses to exert feedback on climate change.

Towards a worldwide wood economics spectrum

Wood performs several essential functions in plants, including mechanically supporting aboveground tissue, storing water and other resources, and transporting sap. Woody tissues are likely to face physiological, structural and defensive trade-offs. How a plant optimizes among these competing functions can have major ecological implications, which have been under-appreciated by ecologists compared to the focus they have given to leaf function. To draw together our current understanding of wood function, we identify and collate data on the major wood functional traits, including the largest wood density database to date (8412 taxa), mechanical strength measures and anatomical features, as well as clade-specific features such as secondary chemistry. We then show how wood traits are related to one another, highlighting functional trade-offs, and to ecological and demographic plant features (growth form, growth rate, latitude, ecological setting). We suggest that, similar to the manifold that tree species leaf traits cluster around the 'leaf economics spectrum', a similar 'wood economics spectrum' may be defined. We then discuss the biogeography, evolution and biogeochemistry of the spectrum, and conclude by pointing out the major gaps in our current knowledge of wood functional traits.

The changing Amazon forest

Long-term monitoring of distributed, multiple plots is the key to quantify macroecological patterns and changes. Here we examine the evidence for concerted changes in the structure, dynamics and composition of old-growth Amazonian forests in the late twentieth century. In the 1980s and 1990s, mature forests gained biomass and underwent accelerated growth and dynamics, all consistent with a widespread, long-acting stimulation of growth. Because growth on average exceeded mortality, intact Amazonian forests have been a carbon sink. In the late twentieth century, biomass of trees of more than 10cm diameter increased by 0.62+/-0.23tCha-1yr-1 averaged across the basin. This implies a carbon sink in Neotropical old-growth forest of at least 0.49+/-0.18PgCyr-1. If other biomass and necromass components are also increased proportionally, then the old-growth forest sink here has been 0.79+/-0.29PgCyr-1, even before allowing for any gains in soil carbon stocks. This is approximately equal to the carbon emissions to the atmosphere by Amazon deforestation. There is also evidence for recent changes in Amazon biodiversity. In the future, the growth response of remaining old-growth mature Amazon forests will saturate, and these ecosystems may switch from sink to source driven by higher respiration (temperature), higher mortality (as outputs equilibrate to the growth inputs and periodic drought) or compositional change (disturbances). Any switch from carbon sink to source would have profound implications for global climate, biodiversity and human welfare, while the documented acceleration of tree growth and mortality may already be affecting the interactions among millions of species.

Tropical forests and the changing earth system

Tropical forests are global epicentres of biodiversity and important modulators of the rate of climate change. Recent research on deforestation rates and ecological changes within intact forests, both areas of recent research and debate, are reviewed, and the implications for biodiversity (species loss) and climate change (via the global carbon cycle) addressed. Recent impacts have most likely been: (i) a large source of carbon to the atmosphere, and major loss of species, from deforestation and (ii) a large carbon sink within remaining intact forest, accompanied by accelerating forest dynamism and widespread biodiversity changes. Finally, I look to the future, suggesting that the current carbon sink in intact forests is unlikely to continue, and that the tropical forest biome may even become a large net source of carbon, via one or more of four plausible routes: changing photosynthesis and respiration rates, biodiversity changes in intact forest, widespread forest collapse via drought, and widespread forest collapse via fire. Each of these scenarios risks potentially dangerous positive feedbacks with the climate system that could dramatically accelerate and intensify climate change. Given that continued land-use change alone is already thought to be causing the sixth mass extinction event in Earth's history, should such feedbacks occur, the resulting biodiversity and societal consequences would be even more severe.

Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation

The haematological complications of acquired copper deficiency have been well documented, but the neurological complications have only recently been reported. An illustrative case of copper deficiency myeloneuropathy with pancytopenia is presented and the potential aetiologies and neurological manifestations of this deficiency state discussed.

