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The Importance of Tubular Function in Chronic Kidney Disease | IJNRD – Dove Medical Press

Maria A Risso,1 Sofa Sallustio,1 Valentin Sueiro,1 Victoria Bertoni,1 Henry Gonzalez-Torres,2,3 Carlos G Musso1,2

1Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2Facultad de Ciencias de la Salud, Universidad Simon Bolivar, Barranquilla, Colombia; 3Ciencias Biomdicas, Universidad del Valle, Cali, Colombia

Correspondence: Carlos G MussoHuman Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, ArgentinaEmail carlos.musso@hospitalitaliano.org.ar

Abstract: Glomerular filtration rate (GFR) and proteinuria-albuminuria are the renal functional parameters currently used to evaluate chronic kidney disease (CKD) severity. However, tubular secretion is another important renal functional parameter to be taken into accountsince proximal tubule (PT) secretion, in particular, is a crucial renal mechanism for endogenous organic cations, anions and drug elimination. The residual diuresis is a relevant survival predictor in patients on dialysis, since their urine is produced by the glomerular and tubular functions. It has been hypothesized that drugs which up-regulate some renal tubular transporters could contribute to uremic toxin excretion, and nephroprevention. However, if tubular transporters down-regulation observed in CKD patients and experimental models is a PT adaptation to avoid intracellular accumulation and damage from uremic toxins, consequently the increase of toxin removal by inducing tubular transporters up-regulation could be deleterious to the kidney. Therefore, a deeper understanding of this phenomenon is currently needed. In conclusion, tubular function has an important role for endogenous organic cations, anions and drug excretion in CKD patients, and a deeper understanding of its multiple mechanisms could provide new therapeutic alternatives in this population.

Keywords: tubular function, chronic kidney disease, drugs

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The Importance of Tubular Function in Chronic Kidney Disease | IJNRD - Dove Medical Press

Sleep helps the brain consolidate information stored in long-term memory – News-Medical.net

A review of more than 130 studies explains how sleep helps people learn new information and plays an important role in storing learned content for future use. The review is published in the January 2020 issue of Physiology.

Forming memories consists of learning new information, consolidating it in areas of the brain for long-term storage and the ability to recall the learned content later. The reviewers looked at studies in humans and animals that suggested that sleep helps the brain consolidate information stored in long-term memory. Earlier findings were based on the concept that different stages of sleep strengthened different types of memory retention. While brain activity during certain sleep states, such as slow wave activity, may be more beneficial for storing specific types of memory, it is now clear that consolidation in sleep has many facets.

Examining electrical activity in the brain can define various stages of sleep and the patterns of sleep architecture (structural organization of sleep). Looking at research that explores these patterns helps scientists understand how the brain consolidates memories during sleep and while awake. Several studies in the review found that learning a task increases subsequent slow-wave activity and sleep spindles-;neural movements (oscillations) that are abundant during sleep-;in the brain. The increase in these activities has been associated with improved performance of the task after sleeping. Other studies showed that enhancing slow-wave activity and spindles during sleep boosted retention of certain types of memories.

More recent research also investigates processes of forming false memories and generalizing previously learned content. "Overall, the specific modulation of brain oscillations of sleep to impact memory consolidation is a relatively new area, but provides substantial potential in unraveling the role of neural oscillations in the process of memory consolidation," the review's authors wrote.

Scientific research continues to develop tools that link neural activity to sleep behavior, the authors explained. "Future research should utilize these tools to scrutinize present and newly evolving concepts of memory consolidation," they wrote.

Source:

Journal reference:

Marshall, L., et al. (2019) Brain Rhythms During Sleep and Memory Consolidation: Neurobiological Insights. Physiology. doi.org/10.1152/physiol.00004.2019.

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Sleep helps the brain consolidate information stored in long-term memory - News-Medical.net

Rising CO2 drives divergence in water use efficiency of evergreen and deciduous plants – Science Advances

Abstract

Intrinsic water use efficiency (iWUE), defined as the ratio of photosynthesis to stomatal conductance, is a key variable in plant physiology and ecology. Yet, how rising atmospheric CO2 concentration affects iWUE at broad species and ecosystem scales is poorly understood. In a field-based study of 244 woody angiosperm species across eight biomes over the past 25 years of increasing atmospheric CO2 (~45 ppm), we show that iWUE in evergreen species has increased more rapidly than in deciduous species. Specifically, the difference in iWUE gain between evergreen and deciduous taxa diverges along a mean annual temperature gradient from tropical to boreal forests and follows similar observed trends in leaf functional traits such as leaf mass per area. Synthesis of multiple lines of evidence supports our findings. This study provides timely insights into the impact of Anthropocene climate change on forest ecosystems and will aid the development of next-generation trait-based vegetation models.

Climate change will likely alter future carbon and hydrologic cycles (1). These cycles are closely tied to plant assimilation of atmospheric CO2 through photosynthesis by the regulation of CO2 and water vapor exchange via small pores on the leaf surface, called stomata. CO2 uptake is necessarily accompanied by water loss through stomata, and this carbon gain to water loss metric is generally referred to as water use efficiency (2). At the leaf level, variation in the photosynthesis (A)tostomatal conductance (gs) ratio over a leaf life span represents a time-integrative or averaged estimate of the intrinsic water use efficiency (iWUE), operating at a common evaporative demand (2). Thus, iWUE, a form of water use efficiency, is an important measure of the potential water cost of maintaining a given rate of carbon assimilation per unit leaf area.

A primary response of plants to increasing CO2 is to increase A and is often accompanied by reducing diffusive gs to minimize transpirational water loss (3). As a result, iWUE is generally known to increase with rising atmospheric CO2 (4). However, the magnitude and direction of iWUE responses to elevated CO2 at broad ecosystem and species ranges in natural ecosystems are poorly understood. Specifically, the decadal responses of two key plant functional groups, evergreen and deciduous, are not clear; this is important given that these functional groups occur across many taxonomic groups, and their relative proportions largely define global ecosystems and ecosystem functions and services (5, 6). It is hypothesized that evergreen plants are more sensitive in their iWUE response to elevated atmospheric CO2 than deciduous plants (7). However, to date, experimental CO2 enrichment studies, which were based on limited species and ecosystem type, are equivocal (7).

Here, we assessed the impact of human-driven increases in atmospheric CO2 [~45 parts per million (ppm)] over the past ~25 years on the iWUE of deciduous versus evergreen plants (244 species; table S1). We focus on iWUE responses of woody taxa from 20 field sites spanning eight biomes between two time periods: 19881991 and 20132015 (Fig. 1A and table S2). To compare the iWUE response of contemporary (20132015) to historical plants (19881991), we used a unique georeferenced herbarium collection of C3 woody flowering species, known as Climate-Leaf Analysis Multivariate Programme (CLAMP) (8), to represent historical samples. We compared these to contemporary leaves collected 25 years later by our team from the same species at the same sites (which we will refer to as species sites) and biomes (which we will refer to as species biomes). We inferred iWUE using leaf stable carbon isotopes (13C). To minimize variability in leaf 13C between historical and contemporary samplesdue to possible differences in phenology, seasonality, and field protocolswe operated the same field sampling protocol as CLAMP (8) and sampled during approximately the same collection season or month as the historical leaves.

(A) Major study areas. (B) Historical and contemporary iWUE at 355 and 400 ppm atmospheric CO2 concentration respectively arranged by increasing averaged iWUE values. Boxplots show median (center line), mean (red dot), interquartile range (IQR), 1.5 times of IQR (whiskers), and outliers (black dots). Numbers in brackets are the number of leaves. All iWUE gains are likely to be larger than zero.

A total of 2031 historical and contemporary leaves were analyzed for leaf 13C, leaf mass per area (LMA), carbon per mass (Cmass), and nitrogen per mass (Nmass). There is no likely difference in average total LMA and Nmass between the historical and contemporary samples [LMA = 0.4 g m2; 95% credible interval (CI95%), 1.4 to 0.6; Nmass = 0.06%; CI95%, 0.12 to 0.27] and the slopes of regression between the two time periods through the origin are close to 1 (LMA slope = 0.97; CI95%, 0.96 to 0.98; r2 = 0.92; Nmass slope = 0.97; CI95%, 0.94 to 1.00; r2 = 0.93) (fig. S1). Average evergreen LMA is likely higher than deciduous within each biome in both the historical and contemporary samples (table S3).

An unequivocal increase in average iWUE (iWUE) was observed in all eight biomes investigated, ranging from highest in the tropical seasonal moist forest [TSF(M)] (17.2 mol mol1; CI95%, 14.3 to 20.0) to lowest in the tropical rainforest (TF) (5.2 mol mol1; CI95%, 1.6 to 8.3) (Fig. 1B and table S4). Among the seven biomes with both evergreen and deciduous groups, evergreen species generally demonstrated a greater iWUE in response to ~45 ppm rise in CO2 than deciduous plants, within cooler biomes (Fig. 2A and table S5): this trend also prevailed when data were further grouped into growth habit (tree versus shrub) or high- and low-light habitat (understory subcanopy versus open canopy) (figs. S2 and S3 and tables S6 and S7). A substantial decrease in the ratio of leaf intercellular CO2 (ci) to ambient atmospheric CO2 (ca), ci/ca, in evergreens compared with deciduous taxa resulted in a higher calculated iWUE gain (fig. S4). Our results agree well with published studies that have reported either a decrease in ci/ca (9, 10) or a near constant ci/ca (11, 12) for tree species. Differences between average iWUE gain in evergreen and deciduous taxa (iWUEe-d) widened, however, with decreasing mean annual temperature (MAT) from the tropical toward the boreal biomes (slope = 0.395; CI95%, 0.770 to 0.004; r2 = 0.70; Fig. 2B).