Concerted changes in tropical forest structure and dynamics: evidence from 50 South American long-term plots

Several widespread changes in the ecology of old-growth tropical forests have recently been documented for the late twentieth century, in particular an increase in stem turnover (pan-tropical), and an increase in above-ground biomass (neotropical). Whether these changes are synchronous and whether changes in growth are also occurring is not known. We analysed stand-level changes within 50 long-term monitoring plots from across South America spanning 1971-2002. We show that: (i) basal area (BA: sum of the cross-sectional areas of all trees in a plot) increased significantly over time (by 0.10 +/- 0.04 m2 ha(-1) yr(-1), mean +/- 95% CI); as did both (ii) stand-level BA growth rates (sum of the increments of BA of surviving trees and BA of new trees that recruited into a plot); and (iii) stand-level BA mortality rates (sum of the cross-sectional areas of all trees that died in a plot). Similar patterns were observed on a per-stem basis: (i) stem density (number of stems per hectare; 1 hectare is 10(4) m2) increased significantly over time (0.94 +/- 0.63 stems ha(-1) yr(-1)); as did both (ii) stem recruitment rates; and (iii) stem mortality rates. In relative terms, the pools of BA and stem density increased by 0.38 +/- 0.15% and 0.18 +/- 0.12% yr(-1), respectively. The fluxes into and out of these pools-stand-level BA growth, stand-level BA mortality, stem recruitment and stem mortality rates-increased, in relative terms, by an order of magnitude more. The gain terms (BA growth, stem recruitment) consistently exceeded the loss terms (BA loss, stem mortality) throughout the period, suggesting that whatever process is driving these changes was already acting before the plot network was established. Large long-term increases in stand-level BA growth and simultaneous increases in stand BA and stem density imply a continent-wide increase in resource availability which is increasing net primary productivity and altering forest dynamics. Continent-wide changes in incoming solar radiation, and increases in atmospheric concentrations of CO2 and air temperatures may have increased resource supply over recent decades, thus causing accelerated growth and increased dynamism across the world's largest tract of tropical forest.

Pattern and process in Amazon tree turnover, 1976-2001

Previous work has shown that tree turnover, tree biomass and large liana densities have increased in mature tropical forest plots in the late twentieth century. These results point to a concerted shift in forest ecological processes that may already be having significant impacts on terrestrial carbon stocks, fluxes and biodiversity. However, the findings have proved controversial, partly because a rather limited number of permanent plots have been monitored for rather short periods. The aim of this paper is to characterize regional-scale patterns of 'tree turnover' (the rate with which trees die and recruit into a population) by using improved datasets now available for Amazonia that span the past 25 years. Specifically, we assess whether concerted changes in turnover are occurring, and if so whether they are general throughout the Amazon or restricted to one region or environmental zone. In addition, we ask whether they are driven by changes in recruitment, mortality or both. We find that: (i) trees 10 cm or more in diameter recruit and die twice as fast on the richer soils of southern and western Amazonia than on the poorer soils of eastern and central Amazonia; (ii) turnover rates have increased throughout Amazonia over the past two decades; (iii) mortality and recruitment rates have both increased significantly in every region and environmental zone, with the exception of mortality in eastern Amazonia; (iv) recruitment rates have consistently exceeded mortality rates; (v) absolute increases in recruitment and mortality rates are greatest in western Amazonian sites; and (vi) mortality appears to be lagging recruitment at regional scales. These spatial patterns and temporal trends are not caused by obvious artefacts in the data or the analyses. The trends cannot be directly driven by a mortality driver (such as increased drought or fragmentation-related death) because the biomass in these forests has simultaneously increased. Our findings therefore indicate that long-acting and widespread environmental changes are stimulating the growth and productivity of Amazon forests.