Dotplots represent mean of posterior distributions (n = 6000 samples), CI95%. Red line is the fitted regression. (A) iWUE of deciduous and evergreen plants in biomes arranged by increasing MAT. (B) Differences between evergreen and deciduous iWUE (iWUEe-d) versus MAT, iWUEe-d = 11 0.4MAT, r2 = 0.70. (C) iWUEe-d versus average difference of evergreen and deciduous LMA (LMAe-d), iWUEe-d = 2.0 + 0.14 LMAe-d, r2 = 0.80. (D) Boxplots of deciduous and evergreen LMA across biomes for combined historical and contemporary samples arranged by increasing MAT. All P(LMAevergreen > LMAdeciduous) 0.95. (E) Comparison of the rate of iWUE gain per unit of CO2 concentration (iWUE/CO2) for total deciduous and evergreen samples [P(iWUE/CO2 evergreen > iWUE/CO2 deciduous) = 0.87]. (F) Scatter plot of LMA versus MAT of evergreen and deciduous plants for combined historical and contemporary samples, n = 2031 leaves.

In this study, atmospheric CO2 is likely a dominant factor for iWUE gain because of the likely difference in atmospheric CO2 concentration between the two time periods (Mauna Loa station; CI95%, 43.60 to 45.89 ppm). In contrast with this, other influential climatic variables, such as air temperature and vapor pressure deficit (VPD) showed only small changes with no likely difference statistically within biomes at CI95% (table S8). Furthermore, our result demonstrated that the small changes in MAT (MAT) and VPD (VPD) between historical and contemporary periods in this study were unlikely to affect iWUEe-d, as the differences in iWUE between evergreen and deciduous within the same biome were not highly influenced by MAT or VPD (fig. S5).

In relation to leaf functional traits, iWUEe-d also varied increasing tightly (r2 = 0.80) with the biome average difference between LMA in evergreen and in deciduous species (LMAe-d; slope = 0.14; CI95%, 0.05 to 0.23; Fig. 2, C and D). The total average iWUE value for each deciduous and evergreen group, with all biomes combined, was quantified by normalizing iWUE with VPD, temperature, precipitation, and altitude using models developed in this study (table S9). We found that average iWUE was higher in evergreen than in deciduous species [P(iWUEevergreen > iWUEdeciduous) = 1] with gains of ~39% (17.1 mol mol1; CI95%, 13.8 to 20.5) and ~15% (7.8 mol mol1; CI95%, 5.0 to 10.4), respectively. These correspond to an iWUE gain of 0.39 mol mol1 ppm1 (CI95%, 0.30 to 0.46) in evergreen and 0.18 mol mol1 ppm1 (CI95%, 0.12 to 0.25) in deciduous species [P(iWUE/CO2evergreen > iWUE/CO2deciduous) = 0.99] (Fig. 2E).

The divergence of evergreen and deciduous iWUE along a MAT gradient (1.4 to 26.7C) parallels those observed for LMA (Fig. 2F) and Nmass (fig. S6). The LMA divergence in functional groups from warmer to colder sites (27.5 to 16C) was observed in a previous study (13) and was associated with LMA increment with leaf life span; this divergent trend is related to the requirement of leaves with longer life spans to maximize carbon gain in shorter growing seasons, i.e., in colder biomes (14). Our results demonstrated how this well-studied trend (13, 14), in LMA divergence from warmer to colder biomes, also manifests in the differential response of evergreen and deciduous taxa to anthropogenic CO2 rise. The smaller differences in LMA between the leaf habit classes in the warmer biomes compared with the colder biomes contributed to the observed trend. High LMA generally occurs in woody evergreens because of their robust leaf structure, which can incur resistance to CO2 diffusion and, hence, lower mesophyll conductance (gm) (7, 15, 16). Therefore, evergreen leaves, in general, are likely to operate at lower gm values than deciduous leaves (16, 17).

Under elevated CO2, leaves with low gm may show a higher increase in A than high gm taxa, and their A is less sensitive to reduction in gsthis, in turn, leads to strong iWUE gain (iWUE = A/gs) (7). At a given gs, A of leaves with low gm (i.e., evergreens) is more limited by lower chloroplast CO2 concentration (cc) and, thus, responds more strongly to rising CO2. The reason for this is that the higher cc gets, the less CO2 affects photosynthesis because of the saturation of the A versus cc relationship (7). We did not measure gm, but we did observe greater average LMA and iWUE responses in evergreens than in deciduous species, suggesting increased CO2 diffusion limitations in the former. LMA and gm are inversely correlated, but the relationship is confounded by mesophyll cell wall thickness and chloroplast surface area that can vary across environmental gradients and species (15, 18). Therefore, in this study, high LMA was associated with greater iWUE response to a ~45-ppm rise in atmospheric CO2 concentration in evergreen compared with deciduous leaves (Fig. 2, C and E).

To validate our results from the two time periods, we used published tree ring 13C datasets (19702013) and leaf 13C datasets (19812005) (1921) containing continuous recent sampling points to track iWUE trends along a rising atmospheric CO2 gradient (iWUE/CO2). The meta-analysis of tree ring iWUE data showed higher average iWUE response in evergreen (0.29 mol mol1 ppm1; CI95%, 0.27 to 0.33) than deciduous (0.21 mol mol1 ppm1; CI95%, 0.18 to 0.24) trees (Fig. 3A, fig. S7, and table S10). Evergreen trees in the boreal-temperate region(s), which were all gymnosperms in the published datasets (seven species), showed a greater average rate of iWUE gain (0.33 mol mol1 ppm1; CI95%, 0.30 to 0.36) than their angiosperm and gymnosperm deciduous counterparts (four species) (0.14 mol mol1 ppm1; CI95%, 0.11 to 0.17), but in the tropics, this disparity was not observed (Fig. 3B). This result corroborated with published studies that showed the average gm of temperate evergreen gymnosperm was onefold lower than temperate deciduous angiosperms (15, 16). Furthermore, a tree ring study at 23 sites across Europe showed that evergreen gymnosperm trees (four species) increased their iWUE substantially more than deciduous angiosperm trees (two species) in the last c. 100 years at ~22 and ~14%, respectively (10). Our meta-analysis of published leaf 13C data from woody angiosperm species showed the same trend of higher collective iWUE increase (iWUEc/CO2) in evergreen (0.76 mol mol1 ppm1; CI95%, 0.62 to 0.91) than in deciduous (0.51 mol mol1 ppm1; CI95%, 0.32 to 0.70) leaves (Fig. 3C and fig. S8). These results confirm our original observations from the two time periods: There is an overall stronger iWUE gain in evergreen compared with deciduous species (Fig. 2, A and E) in response to rising atmospheric CO2.

Dotplots represent mean of posterior distributions (n = 6000 samples), CI95%. (A) iWUE/CO2 from published tree ring 13C data for the various time intervals between 1970 and 2013 for evergreen (n = 29 trees) and deciduous trees (n = 23 trees). (B) Result from (A) separated into bioclimatic zones showing higher average iWUE gain in evergreen (n = 24 trees) than in deciduous trees (14 trees) in the boreal-temperate zone, but the opposite in the tropical zone (deciduous n = 9 trees; evergreen n = 5 trees) [P(iWUE/CO2 deciduous > iWUE/CO2 evergreen) = 0.95]. (C) iWUEc/CO2 calculated from published leaf 13C data collected between 1981 and 2005 for deciduous (n = 470 species sites) and evergreen (n = 1053 species sites) species.

To further test this differential evergreen/deciduous response to ~45-ppm rise in CO2, we used data from a field infrared gas exchange analysis (IRGA) experiment conducted in situ on a subset of the same leaves used for this 13C study. Leaf A and gs responses to ~355- and ~400-ppm cuvette CO2 concentration were measured, referencing values for the historical and contemporary period, respectively. The responses measured with the gas analyzer were instantaneous responses to CO2 concentration rather than long-term responses (decadal) that are most likely influenced by acclimation. This experiment showed that average gain in leaf iWUE in evergreen leaves (0.22 mol mol1 ppm1; CI95%, 0.20 to 0.25) was likely higher than that in deciduous leaves (0.20 mol mol1 ppm1; CI95%, 0.17 to 0.23) [P(iWUE/CO2evergreen > iWUE/CO2deciduous) = 0.92] (Fig. 4A). Results from our in situ gas exchange study showed that an increase in A can largely contribute to an increase in iWUE under a ~45-ppm CO2 rise with higher average A gain in evergreen (22.4%; CI95%, 19.1 to 25.7) than in deciduous leaves (16.7%; CI95%, 13.4 to 20.1) (Fig. 4B). However, gs instantaneous responses showed no likely change in both groups (evergreen: 0.2%; CI95%, 2.3 to 1.8; deciduous: 1.0%; CI95%, 1.1 to 3.2) (Fig. 4C). Evergreen ci/ca showed a likely decrease, but no change was observed in deciduous leaves (evergreen: 0.015 Pa; CI95%, 0.019 to 0.010; deciduous: 0.001 Pa; CI95%, 0.003 to 0.006).

Dotplots represent means of posterior distributions (n = 6000 samples), CI95%. Evergreen n = 135 leaf samples (33 species); deciduous n = 119 leaf samples (31 species). (A) Dotplots of iWUE in evergreen and deciduous leaves. (B) Dotplots of A in evergreen and deciduous leaves. (C) Dotplots showing average gs in evergreen and deciduous are unlikely to be higher than zero at CI95%.

Currently, these experimental results (Fig. 4C) do not account for possible anatomical adaptions in stomatal density and/or size that could influence gs. Stomatal density in most plant species is well known to decrease with increasing atmospheric CO2 concentration that could lead to a general decrease in maximum stomatal conductance (22). Work is therefore ongoing to assess anatomical adaptations at the species and functional group level to test these conclusions further. Results from the in situ IRGA measurements, which estimate the instantaneous responses to CO2, lend support to the long-term observations from our extensive biome-level field-based 13C study and suggest that the magnitude of iWUE change observed here is due to a substantial increase in A coupled with little or no change in gs. Together, these results suggest that notable adjustment of photosynthetic biochemistry has occurred in woody vegetation with ~45-ppm CO2 rise.