Fingerprinting the impacts of global change on tropical forests

Recent observations of widespread changes in mature tropical forests such as increasing tree growth, recruitment and mortality rates and increasing above-ground biomass suggest that 'global change' agents may be causing predictable changes in tropical forests. However, consensus over both the robustness of these changes and the environmental drivers that may be causing them is yet to emerge. This paper focuses on the second part of this debate. We review (i) the evidence that the physical, chemical and biological environment that tropical trees grow in has been altered over recent decades across large areas of the tropics, and (ii) the theoretical, experimental and observational evidence regarding the most likely effects of each of these changes on tropical forests. Ten potential widespread drivers of environmental change were identified: temperature, precipitation, solar radiation, climatic extremes (including El Niño-Southern Oscillation events), atmospheric CO2 concentrations, nutrient deposition, O3/acid depositions, hunting, land-use change and increasing liana numbers. We note that each of these environmental changes is expected to leave a unique 'fingerprint' in tropical forests, as drivers directly force different processes, have different distributions in space and time and may affect some forests more than others (e.g. depending on soil fertility). Thus, in the third part of the paper we present testable a priori predictions of forest responses to assist ecologists in attributing particular changes in forests to particular causes across multiple datasets. Finally, we discuss how these drivers may change in the future and the possible consequences for tropical forests.

Increasing biomass in Amazonian forest plots

A previous study by Phillips et al. of changes in the biomass of permanent sample plots in Amazonian forests was used to infer the presence of a regional carbon sink. However, these results generated a vigorous debate about sampling and methodological issues. Therefore we present a new analysis of biomass change in old-growth Amazonian forest plots using updated inventory data. We find that across 59 sites, the above-ground dry biomass in trees that are more than 10 cm in diameter (AGB) has increased since plot establishment by 1.22 +/- 0.43 Mg per hectare per year (ha(-1) yr(-1), where 1 ha = 10(4) m2), or 0.98 +/- 0.38 Mg ha(-1) yr(-1) if individual plot values are weighted by the number of hectare years of monitoring. This significant increase is neither confounded by spatial or temporal variation in wood specific gravity, nor dependent on the allometric equation used to estimate AGB. The conclusion is also robust to uncertainty about diameter measurements for problematic trees: for 34 plots in western Amazon forests a significant increase in AGB is found even with a conservative assumption of zero growth for all trees where diameter measurements were made using optical methods and/or growth rates needed to be estimated following fieldwork. Overall, our results suggest a slightly greater rate of net stand-level change than was reported by Phillips et al. Considering the spatial and temporal scale of sampling and associated studies showing increases in forest growth and stem turnover, the results presented here suggest that the total biomass of these plots has on average increased and that there has been a regional-scale carbon sink in old-growth Amazonian forests during the previous two decades.

Increasing dominance of large lianas in Amazonian forests

Ecological orthodoxy suggests that old-growth forests should be close to dynamic equilibrium, but this view has been challenged by recent findings that neotropical forests are accumulating carbon and biomass, possibly in response to the increasing atmospheric concentrations of carbon dioxide. However, it is unclear whether the recent increase in tree biomass has been accompanied by a shift in community composition. Such changes could reduce or enhance the carbon storage potential of old-growth forests in the long term. Here we show that non-fragmented Amazon forests are experiencing a concerted increase in the density, basal area and mean size of woody climbing plants (lianas). Over the last two decades of the twentieth century the dominance of large lianas relative to trees has increased by 1.7-4.6% a year. Lianas enhance tree mortality and suppress tree growth, so their rapid increase implies that the tropical terrestrial carbon sink may shut down sooner than current models suggest. Predictions of future tropical carbon fluxes will need to account for the changing composition and dynamics of supposedly undisturbed forests.

Career hazards for the dancer

Most dance injuries are of the overuse variety. Their gradual onset, coupled with the intense competition for professional positions, often results in injuries being ignored and thus seen late in their course. While treatment of the specific injury is of paramount concern, maintenance of the extremes of flexibility, strength, and conditioning necessary to dance professionally is an equally important treatment element.