Our biome-wide field study of iWUE responses to a mere 45-ppm CO2 rise between 1988 and 2015 suggests greater average iWUE gain in evergreen than in deciduous species, particularly in the cooler climate biomes. The diverging trend in iWUE gain highlights a strong link between LMA, MAT, and plant-CO2 responses in woody evergreen and deciduous taxa: This is strongly associated with the more distinct differences in LMA and leaf phenological traits observed between evergreen and deciduous taxa in colder biomes than in warmer biomes. This knowledge has the potential to enhance development of new-generation trait-based vegetation models, of which temperature, photosynthetic water use, and LMA are important components. That the differential response of evergreen and deciduous leaf habits in natural ecosystems has been given little attention to date is unexpected given that such a profound physiological response occurring at a continental scale could incur a substantial shift in natural forest and woodland ecology (e.g., forest fraction of evergreeness and deciduousness) and alter seasonal energy, water, and carbon balance and dynamics. Our results indicate that future increases in atmospheric CO2 may confer a competitive advantage to woody angiosperm evergreens over their deciduous neighbors to a greater extent in cooler biomes than in warmer biomes. Therefore, understanding of the differential physiological response induced by climate change in evergreen and deciduous taxa will improve our ability to build more mechanistic and predictive models on vegetation response to future climate change. While our field study covered a substantial number of woody angiosperm species, and was supported by published tree ring 13C data that included gymnosperm species (seven evergreen and two deciduous species), future research may benefit by including more gymnosperm species to confirm the differential response of leaf habits within this group to rising atmospheric CO2, particularly in the conifer-dominated boreal biome. Further profound increases in atmospheric CO2 are projected by the year 2050 under all representative concentration pathway (RCP) scenarios [RCP 2.5 = 443 ppm; RCP 4.5 = 487 ppm; RCP 6.0 = 478 ppm; RCP 8.5 = 541 ppm (23, 24)]. In this context, higher iWUE under elevated CO2 atmospheres may have contributed to evergreen expansion in past greenhouse intervals such as the Eocene (ca. 55 million years ago), particularly in seasonally dry areas of the mid latitudes (25), rather than to elevated temperatures alone, which is the current paradigm (26).

Historical herbarium samples from the CLAMP collected using the same protocol and person (Wolfe) (8) in 19881991 were recollected in 20132015 by our team (W.K.S., M.M., and J.C.M.). This yielded contemporary leaf samples of the same species from the same sites/biomes. The same standard collection protocol was used for both historical and contemporary samples. This approach was used to minimize variability of leaf 13C. To our knowledge, CLAMP, a unique georeferenced global inventory of C3 woody angiosperm leaf physiognomic data (8, 27), is the only herbarium archive that was collected by the same person (Wolfe) using the same protocol over several biomes with each including many species (average, 25 species per site). In this study, field sites in each biome were selected from the CLAMP archive. Of the original 173 sites sampled by Wolfe (8), we selected 20 to represent eight of Whittakers vegetation biomes (28): boreal forest (BF), temperate rainforest, temperate deciduous forest (TDF), Mediterranean (MED), subtropical desert, tropical seasonal dry forest [TSF(D)], TSF(M), and TF (table S2). We restricted selection to sites below 700 m above sea level to limit the influence of lower CO2 partial pressure and atmospheric pressure on leaf traits and carbon isotope composition (13C) at higher altitudes. Site selection was based on individual site accessibility within the planned data gathering schedule and acquisition of the required scientific collection permits. Where possible, we selected three sampling sites in each biome, except in the TF of Fiji (two sites) and TSF(D) in Puerto Rico (one site). As a result of using CLAMP herbarium samples, sites in the boreal and temperate biomes are restricted to Northern America, with tropical biomes in Puerto Rico [TSF(D) and TSF(M)] and Fiji (TF). Although all the tropical biome sites are situated on islands, the plants species sampled here are from areas that experience tropical climate. We are confident that our tropical sites are representative tropical biomes as there is no evidence to suggest that the physiology of tropical island vegetation differs from that on a tropical mainland, especially at the leaf level. For instance, one of the best studied tropical forests in the world is Barro Colorado Island in Panama. Only evergreen plants were sampled in Fiji, and therefore, this biome was not used to quantify iWUEe-d. To obtain a representative sample of C3 woody angiosperm species within the BF, which is usually dominated by conifers, our sampling was conducted within the interior BF zone of Alaska, which has extensive areas of open and closed deciduous forests (29). Regarding our BF sites, deciduous trees make up virtually all of the native angiosperm tree population, while the gymnosperms are mostly evergreen trees. Since we are making a direct comparison of the historical CLAMP samples with contemporary samples of exactly the same species from the same locations, we were prohibited from including gymnosperms. As a result, our fieldwork study on BF only covered angiosperms of three leaf habit and growth habit groups without evergreen trees. These included deciduous trees, deciduous shrubs, and evergreen shrubs.

Contemporary leaf samples were collected in the field between 2013 and 2015 from the same species as those in the historical CLAMP herbarium collected between 1988 and 1991 from the same sites or biomes. All fieldwork was carried out in the growing season (table S2), corresponding as closely as possible to the collection month of historical samples. Tree and shrub growth habits were sampled in all biomes and were largely represented in both evergreen and deciduous plant groups. Our sampling focused on outer-canopy leaves, meaning sun leaves for plants growing in relatively open environments, and leaves exposed to sun flecks when sampling naturally shade-dwelling species. We sampled fully expanded leaves, the developmental stage at which many leaf traits are relatively stable. In one aspect of the statistical analyses in this study (see section on Statistical analysis), we divided our dataset into two broadly defined habitat groups based on our field observations to reflect high- and low-light habitat: open canopy and understory subcanopy. For this study, open canopy refers to plants that are located either in open areas or at the forest canopy edge and receiving direct sunlight. By contrast, understory subcanopy refers to plants occurring within the forest canopy, in shade but receiving sun flecks. In all biomes, we sampled both the open-canopy and understory-subcanopy habitats for evergreen and deciduous plants, except for the BF and TDF biomes, there were no evergreen plant samples in the open-canopy habitat, and in the subtropical desert biome, all habitats were classified as open canopy. In the historical CLAMP samples, sun-exposed twigs were collected that may be directly exposed to the sun or sun fleck subjected to a species natural habitat. On each herbarium specimen, we had carefully selected leaves that were fully expanded (i.e., visually mature) and thick to increase the chance of including mature sun-exposed leaves.

To minimize the potentially confounding influence of height on leaf 13C and LMA, leaves from tall trees were collected at basal-exterior canopy level within arms reach, up to 3 m in line with CLAMP historical collection methods. This protocol standardized collection height with historical samples. Before collection, the leaves gathered for trait analysis were also used for physiological measurements (see section on In situ field IRGA experiments). Our sampling protocol is in accordance with the collection methods used by Wolfe (8) following the CLAMP protocol. That is, our protocol standardizes historical and contemporary sampling methods, with the aim of reducing trait variability caused by sampling method and relevant biotic and abiotic factors that may have differed between contemporary and historical sampling periods.

Only broadleaf woody C3 angiosperm species were sampled for this study (gymnosperms, grasses, and crops were not included). A total of 1550 contemporary leaf samples, each from individual plants, were collected in the contemporary fieldwork. A total of 481 historical leaf samples were subsampled from the CLAMP herbarium collection. The entire dataset used in this study comprises 244 matching historical and contemporary woody angiosperm species from 64 families (table S1). All specimens were identified to species level. Taxonomic nomenclature was updated using the online Taxonomic Name Resolution Service v 4.0.

Mean monthly precipitation, mean monthly air temperature, maximum monthly air temperature, and vapor pressure over time periods (19881991 and 20132015) for each study site were obtained from 0.5 0.5 resolution Climate Research Unit data (CRU TS v.4.0) (30) gridded dataset via The Royal Netherlands Meteorological Institute (KNMI) Climate Explorer. Monthly saturated vapor pressure was calculated from maximum monthly air temperature. These were then subtracted with monthly vapor pressure to obtain monthly VPD (31) and used to infer leaf-to-air VPD. MAT and mean annual precipitation (MAP) were calculated from the monthly data.

Leaf samples were oven dried at 50 to 60C for 2 days. One half of each dried leaf blade was used for LMA analysis and the other half for 13C, carbon (C), and nitrogen (N) elemental analyses. To standardize LMA data collection from both historical and contemporary leaves, all leaves were rehydrated. Leaf area shrinkage from drying can be reversed by rehydration (32). LMA was determined by dividing the dry leaf mass by the rehydrated leaf area. For the 13C, N, and C elemental analyses, dried leaf fragments were placed with a tungsten bead in Eppendorf tubes and finely ground in a mixer mill (Tissue Lyser, Qiagen Inc., Valencia, CA, USA). Each sample (~3 mg) was then enclosed in a tin capsule using a crimper plate. Samples were analyzed for 13C, C, and N using a PDZ Europa ANCA-GSL elemental analyzer interfaced with a PDZ Europa 20-20 isotope ratio mass spectrometer (Sercon Ltd., Cheshire, UK) at UC Davis Stable Isotope Facility, University of California, Davis, USA. Instrumental error was 0.18 (per mil) for 13C (SD). Carbon isotope composition was calculated as13C()=(RsampleRstandard)/Rstandard1000(Eq. 1)where Rsample and Rstandard are the 13C/12C ratio of the sample and the international standards Vienna Pee Dee Belemnite, respectively. Carbon isotopic discrimination (plant) is given asplant=(13Cair13Cplant)/1+(13Cplant/1000)(Eq. 2)

In relation to the intercellular CO2 (ci) and ambient CO2 (ca) partial pressures, plant in C3 leaves is given as follows (33)plant=a+(ba)(ci/ca)(Eq. 3)where a is the fractionation due to diffusion in air (4.4) and b is the net fractionation caused by carboxylation (27). Equation 3 is widely used and assumes that the effects of boundary layer, internal conductance, photorespiration, day respiration, and allocation are negligible. Atmospheric CO2 concentration (ca) and 13Cair information were taken from a published instrumental dataset (19802015) from the Mauna Loa station (3436) corresponding to the historical and contemporary collection months (table S2). The full equation of plant includes several elements such as photorespiration, day respiration, and the CO2 mole fractions in the ambient air, at the leaf surface, in the intercellular air spaces, and at the chloroplast (cc) (37, 38). Photorespiration and cc are known to influence plant (38), and therefore, it is desirable to include these traits. However, we did not measure photorespiration and gm; the latter is required for estimating cc. In this study, we were interested in quantifying the differences between evergreen and deciduous iWUE (iWUEe-d) rather than their absolute values. On the basis of this reasoning, the use of the simplified linear model of Farquhar et al. (33) (Eq. 3) as an approximation to plant is appropriate for the purpose of this study.

iWUE can be expressed as the ratio of photosynthesis (A) and leaf conductance to water vapor transfer (g) in Eq. 4 below (33) using ci/ca calculated from Eq. 3 and caiWUE=A/g=ca(1ci/ca)/1.6=ca(1(a)/(ba))/1.6(Eq. 4)

iWUE inferred from 13C is an average estimate of iWUE over a leaf life span, i.e., time integrated.

All statistical analysis was undertaken using JAGS 4.1.0. (39) and R statistical software (40). Bayesian models using JAGS, through the R package rjags (41) interface, were used: Inference of each parameter was made from Markov Chain Monte Carlo (MCMC) sampling from 6000 samples of the posterior distribution from three chains, each with 10,000 iterations with a burn-in of 2000 and a thin rate of 4 (42). Normal distribution priors with mean zero and variance 100 were used for intercept and slope parameters, while a uniform (0, 10) prior was used for the SD on the variance terms. Convergence was checked by visual assessment of MCMC chains and using the Gelman-Rubin statistic (42). Mean of trait or group was calculated from posterior distributions. CI95%s of parameter estimates were calculated as the 2.5 and 97.5% quantile of posterior distributions. The 50% credible interval (CI50%) of parameter estimates were calculated as 25 and 75% quantile of posterior distributions. The CI95% represents the interval that captures 95% of the posterior distribution, e.g., when the CI95% for a statistics score is between a and b, this means that we have a 95% chance of having a score between a and b (note that credible interval is different from confidence interval). A CI50% statistics score between a and b implies a 50% chance of having a score between these two values. Therefore, the extent of CI overlapping with zero determines how likely a value is close to zero. Statistical comparisons between groups were made by examining value of CI95% and/or by probability of group differences bigger than or smaller than zero, e.g., P(x > y) = z denotes that the probability of variable x being bigger than variable y, given the data, is z.

To evaluate the robustness of our sampling method in minimizing the variability between the historical and contemporary samples, we first statistically test the difference in the mean of LMA and Nmass in the two time points. Second, we plotted historical and contemporary samples through the origin each for LMA and Nmass. A regression slope that is close to 1 would indicate a general level of uniformity between the historical and contemporary samples. LMA and Nmass are well known to vary with plant height, sun and shade leaf morphotypes, and age (43, 44).

We aggregate across biomes the iWUE at each time point (historical versus contemporary) to calculate the total gain in iWUE (iWUE) for the deciduous and evergreen species groups, using statistical models incorporating environmental variables (environment-normalized model) (Fig. 2E). However, samples from the TF biome (Fiji) were excluded because of the absence of deciduous plant samples. The environment-normalized model standardizes the aggregated iWUE values when calculating the total gain in iWUE: Leaf 13C or its derived variables (e.g., iWUE and ci/ca) are widely known to be confounded by latitude (20), altitude (19, 20), and site climatic variables such as VPD (45), temperature (1921, 45), and precipitation (1921). Using our own dataset, we examined the relationship between iWUE and environmental variables such as altitude, latitude, and bioclimatic variables (precipitation, temperature, and VPD). Our aim was to generate an equation that could be used to normalize iWUE values against environmental variables when aggregating data across biomes (see Fig. 2E).

For evergreen species, we averaged site monthly precipitation, temperature, VPD, and atmospheric CO2 concentration by 12 months up to and including the collection month to match the average period of photosynthetic opportunities. One meta-analysis study showed that mean annual climate parameters were more likely to match evergreen photosynthetic windows for carbon isotope discrimination of C3 plants (21). Although photosynthesis of evergreens is reduced during winter time with small winter carbon gain (46, 47), this may still influence the average carbon isotope discrimination in a leaf life span. The leaf life span of evergreen angiosperms in the boreal-temperate and tropical biomes each showed a skewed distribution with central tendencies (median) of approximately 18 and 15 months (48), respectively (fig. S9). Therefore, our approach of averaging site climatic data by a period of 12 months up to and including the collection month was a reasonable approximation of evergreen leaf life span collected at the time. This approximation took into consideration the fact that we sampled only fully expanded leaves that were neither young nor too old (i.e., visibly unhealthy). For deciduous species, we averaged these climate variables from the start of growing months up to and including the collection month.

The correlation matrix between iWUE and the foregoing environmental variables are presented in table S11. VPD shows the strongest correlation with iWUE (r2 = 0.26) followed by precipitation (r2 = 0.24), altitude (r2 = 0.20), and absolute latitude (r2 = 0.10). Temperature shows the weakest correlation with iWUE (r2 = 0.05) but is instead strongly correlated with absolute latitude (r2 = 0.93), precipitation (r2 = 0.65), and VPD (r2 = 0.53), and weakly correlated with altitude (r2 = 0.10). Therefore, temperature was not included in our model because of the extreme collinearity between covariates, which could lead to high correlation in some of the posterior parameter estimates. Last, our statistical model consists of iWUE as the dependent variable, while time (factor), altitude, averaged site VPD, and precipitation are the independent variables (Model 1). Latitude was excluded from the model because its coefficient was subsequently shown to likely contain zero at CI95% when included in the regression. To calculate the rate of iWUE change in relation to atmospheric CO2 concentration, the same model was used with time factor replaced by CO2 concentration (Model 2). In the following models, each i represents one leaf. See table S9 for coefficient values.iWUEi=j(i)+j(i)Timei+1VPDi+2PREPi+3ALTi+i(Model 1)where iWUEi is the iWUE of individual i; Timei is the categorical time variable (historic and contemporary) corresponding to individual i; VPDi is the VPD corresponding to individual i; PREPi is the precipitation corresponding to individual i; ALTi is the altitude corresponding to individual i; j(i) is the intercept of the iWUE-time relationship in categorical leaf habit j (deciduous and evergreen); j(i) is the slope of the iWUE-time relationship in categorical leaf habit j (deciduous and evergreen), this is iWUE; 1 is the slope of the iWUE-VPD relationship; 2 is the slope of the iWUE-PREP relationship; 3 is the slope of the iWUE-ALT relationship; and i is the residual of individual i.iWUEi=j(i)+j(i)(CO2)i+1VPDi+2PREPi+3ALTi+i(Model 2)where, iWUEi is the iWUE of individual i; (CO2)i is the atmospheric carbon dioxide concentration corresponding to individual i; VPDi is the atmospheric VPD corresponding to individual i; PREPi is the precipitation corresponding to individual i; ALTi is the altitude corresponding to individual i; j(i) is the intercept of the iWUE-CO2 relationship in categorical leaf habit j (deciduous and evergreen); j(i) is the slope of the iWUE-CO2 relationship in categorical leaf habit j (deciduous and evergreen), this is iWUE/CO2; 1 is the slope of the iWUE-VPD relationship; 2 is the slope of the iWUE-PREP relationship; 3 is the slope of the iWUE-ALT relationship; and i is the residual of individual i.

For j(i), the slope of the iWUE-CO2 relationship, the actual full unit of WUEi/CO2 is mol CO2 mol1 H2O/mol CO2 mol1 air: For simplicity and readability, we prefer to use mol mol1 ppm1. We further investigate iWUE in evergreen and deciduous plants in each biome by dividing the dataset into growth habit (shrub versus tree) or habitat (understory-subcanopy versus open-canopy) categories. In each category, the probability of evergreen iWUE higher than deciduous iWUE was calculated.

Photosynthesis and photosynthetic water use were measured on 254 leaf samples from 64 of our 13C study species. Measurements were made with a CIRAS-2 gas analyzer (PP Systems, Amesbury, MA, USA) attached to a PLC6 (U) cuvette fitted with a 1.7-cm2 measurement window and a red/white-light light-emitting diode unit. Measurements were carried out between June and August 2014 at two BF sites (16 species, Bird Creek and Kenai, Alaska, USA), one TDF site (11 species, Smithsonian Environmental Research Center, Maryland, USA), two TSF(M) sites (15 species, Cambalache and Guajataca, Puerto Rico), and one TSF(D) site (9 species, Borinquen, Puerto Rico), all from a subset of the contemporary samples. Photosynthesis (A) and stomatal conductance (gs) were assessed on an average of four individual plants per species between 9:00 am and 13:00 pm. A sun-exposed branch was sampled from each plant using a pruner and was immediately recut under water (49). Following this, a fully expanded leaf from each branch was enclosed in the cuvette of the gas analyzer, which was running at a subambient 19881991 averaged reference CO2 concentration of 355 ppm. Stomatal conductance at subambient CO2 concentration was recorded upon stabilization of its value, which typically took less than 15 min. Subsequently, reference CO2 was established at 400 ppm (year 2016 values), and the leaf was left to equilibrate for at least 15 min before gs at contemporary ambient atmospheric CO2 was recorded. Randomization of the sequence of the two treatments was ensured; overall, about 65% of the measurements started at 400 ppm and were reduced to 355 ppm, while the rest of measurements (35%) started at 355 ppm and were increased to 400 ppm. On several occasions, the reversibility of the CO2 effects on A and gs was tested. This was done by measuring gs at a starting CO2 concentration of 400 ppm, after which CO2 was reduced to 355 ppm for several minutes before it was returned to the initial concentration of 400 ppm. The final A and gs values at 400 ppm were the same as those initially recorded.

iWUE data calculated from tree ring 13C were used to quantify the iWUE-CO2 response of individual deciduous and evergreen trees along a decadal time series of various time intervals between 1970 and 2013. Data were compiled from 17 published studies (5066) consisting of 52 trees from 22 species, of which 23 trees were deciduous (12 species) and 29 evergreen (10 species). Atmospheric CO2 concentration data were acquired from the Mauna Loa station data (3436). Annual 13Cair information was obtained from published ice-core data. iWUE values were calculated from 13C by using Eq. 3. For each study site, we obtained mean monthly precipitation, mean monthly air temperature, maximum monthly air temperature, and vapor pressure from 0.5 0.5 resolution CRU TS v.4.0 (30) gridded dataset for the period of 13C for each individual tree. VPD values were calculated as per the method described in the section Climate data. Regression slopes (iWUE/CO2) for individual trees were determined by fitting a simple linear model (using the Bayesian linear regression approach, see section on Statistical analysis) with iWUE as the dependent variable, and atmospheric CO2 concentration, VPD, and MAP as the independent variables. In the following model, each i represents a value from a growth ring as determined in a study, from a tree, jiWUEi=j(i)+j(i)(CO2)i+1VPDi+2PREPi+3ALTi+i(Model 3)where, iWUEi is the iWUE of individual i; (CO2)i is the atmospheric carbon dioxide concentration corresponding to individual i; VPDi is the atmospheric VPD corresponding to individual i; MAPi is the MAP corresponding to individual i; j(i) is the intercept of the iWUE-CO2 relationship in categorical individual tree j; j(i) is the slope of the iWUE-CO2 relationship in categorical individual tree j; 1 is the slope of the iWUE-VPD relationship; 2 is the slope of the iWUE-PREP relationship; and i is the residual of individual i.