Research priorities for nephrology nursing: American Nephrology Nurses' Association's Delphi Study

The purpose of this study was to identify and prioritize research topics of importance for nephrology nursing and the American Nephrology Nurses' Association (ANNA). This was an explorative survey design using the Delphi technique. Nephrology nurses who are members of ANNA participated in the study. In Round 1 participants included 90 members of the Advanced Practice Special Interest Group. Round 2 participants were 537 nephrology nurses who attended the 28th ANNA National Symposium. Participants in Round 3 were 491 ANNA members who had at least a master's degree in nursing or another field. A three-round Delphi technique was used to solicit, identify, and prioritize problems for nephrology nursing research. In Round 1, 90 nurses identified problems in response to an open-ended question. These responses were analyzed and categorized into a 21-item research survey that was used for subsequent rounds. Round 2 participants rated each research question/topic on the survey on a 1 to 5 scale for level of importance. In addition, they were asked to identify the top-ranked research priorities from the 21 questions. In Round 3, the participants were asked to do the same as in Round 2. In addition, they indicated whether the research priority was primarily a nursing responsibility or a collaborative effort with other health care personnel. Based on 3 rounds of the Delphi study and analysis of both level of importance and rated-research priority, the five areas that were identified as research priorities are (a) nursing interventions to prevent vascular access infections, (b) nursing interventions to maintain vascular access patency, (c) educational needs of patients and families, (d) levels of nursing competence and the effect on patient outcomes, and (e) validation of nursing interventions to achieve patient outcomes. These research priorities provide direction for nephrology nursing research and the ANNA. This Delphi study represents a significant step for ANNA in its commitment to research.

Nephrology nurses' perceptions of barriers and facilitators to using research in practice

OBJECTIVE

The purpose of this study was to determine nephrology nurses' perceptions of barriers to research utilization and to identify effective ways to facilitate integration of research findings in nephrology nurses' practice.

DESIGN

This was an explorative, descriptive study.

SAMPLE/SETTING

Four hundred ninety-eight nephrology nurses participated in the study. The primary areas of clinical practice were hemodialysis (36%), peritoneal dialysis (29%), transplantation (15%), pediatric nephrology (3%), or various combinations (18%).

METHODS

Participants completed a demographic data form and the previously validated instrument, Barriers and Facilitators to Using Research in Practice. Descriptive statistics were used to analyze the data.

RESULTS

The majority of respondents (52%) were staff nurses. The other respondents included 30% in management, 12% in advanced practice roles, and 6% in education. The barriers to research utilization most frequently identified were insufficient time on the job to implement new ideas and not enough time to read research. The most effective facilitators identified were increased administrative support and encouragement, increased time available for reviewing and implementing research findings, and improved understandability of research reports.

CONCLUSIONS

Additional nursing and nonnursing administrative support for research activities and designated time to read research and implement research-based clinical practices may facilitate the development of research-based nephrology nursing practice.

Aetiology of transient global amnesia

The pathophysiology of transient global amnesia (TGA) has been obscure since the definition of this syndrome more than 30 years ago. Current hypotheses include migraine, seizure, or transient cerebral arterial ischaemia. However, none of these potential mechanisms explain both the absence of other neurological signs or symptoms during TGA, and its frequent precipitating activities: many of which would be expected to result in marked increases in venous return from the arms to the superior vena cava. Patients with TGA also commonly have a Valsalva manoeuvre at the onset of attacks. I suggest that a Valsalva manoeuvre, blocking venous return through the superior vena cava, may allow brief retrograde transmission of high venous pressure from the arms to the cerebral venous system, resulting in venous ischaemia to the diencephalon or mesial temporal lobes and to TGA.

Donor left ventricular hypertrophy increases risk for early graft failure

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25% of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33% vs 3%, P = 0.007).

Successful lung transplantation in spite of cystic fibrosis-associated liver disease: a case series

Lung transplantation has recently offered hope for prolonged survival in patients with cystic fibrosis. Patients with cystic fibrosis have a 7% prevalence of associated liver disease and portal hypertension. These patients have been previously excluded from consideration for lung transplantation. The natural history of cystic fibrosis-associated liver disease suggests a benign and protracted course in most cases. At the University of Washington, 14 of 53 patients (26%) have undergone lung transplantation for cystic fibrosis-related respiratory failure. We report the outcome of double lung transplantation in four of these 14 patients who also had cystic fibrosis-associated liver disease and portal hypertension, all of whom were symptom free from their liver disease. All four patients are alive and well without complications 4 to 31 months after transplantation. We conclude that the presence of cystic fibrosis-associated liver disease with portal hypertension, in the setting of good synthetic function (albumin > 3.0 gm/L and normal prothrombin time), normal serum bilirubin, minimal varices, without ascites or encephalopathy, should not be an absolute contraindication to lung transplantation. We recommend that other transplantation centers also include this patient population in consideration for lung transplantation.