By including VPD and MAP in the regression, we normalized the response slope of each tree with climatic variables, VPD and MAP. MAT is excluded from the model because of the strong collinearity with VPD (r2 = 0.72). The values for 1 and 2 are 5.47 (CI95%, 4.01 to 6.97) and 0.08 (CI95%, 0.09 to 0.06), respectively. On a centennial scale, a long-term iWUE fluctuation along the atmospheric CO2 gradient generally follows an exponential increase. However, we can reasonably approximate the iWUE trend with a linear model at a shorter decadal time scale. This shorter decadal time scale varies between 10 and 40 years from 1970 to 2013 depending on studies. Last, iWUE/CO2 values from posterior distributions of trees (6000 samples for each tree) were aggregated into deciduous and evergreen plant groups by averaging iWUE/CO2 values from posterior distributions. This approach therefore takes account of the uncertainty of iWUE/CO2 values of each tree. Further, we also aggregated deciduous and evergreen plant groups for two climatic zones: boreal-temperate and tropical.

Published (1921) and unpublished angiosperm leaf 13C data collected between 1981 and 2005 were used for meta-analysis. Year of data collection was added to the collated dataset based on original publications. Any data source without collection dates was assumed to be 2 years before the date of paper submission (~5% of datasets). Atmospheric CO2 concentration and 13Cair information corresponding to collection year were obtained from a published instrumental dataset (19802015) at the Mauna Loa station (3436). For 13C values without environmental data, we obtained MAT and MAP data from 0.5 0.5 resolution CRU TS v. 4.0 (30) gridded dataset. The final dataset includes 1523 species site points from 76 studies of 1000 species across eight biomes. To quantify the response of deciduous and evergreen leaves to elevated CO2, we used a linear model with iWUE as the dependent variable and atmospheric CO2 with interaction between deciduous and evergreen groups. The iWUE trend along rising atmospheric CO2 gradient across collective leaf samples from different studies in various localities may be influenced by environmental conditions of the location. To investigate the likely influential environment factor that may have contributed to the observed iWUE trend, we quantified the amount of variation contributed by atmospheric CO2 concentration, MAT, MAP, altitude, and latitude across time. We first regressed collection year against all the foregoing environmental variables and then used R package relaimpo (67) to quantify the amount of variation contributed by each environmental factor. The proportion of variance explained by the model was 99.3%, of which 98% was contributed by CO2 followed by MAT at ~1%. Therefore, we can be confident that CO2 was influential in driving iWUE trends across collection time compared with other environmental variables. We designated the iWUE gain across collective leaf samples of different species and environmental conditions/locations as iWUEc to differentiate it from iWUE. The latter is derived from iWUE gain of the same species composition and locality.

Supplementary material for this article is available at http://advances.sciencemag.org/cgi/content/full/5/12/eaax7906/DC1

Fig. S1. Historical and contemporary leaf functional trait plots through the origin.

Fig. S2. iWUE gain (iWUE) of deciduous and evergreen plants in biomes for growth habit, arranged by increasing MAT.

Fig. S3. iWUE gain (iWUE) of deciduous and evergreen plants in biomes for habitat group, arranged by increasing MAT.

Fig. S4. The changes in the ratio of leaf intercellular (ci) to ambient CO2 (ca), ci/ca, in evergreens and deciduous species in biomes, arranged by increasing MAT.

Fig. S5. iWUE change (iWUE) of deciduous and evergreen plants versus MAT change (MAT) and VPD change (VPD) in biome growth habit and habitat group.

Fig. S6. Scatter plot of Nmass versus MAT for combined historical and contemporary samples of evergreen and deciduous plants.

Fig. S7. Trend of iWUE from tree ring data along increasing atmospheric CO2 concentration between the years 1970 and 2013.

Fig. S8. Evergreen and deciduous iWUE plotted against atmospheric CO2 concentration showing slope of response.

Fig. S9. Kernel density plots of leaf life span (month) of deciduous and evergreen plants in the boreal-temperate and tropical biomes.

Table S1. List of species studied, their leaf habit (evergreen, deciduous), habitat (understory subcanopy and open canopy), and growth habit (shrub and tree).

Table S2. Summary of historical and contemporary site location, vegetation type, and collection date in alphabetical order by biome and site name.

Table S3. Historical and contemporary samples showing average LMA in evergreen and deciduous group within biome and probability of evergreen LMA larger than deciduous LMA, P* = P(LMAevergreen > LMAdeciduous).

Table S4. Average iWUE change (iWUE) in biome between two time points 19881991 and 20132015 with CI95% from posterior distributions in Bayesian analysis.

Table S5. Average iWUE gain (iWUE) in evergreen and deciduous plants within biome with CI95% from posterior distributions in Bayesian analysis.

Table S6. Shrub and tree, average iWUE gain (iWUE) in evergreen and deciduous plants within biome, with CI95% from posterior distributions in Bayesian analysis.

Table S7. Understory-subcanopy and open-canopy habitat, average iWUE gain (iWUE) in evergreen and deciduous plants within biome, with CI95% from posterior distributions in Bayesian analysis.

Table S8. Average annual air temperature change and average annual VPD change of biomes between two time periods 19881991 and 20132015 with CI95% from posterior distributions in Bayesian analysis.

Table S9. Average of coefficients of Model 1 and Model 2 with CI95% from posterior distributions in Bayesian analysis.

Table S10. Slope of iWUE response to atmospheric CO2 concentration (iWUE/CO2) for individual trees arranged by leaf habit, species, and references.

Table S11. Pearson correlation matrix (lower half panel in gray) and significance (upper half panel) between iWUE, VPD, precipitation, temperature, altitude, and latitude.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial license, which permits use, distribution, and reproduction in any medium, so long as the resultant use is not for commercial advantage and provided the original work is properly cited.

H. G. Jones, in Water Use in Plant Biology, M. A. Bacon, Ed. (CRC Press, 2004), pp. 2741.

I. R. Cowan, G. D. Farquhar, in Integration of Activity in the Higher Plant, D. H. Jennings, Ed. (Society for Experimental Biology, 1977), pp. 471505.

Intergovernmental Panel on Climate Change, Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assesement Report of the Intergovernmental Panel on Climate Change, Core Writing Team, R. K. Pachauri, L. A. Meyer, Eds. (Intergovernmental Panel on Climate Change, 2014).

R. H. Whittaker, Communities and Ecosystems (MacMillan, New York, ed. 2, 1975).

L. A. Viereck, C. T. Dyrness, A. R. Batten, K. J. Wenzlick, The Alaska Vegetation Classification (U.S. Department of Agriculture, Forest Service, Pacific Northwest Research Station, 1992).

R. G. Allen, L. S. Pereira, D. Raes, M. Smith, in Crop evapotranspiration: Guidelines for computing water requirement - FAO Irrigation and drainage paper 56 (Food and Agriculture Organization, 1998).

R. F. Keeling, S. C. Piper, A. F. Bollenbacher, S. J. Walker, Monthly atmospheric 13C/12C isotopic ratios for 11 SIO stations (Carbon Dioxide Information Analysis Center, Oak Ridge National Laboratory, Oak Ridge, TN, 2010).

M. Plummer, in Proceedings of the Third International Workshop on Distributed Statistical Computing (DSC 2003) (Vienna, Austria, 2003).

A. Gelman, J. Hill, Data Analysis Using Regressiion and Multi-Level/Hierarchical Models (Cambridge Univ. Press, 2007).

Acknowledgments: We are grateful to S. Wing and staff at Smithsonian NMNH for the hospitality and for access to herbarium specimens and the loan of leaves from the CLAMP collection. We are also grateful to the following people and institutions for permissions and field assistance: Smithsonian Environmental Research Center, Maryland, USA (P. Megonigal, S. McMahon, and J. Shue), Jasper Ridge Biological Preserve, California, USA (N. Chiariello and T. Corelli); The University of the South Pacific, Fiji (M. Tuiwawa, A. Naikatini, and S. Pene), Tonto National Forest (E. Hoskins and C. Denton), California State Parks (T. Hyland and J. Kerbavaz), Alaska State Parks (P. Russell and L. Ess), and Oregon State Parks (N. Bacheller). Many thanks to S. Culhane, E. Doyle, and C. Egan for field assistance. Funding: We gratefully acknowledge funding from a Science Foundation Ireland (SFI) Principal Investigator Award (PI) 11/PI/1103. A.P. was supported by SFI Career Development Award grant 17/CDA/4695 and SFI center grant SFI/12/RC/2289_P2. R.A.S. was supported by a Natural Environment Research Council grant (no. NE/P013805/1) and an XTBG International Fellowship for Visiting Scientists. Author contributions: W.K.S. led the writing, with input from J.C.M., C.Y., and M.M. J.C.M., C.Y., M.M., I.J.W., A.P., R.A.S., T.L., and R.C. discussed and commented on the manuscript. W.K.S., M.M., C.Y., and J.C.M. designed the study and organized and conducted fieldworks. W.K.S. and M.M. sampled CLAMP historical herbarium samples and curated all leaf samples. W.K.S. contributed to the LMA, Nmass, and 13C data. C.Y. and W.K.S. contributed to the IRGA experiment data. C.Y. processed the IRGA experiment data. W.K.S. and A.P. performed the statistical analysis. W.K.S. conducted meta-analysis for published tree ring and leaf 13C data. I.J.W. contributed leaf 13C data for meta-analysis. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials. Additional data related to this paper may be requested from the authors.

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Rising CO2 drives divergence in water use efficiency of evergreen and deciduous plants - Science Advances

Brain Circuitry Holds Key To Treating Obesity: Study – International Business Times

KEY POINTS

Overeating has been an issue for most of us at some time or the other. Some people have been able to control it, but others who havent been able to do it suffer from issues such as weight gain and obesity.

A new study has looked into how food craving affects the brain. Food craving leads to loss of self-control and eating even when your brain tells you that the foodstuff may be harmful to your health. Impulsivity is one of the reasons behind overeating, binge eating, weight gain, obesity and many psychological disorders such as drug addiction and gambling addiction.

The researchers have found that a specific circuit in the brain causes impulsivity. Because the researchers have identified this circuit, this holds hope that future medical therapies to treat overeating.

"There's underlying physiology in your brain that is regulating your capacity to say no to (impulsive eating), in experimental models, you can activate that circuitry and get a specific behavioural respons." Emily Noble, an assistant professor in the UGA College of Family and Consumer Sciences who served as lead author on the paper, stated in the findings, which were published in a paper titled Hypothalamus-hippocampus circuitry regulates impulsivity via melanin-concentrating hormone, published in the Nature journal.

The experiment was done on rats and the researchers focused on a subset of brain cells, which produce a transmitter called the melanin concentrating hormone (MCH). The researchers trained the rats so that they could press a lever to receive a high-sugar, high fat pellet and kept a timer at 20 seconds for every press. If the rat would press the lever before 20 seconds were up, the delivery of the pellet would be delayed another 20 seconds.

The researchers confirmed the findings of previous studies, which stated that MCH was responsible for increasedfood intake but also showed for the first time that it was responsible for impulsivity. They then used advanced techniques to activate MCH neural pathways between the hippocampus and hypothalamus in these mice parts of the brain responsible for learning and memory.

MCH did not interfere with the liking for the food, but rather it acted on the inhibitory control in the rats the ability to control themselves from reaching out for the pellet before 20 seconds were up. Activating the pathway increased impulsive behavior regardless of whether their body needed the calories or not.

Activating this specific pathway of MCH neurons increased impulsive behavior without affecting normal eating for caloric need or motivation to consume delicious food. Understanding that this circuit, which selectively affectsfoodimpulsivity, exists opens the door to the possibility that one day we might be able to develop therapeutics for overeating that help people stick to a diet without reducing normal appetite or making delicious foods less delicious," Noble stated.

s According to the World Population Review, Micronesian country Nauru holds the position as the most obese country in the world. Pictured: A physiotherapist (L) assists obese patients with exercises in an obesity unit at the CHU Angers teaching hospital. Photo: Getty Images/Jean-Sebastien Evrard

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Brain Circuitry Holds Key To Treating Obesity: Study - International Business Times

The Daily Show With Trevor Noah Talks About The Greys Anatomy Of Wars – Deadline

Trevor Noah and The Daily Show crew usually are up for a few laughs on the serious topics they tackle. But tonight, it was more about rueful laughter, as they discussed the Washington Posts blockbuster story that showed three different presidential administrations lied about American progress in the war in Afghanistan.

Its the Greys Anatomy of wars, said Noah. We thought it ended years ago, but somehow, its still going strong. He went on to detail that for 18 years, US officials lied about the Afghanistan war, painting a rosy picture that everything is well a tactic used by every failing couple on Instagram, he noted.

The government lied about every detail of the war, even spinning suicide bombers as a sign of success. That, Noah noted, is like touting yourself as a catch in online dating because you have your own room in moms basement.

Related Story'Good Talk With Anthony Jeselnik' Renewed For Season 2 By Comedy Central

What makes it egregious is that they lied about even having a plan, Noah said, showing clips from politicians who noted that, We didnt know why we were there or how we could get out..we didnt have the foggiest notion of what we were doing.

Not knowing who they were going to fight thats a strategy for drunk dudes in Boston, Noah said. The people in charge didnt know how to define success Like what they did with Game of Thrones.

He went on to detail the various boondoggles, including a $34 million effort to grow soybeans in a country whose soil and climate were not a fit, or $28 million for forest camouflage uniforms for the Afghan army in a country thats mostly desert.

Now, you might be thinking, Who can we be mad at?' The answer is the last three administrations. They all exaggerated American success, Noah said. In a time where partisanship has split the country, Its nice to learn that something brings leaders together: lying about war.

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The Daily Show With Trevor Noah Talks About The Greys Anatomy Of Wars - Deadline

Pink Wall review: eviscerating anatomy of a relationship from Downton’s viscount – The Telegraph

Dir: Tom Cullen. Cast: Tatiana Maslany, Jay Duplass, Sule Rimi, Ruth Ollman, Sarah Ovens, T. J. Richardson.15 cert, 82 min

Theres a bloodcurdling moment in the first scene of Pink Wall, a sharp, stinging relationship drama from actor-turned-filmmaker Tom Cullen, which pins your attention to the screen and keeps it there. The central couple, played to the hilt by Tatiana Maslany and Jay Duplass, are sat next to each other during a pub lunch in Wales, and a stray comment by her brother, whos across the table, turns the atmosphere on a dime.

Maslanys terrifyingly sudden rage at hearing the insult cuck (aimed at her boyfriend, implying he doesnt wear the trousers) is something to behold....

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Pink Wall review: eviscerating anatomy of a relationship from Downton's viscount - The Telegraph

Whakaari/White Island: Anatomy of a deadly eruption and the quest to save survivors – Stuff.co.nz

It was a beautiful day for a once-in-a-lifetime adventure. But when disaster struck at Whakaari/White Island, some of thepeople who were there didn't come home. Nikki Macdonald examines how the tragedy unfolded.

2.10pm

At 2.10pm the GNS Science webcam at Whakaari/White Island's crater rim snapsan ant-trail of tourists checking out New Zealand's most active volcano. One minute later, the ever-puffingcone, whose Mori name means the dramatic volcano, blowsits top. There are 47 tourists still on the island, but the world doesn't know that yet.

Near the pier wheretour passengers load and unload, a boat is waiting to leave, to return its day-trippers to Whakatne, 50km away.On board is a group who just 20 minutes earlier were in their hard hats and gas masks, doing that same regular loop to the crater's steamy yellow edge,offered as part of the standard 1hour inner-crater tour.

"No, no, no," a passenger cries out, as they watch the mushrooming cloud of white and black smoke and ash surge from the area they've just left. "Ca commence," a French tourist exclaims it's starting. "Go inside, go inside," a frantic voice calls out.

The beautiful silent shroud turns sinister, rolling across the island.At the pier, about 13 people huddle as the toxic tower rises above their heads. Ash-covered tourists run into the sea.

The Volcanic Air tour helicopter parked on the beach is shunted from its helipad, its rotors bent into spidery legs. That's 1.5 tonnes of metal, carried by the force of the explosion. Its four German passengers are down by the beach. Two passengers and the pilot escape serious harm by jumping into the water. The others suffer burns.

Theash cloud soars to more than 3600mfarenough to see fromsatellites.

Six weeks earlier, Stuff reportedthat the island's sulphurdioxide gas and volcanic tremorshad hit their highest levels since 2016,increasingthe possibility of an eruption. On November 18, GNS raised the volcano's alert level from one to two out of five advising that eruptions of steam, gas, mud and rocks could occur "with little or no warning".

GNS vulcanologist Geoff Kilgoursays rocks and minerals had been slowly clogging the geothermal vents, increasing the pressure, like blowing up a balloon. But like a balloon, you can't predict when it might burst.

White Island Tours' websitesays it operates through the various alert levels, but"there isalways a risk of eruptive activity".

At 2.17pm, police are alerted to the disaster.

MICHAEL SCHADE/AP

Tourists who have just left Whakaari watch helplessly from a boat as ash consumes the island.

2.24pm

Tour guides in navy and white striped T-shirts take inflatables from the tour boat to rescue the ash-caked huddle on the pier. At least five rescuees are in critical condition their skin blistered beneath their clothes from severeburns.

University of Auckland vulcanologistProfessor Shane Croninsays the eruptionwould have released a"violent ejection" of hot blocks and ash, and formed'hurricane-like' currents ofwet ash and coarse particles radiating from the explosion vent. That, and a cloud of "pretty much every nasty gas you can think of".

"These can be deadly in terms of causing impact trauma, burns and respiratory problems," Cronin says.

Lillani Hopkins

Geoff and Lillani Hopkins were on the island minutes before the eruption, and helped tend horribly burnt patients on the boat ride back to Whakatne.

The boat crew plead for doctors there are two. Hamilton pastor Geoff Hopkins and his daughter Lillaniare first aiders and also offer to help.

Lillanitriages the patients attaching red, orange or green tags, to show those most at risk of dying. They cut off the victims' clothes, andreplacethem withtheir own to keep themwarm. They're burnt but cold; in shock, drifting in and out of consciousness. They pourwater on the burns. When the water runsout,Lillaniholds a screaming man's hand and sings.

The Hopkinsesare two of few Kiwis on the tour. Those caught in the blast came from all over the world Australia, Britain, Malaysia, the United States, China.Many came from cruise ship, the Ovation of the Seas, which was docked for theday at Tauranga. Later that afternoon, its 4000-odd passengers listenas the captain announcesone of the ship's tour groups hasbeen caught in a volcanic eruption. He reads a list of passengers asked to report in. It's long. Cruisersanxiously checktheir phones.

At 2.30pm, GNS issues a volcanic alert bulletin, raising the alert level to 4, signifying amoderate volcanic eruption.

WHITE ISLAND FLIGHTS/SUPPLIED

Tourism operator White Island Flights captured this image of the Whakaari/White Island eruption.