Effect of long-term platelet donation on lymphocyte subsets and plasma protein concentrations

Previous studies of changes in immune function in platelet donors have investigated subjects who were undergoing plateletpheresis using older equipment that is no longer in general use. Therefore, the purpose of this study was to determine the effect of long-term platelet donation on lymphocyte numbers and subsets and plasma protein concentrations in platelet donors using newer cell separators. Three groups included in the study were nondonor controls (n = 27), long-term whole blood donors (n = 29), and long-term platelet donors (n = 20). Using a cross-sectional analysis, lymphocyte numbers and subsets were determined and compared among the three groups. Plasma concentrations of total protein, globulin, albumin, and IgG were also compared. Among the three groups there were no significant differences in total white blood cell counts, percentage or absolute number of lymphocytes, or percentage or absolute number of lymphocyte subsets. Serum total protein, globulin, albumin, and IgG concentrations of platelet donors were within normal ranges. These data support the current Food and Drug Administration (FDA) and American Association of Blood Banks' standards for the frequency of platelet donation allowed and monitoring required for plateletpheresis donors. Furthermore, these data indicate that the FDA could eliminate the requirement for the warning in informed consents about lymphocyte depletion in platelet donors.

Calcium metabolism in blood and peritoneal lymphocytes from continuous ambulatory peritoneal dialysis patients

OBJECTIVE

Cellular immune function in peritoneal dialysis patients has been shown to be depressed, but the mechanism of this immunosuppression has not been ascertained. Because calcium is an important mediator of lymphocyte activation, this study was designed to investigate if there was an alteration of calcium metabolism in the lymphocytes of continuous ambulatory peritoneal dialysis (CAPD) patients.

DESIGN

Sixteen CAPD patients were studied at the initiation of CAPD and after two months of treatment. Twenty-three normal controls were also enrolled in the study. Cytoplasmic calcium changes were investigated in response to the mitogen phytohemagglutinin (PHA) in peripheral blood and peritoneal lymphocytes, using the intracellular calcium probe indo-1 and flow cytometry. Baseline cytoplasmic calcium levels and changes in cytoplasmic calcium in response to PHA were assessed at the initiation of CAPD and after two months of therapy.

RESULTS

Peripheral lymphocytes of patients and controls had similar calcium baseline levels, but the peritoneal lymphocytes had baseline cytoplasmic calcium levels averaging 81% higher than the corresponding calcium levels of the patients' peripheral blood lymphocytes. As compared to peripheral lymphocytes, the response to PHA stimulation was significantly less in the peritoneal lymphocytes, increasing an average of only 46.8% above baseline. Peripheral blood lymphocytes of the patients responded by an average increase of 78.9% over baseline. Control cells increased an average of 66.3% over baseline. Follow-up studies done two months after the initiation of CAPD indicated there were no significant changes (as compared to month 0) that occurred in baseline or stimulated intracellular calcium concentrations.

CONCLUSIONS

While the peripheral lymphocytes of CAPD patients respond adequately to PHA, the high baseline calcium levels of the peritoneal lymphocytes suggest that these cells may be in a state of chronic activation and may respond minimally to an antigenic challenge.

Nutritional management of patients with acute renal failure

Patients with acute renal failure are at high risk for developing malnutrition. Provision of adequate nutrition support begins with an understanding of the metabolic alterations that occur due to the disease state and renal replacement therapies. Assessment of nutritional requirements and implementation of appropriate feeding modalities can lead to optimal nutritional status and positive patient outcomes. Building collaborative relationships with other health care professionals is crucial to overcoming the barriers that hinder implementation of appropriate nutritional management.