2.40pm

Before the dust has settled, rescue efforts begin from the air, with Westpac rescue helicopters, two private helicopters and a Volcanic Air tourist helicopter scrambled to help.

Prime Minister Jacinda Ardern later paystribute to the courage of the pilots who selflessly headed into theeruption's aftermath.

One is pilot Mark Law, of Whakatne helicopter company Khu. He's been flying tourists to Whakaari/White Island for years. When he hearsof the eruption, he doesn'thesitate to fire up the rotors of his Squirrel and make the 20-minute flight to the island.

Michael Schade/AP

Crew from tour boats who were waiting to leave sent inflatables back to the island to rescue those caught in the eruption.

His colleague Jason Hill flies their second chopper. Inside the volcano's crater, the dust and gas are swirling, restricting visibility.

On the ground, they can see distressed people. Some sitting, some lying. Several have horrific injuries. They hear emergency services aren't coming, so they start rescuing patients themselves. The dust is so deep it's like running through talcum powder.

Volcanic Air chief pilot Tim Barrow arrives to help.Between them, they load up 12 patients and get them out, to Whakatne Hospital. They're struggling to breathe, and one of Barrow's charges dies on the way.

CHRISTEL YARDLEY/STUFF

Mark Law was one of three commercial helicopter pilots who courageously flew to the island immediately after the eruption, to evacuate patients.

On board oneWestpachelicopter is Dr Tony Smith. He's St John's clinical director, but also works half time as an intensive care specialist for Auckland Hospital. They have a permanent rescue helicopter crew, and he happens to be the doctor on call.

When the call comes in around 2.30pm, information is sketchy. All they know is there'sbeen an eruption, with multiple casualties. As they flytoward the volcano, the scale of the disaster becomes clearer from information from the ground, but it also becomes visible from the air.

"Even before we went over the Coromandel Peninsula we could see the plume of smoke. It was clear that something big had happened."

AUCKLAND WESTPAC RESCUE HELICOPTER

St John clinical director Tony Smith (left) and a paramedic are seen on White Island after the eruption.

They circle over the crater, looking for a safe landing, checking for life. They find neither they can see people, but only those who haven't made it.

Safety is never black or white, always grey, Smith says. They put down on the beach, near the pier, where they figure the boats can fish them out if they have to flee to the water. Everything is covered in thick yellow sulphurous ash. Every wind gust or rotor swish kicks up a dust cloud. It's like walking around in fog.

They can smell the sulphur through the respirator masks. It's incredibly irritating within minutes eyes and any exposed skin are sore. There are no more survivors to save so they head out, back to Whakatne, where six critically injured evacuees are waiting at the airfield and wharf.

SUPPLIED

This 1.5 tonne tour helicopter was shunted off its helipad by the force of the eruption.

3.26pm

On Whakatne's coast, police cordon off Muriwai Drive, to give emergency services room and privacy to deal with the injured. Casualties are removed on stretchers, covered in survival blankets, some dressed only in their underwear. Manyhave life-threatening burns.

Whakatne Hospital goes into mass casualty response, handlingmore critical patients in 12 hours than it normally gets in 12 months. Five will not make it, but the country doesn't know that yet.

Patients are placed wherever there'sspace in the Emergency Department, in the wards, even in the operating theatres. They need stabilising. Some have lungs so burntthey need ventilators to breathe. Others need anaesthetic to deal with the pain. Medicssend out for catering packs of Gladwrap, to cover the weeping wounds.

ONE NEWS

Police cordoned off Whakatne's Muritai Drive, to give emergency crew room to receive the injured.

Of the 31 patients, 27 have burns to more than 30 per cent of their bodies the normal entry criterionfor the national burns unit at Auckland's Middlemore Hospital. They need to get out of tiny Whakatne Hospital, but Middlemore can't cope with everyone. Smith helps co-ordinate ambulances, helicopters and aircraft to fly the injured to the country's four burns units, at Hutt Hospital, Christchurch, Waikato and Middlemore, and the two next best options Auckland and Tauranga.

Some patients have burns to more than 50 per cent of their bodies. The skin is red and blistered, with pieces falling off. The deepest burns turn the skin white, thick and leathery. Medics will need 1.2 million square centimetres of donor skin to patch all the scorched bodies.

Looking around Whakatne ED, Smith is blown away by the scale of the task ahead.

Lillani Hopkins

The ash cloud soars to more than 3600m - far enough to see from satellites.

"In terms of numbers of patients with very severe injuries, andsubsequent impact on the healthcare system of New Zealand,this is by far and away the biggest event we have ever experienced. Patients with 50 per cent burns will occupy many many many tens of hours of surgical operating and operating theatre time, many weeks of intensive care. These are complex patients that require a lot of complex therapies to get them to survive."

At 3.30pm, theNational Emergency Management Agency issues a national warning for a moderate volcanic eruption, advising people living near the ashfall to close windows and wear a dust mask.

BROOK SABIN

Tourists have been visiting Whakaari/White Island for more than 30 years. (File photo)

3.45pm

Prime Minister Jacinda Ardern gives a press conference saying 100 people are believed to have been on the island, and some are unaccounted for. Reports begin to filter to the public, of at least 20 injured, some critical, and possible deaths

At 4.25pm, GNS drops the volcano's alert level back to 3, warning of eruption hazards near the vent. Experts report there "remains significant uncertainty as to future changes but currently, there are no signs of escalation".

4.59pm

Police issue an update, saying only 50 tourists are now believed to have been on the island during the eruption.That's the only good news of the evening.

Just 90 minutes later, the police National Operation Commander, Deputy Commissioner John Tims, stands in the Beehive theatre and announces one of those rescued from the island has died. More deaths are likely, he says.

He doesn't know how many remain on the island, but it could be up to 27. And authorities have decided it's too dangerous for police and emergency services to go back in.

Ross Giblin

National Police Operation Commander, Deputy Commissioner John Tims, was the bearer of continual bad news.

9pm

Police confirm five people have died. Around the world, desperate friends and relatives begin to post missing persons reports on the Red Cross family links website. Theyare parents and children; husbands and wives; young and old.Their nationalities span the globe.

Some are false alarms a 7-year-old Australian boy is later found safe with family in Whakatne. Others are not.

10.20pm

Ardern and Civil Defence Minister Peeni Henare arrive in Whakatne and head to Whakatne District Council for a briefing.

Two hours later, just after midnight, police deliver a critical blow to hope: nomoresearchand rescue will be attempted tonight, despite "double digit" numbers left on the island. A police Eagle helicopter, rescue helicopter and defence force planes have donerecces, butseen no sign of life.

TOM LEE/STUFF

Prime Minister Jacinda Ardern arrives in Whakatne for a briefing on the situation on White Island on Monday night.

TUESDAY, 10 DECEMBER

Even as eight bodies lie unrecovered and unidentified in their ashen graveyard, the questions begin.

Local man Hayden Marshall-Inman is the first victim to be named one of two White Island Tours staff killed. As a tour guide for more than a decade, he knew the risks, his brother says.But he's angry that red tape is preventing them bringing his brother's body home.

"It smells like Pike River all over again.People from Wellington making decisions for people that go on the island daily who knows the island inside out."

FACEBOOK

Hayden Marshall-Inman.

As Australian Prime Minister Scott Morrison confirmsup to threeof the five dead may be Australian, another 11 are unaccounted for and 13 have been hospitalised, the scale of the diplomatic disaster begins to crystallise.

The dead and injured come from seven countries two from Britain, four from Germany, 24 from Australia, five from New Zealand, two from China, one from Malaysia and nine from the United States.

Stories begin appearing on international media, of their countrymen and women caught in the tragedy. And with them come the question why were they allowed on an active volcano that was known to begetting jumpier?

Supplied

Newly weds Lauren and Matt Urey were on White Island when it erupted. They were taken to hospital with burns. Their condition is unknown.

American honeymooners Lauren and Matthew Ureywere severely burntin the explosion. Lauren's mother Barbara Barham is livid had her daughter known it was risky, she would never have gone, she says.Lauren's father says allowing tourists on to an active volcano is "absurd".

Tourists have been trekking out to the island for more than 30 years, including through the volcano's most active period, from 1975 to 2001, when small eruptions were frequent. It has claimed lives before in 1914, a lahar killed 10sulphur miners asleep in their beds. The only survivor was a tabby cat.

Ray Cas, Australian professor of geoscience at Melbourne's Monash University, has said White Island was "a disaster waiting to happen".

CHRISTEL YARDLEY/STUFF

Flowers and cards have started to be placed at the cordon site for White Island victims.

Whether tourists should have been there at all is a question that must be asked, Ardern later says. At 5pm, police announce they will be asking it, in addition tohealth and safety watchdog WorkSafe.

But for now the focus is on supporting grieving families, and the heroes who went in to help.One survivor will later die in hospital, on Tuesday night, bringing the death toll to eight.

"All incidents like this affect everybody," Tony Smith says. "You are a human being. It's impossible to go to something like this and not be affected ... This will be an incident which will be forever etched in our memories."

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Whakaari/White Island: Anatomy of a deadly eruption and the quest to save survivors - Stuff.co.nz

Senior Lecturer/Associate Professor in Applied Anatomy job with UNIVERSITY OF BRISTOL | 188877 – Times Higher Education (THE)

Centre for Applied Anatomy

Contract type: Open endedWorking pattern: Full time

Closing date for applications: 12-Jan-2020

We have an exciting opportunity to appoint a new member of academic teaching staff to the Centre for Applied Anatomy at the University of Bristol. The Centre focuses on the excellence of practical applied anatomy teaching which is delivered with clinical and professional relevance.

You will work with the Head of Centre in providing educational direction, leadership and management for the Centre for Applied Anatomy (CAA) and to assist in its continued development. You will also act as the Director of Teaching for CAA.

You may teach across all teaching streams in the Centre for Applied Anatomy (Science, Veterinary, Medical, Dental) and will be expected to contribute substantially to practicals, lectures, seminars and project supervision. As Director of Teaching, you will provide leadership to ensure that the Centres educational offerings are distinctive, innovative, high quality and competitive

For informal enquiries please contact:Michelle Spear; Hos-anat@bristol.ac.uk; 0117 33 17839

We welcome applications from all members of our community and are particularly encouraging those from diverse groups, such as members of the LGBT+ andBAME communities, to join us.

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Senior Lecturer/Associate Professor in Applied Anatomy job with UNIVERSITY OF BRISTOL | 188877 - Times Higher Education (THE)

Did Cristina Yang Ever Have a Healthy Relationship on ‘Grey’s Anatomy’? – Showbiz Cheat Sheet

WhenCristina Yang(Sandra Oh) leaves Greys Anatomy in season 10, fans ugly cry. Many viewers believe herdeparture is harder to watchthan the death ofDerek Shepherd(Patrick Dempsey). So, its not surprising that fans still talk about Cristinas time on the show. The latest debate is over whether she ever had a healthy relationship. Lets take a look at what fans are saying.

During the first season ofGreys Anatomy, Cristina begins dating Preston Burke (Isaiah Washington). Early on in the season, Burke breaks off the relationship because he does not want it to ruin their reputations. When Cristina has a miscarriage, the two get back together.

Burke literally never considers what Cristina wants,wrote one Reddit user. When Cristina wants the relationship kept private, he makes it public without her okay. When they get engaged and she wants to tell Meredith before anyone else knows, he almost immediately goes and tells other people. When she says she wants something small, secular, in a courthouse, he gets into planning a big extravagant church wedding.

The pair are engaged and plan a wedding in under one year. On the day of their marriage, Burke and Cristina have a talk that does not end well. The bride remarks that she thought this was what she wanted, however, that is not good enough for Burke. He wants her to know that she wants to be with him. He promptly leaves the church, packs up his things, and moves out.

Their relationship wasnt healthy at all, added concluded the fan. It was pretty clear from the beginning that Burke held all the power.

Cristina is immediately attracted to Owen Hunt (Kevin McKidd) when he makes a guest appearance on Greys Anatomy. Later, when he returns from Iraq, he and Cristina begin a relationshiponly for it to end when he strangles her in his sleep. He does go to therapy sessions for his PTSD and eventually rekindles the relationship with Cristina.

The pair break-up yet again when Teddy Altman (Kim Raver)and old army friend of Owen scomes to work at the hospital, sparking jealousy issues.

Cristina restores their relationship when Owen is unexpectedly shot during a shooting in the hospital. The two get married suddenly, and Cristinas friends believe Owen is taking advantage of her due to the PTSD she has from the shooting.

I hated his whole army personality thing,wrote one fanabout Owen. I also felt like he was super manipulative in his relationship with Cristina.

Cristina gets pregnant shortly after the shooting but desires to have an abortion. Owen does not agree with her decision and tries to bully her into keeping the baby. Fans find the abortion fight to be one of Owens worst moments.

I think Owen is very similar to Burke, added another Redditor. He loved his idea of Cristina but didnt love her.

Fans feel that Cristinas relationship with Owen and the one with Burke were both destructive.

Fans will agree that throughout Cristinas 10 seasons on Greys Anatomy, Meredith (Ellen Pompeo) was her only thriving relationship. They have each others backs, no matter what the situation.

Although I love Meredith and Christinas practically perfect friendship, I think it was necessary for them to have some struggles with each other in season 10, wroteone viewer on Reddit. I think it made their friendship more realistic and relatable to the audience because we all know what its like to have a little competition and disagreements with close friends. Plus, afterward, they were just as close if not closer than they were before.

The two go through strong arguments with each other, but they work it out amicably.

Derek is the love of my life, but youre my soulmate, Meredith told Cristina in the first episode of season 7.

The twisted sisters are the one genuine relationship that Cristina has on the show that is thriving and strong throughout her time at the hospital. Current episodes of Greys Anatomy still includeCristina via text messageand phone calls with Meredith. You can watch for more Cristina references when the show returns on Jan. 23, 2020.

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Did Cristina Yang Ever Have a Healthy Relationship on 'Grey's Anatomy'? - Showbiz Cheat Sheet

Innova Invitro The Place Where Parenting Dreams Come True – Georgia Today

Infertility was always a very serious problem for society, both as a medical and as a social-demographic issue. In an era of late parenting, combined with career growth goals which weakened the institution of family, the hazardous effects of toxic influences of ecology and environmental factors saw infertility becoming not just a personal tragedy but a global problem.

Innova Invitro, established and guided by Dr. Ketevan Osidze who is well-known for as being a doctor with excellent results, is fully dedicated to meeting patients expectations. The clinic has been operating since 2016 and is recognized worldwide as having international standards and high pregnancy rates.

We all know that to be a leading clinic in Tbilisi requires hard work. Please tell us a little more about Innova Invitro.

I am really happy to have such an amazing team. I have 16 years working experience in the field of IVF but my goal was to start with the best possible embryology lab. I chose one of the leaders in the field of IVI, the Valencia Institute of Infertility, as a provider of accreditation and runner of our embryology service. Our Embryology Lab Director Jordan Garcia Ortega is a well-known professional worldwide with amazing experience. I think having such an influential person here had an overall impact on the service and quality in this region. We are proud that several Georgians have been trained by him. We continue to employee embryologists from IVI as the number of patients is growing constantly.

What is main activity of your clinic?

We offer services of any difficulty as we are fully equipped and have the know-how. To performing IVF and ICSI intracytoplasmic sperm injection, we can add genetic tests of embryos PGT-A, PGD, and NIPD tests for pregnancies. Our main activity includes ambulatory treatment and diagnostics of infertility. The clinic has all the necessary means to treat women and men: an external control hormonal lab, referral department of laparoscopy, endocrinology and andrology services, and outstanding specialists with up to date ultrasound and XR machines. We think that only proper diagnosis can ensure a successful medical intervention. Our multidiscipline team of gynaecologists, obstetricians, endocrinologists, therapeutics, and anaesthesiologists care about the well-being and satisfaction of patients and their babies.

We feel special responsibility providing donation and surrogacy services, as it is not only medical intervention. We care very much about the transparency and safety of the process for all parties couples, egg or sperm donors and surrogate mothers. This is an absolutely legal process which is well controlled by the government.

We know that you have very positive feedback from patients. What makes your clinic different from others?

Our priority is high standards of medical service, and an individualized and timely approach to any case with properly planned interventions. We have a special department for international patients to make it easy for them to plan and prepare for surrogacy and donation services. They arrive only at the final stages for the procedure and have to spend only several days in Tbilisi. I have to mention that they usually want to stay longer just as tourists and usually come back for several weeks with friends after the babies are born. I can say that medical tourism is contributing a lot to the rise of tourism activity overall. Timely and planned visits and long-distance services are very important to local customers as well, as a lack of time is a reality for many.

What is main diagnosis of your patients?

It is most commonly infertility due to tubal patency problems post-inflammation or post-surgery. Everyone is concerned about the very fast decline in sperm parameters and subfertility and infertility. Along with genetic errors in the Y chromosome, this situation is connected with ecology, air pollution, chemicals in food, steroid abuse and heavy metals in building materials, possible the harm of Wi-Fi and other urban factors, including stress. We are really glad to see men overcoming the stigma of coming for a check-up and visiting earlier, sometimes even before marriage. Infertility is problem of a couple not of a single individual, so faster diagnosis gives faster results.

What are your plans?

We follow all the advances in reproductive medicine field. We would like to share our experience and expertise with professional society by participating in international research and training programs. As part of social responsibility, we will continue to make efforts to make society more informed and educated about infertility treatment and prevention.

What does partnering with IVI mean for your clinic and what is the priority area of activity for Inova Invitro?

The priority area for Inova Invitro is the comprehensive diagnosis and management of all pathologies of infertility, all the while adhering to international standards pertaining to the treatment procedures. The main focus is on vitro fertilization and donation-surrogacy programs. We are home to personnel of the highest calibre with 15 years working experience in the realm of in vitro fertilization. The collaboration with IVI gives our specialists the opportunity to, along with providing the best standards of treatment, develop an integrated approach that incorporates complex diagnostics and consultation.

What makes patients turn to donation or surrogacy? What do these two procedures entail?

Premature ovarian syndrome, genetic abnormalities, poor quality eggs or embryos are among the conditions that urge us to recommend egg donation. Egg fertilization is carried out in the embryological laboratory by the recipient's partner or donor sperm, then transplanted into the uterine cavity of a "potential mother" under ultrasonography. About 12 days after embryo transfer, a pregnancy test or blood test is performed to determine pregnancy.

In case of infertility, when referring to the surrogacy program, stimulation is provided for the biological mother or the donor, and the fertilized egg is transferred to the surrogate mothers womb. Surrogate mothers have no genetic relationship with the embryos.

What are the root causes of infertility?

Infertility is a sensitive global issue. The causes may range from stress, late marriage, ecology, or the deterioration of male spermogram, among others. Quite often, a delayed visit to a doctor becomes one of the major obstacles.

What do you see as the major priority of Inova Invitro?

Our collaboration with Spain, an indisputable leader in the field, and working in accordance with the standards that they set, has been Invitros major asset. Partnering with IVI is a major advantage in terms of research, results and technical support.

Inova Invitro is a clinic that never fails to adhere to the best of European standards, which is also stressed by its maintenance of an embryological laboratory, headed by Jordan Garcia Ortega, a leading specialist at IVI.

How does your team work towards the clinics common goal?

The success of Inova Invitro almost entirely lies in our team's passion and effort to deliver the latest in state-of-the-art expertise and innovation. IVI specialists are valuable members of our team. Our clinic is home for specialists from all the adjacent fields to fertilization, which is another remarkable asset. One can benefit from all the services he/she needs in the comfort of a single space.

What is the pace of development for the field of reproductive medicine?

The field is developing rapidly; new methods are emerging, such as the so-called "gene modification" or embryonic genetic evaluation. All new discoveries are accessible at our clinic and we apply them strictly in accordance with healthcare licensing.

The field of reproductive medicine is undergoing some outstanding developments in Georgia, as the country's healthcare system actively supports it. Under our state-controlled regulations, the patient receives a safe and comprehensive service within a high quality program. The rights of patients, donors and surrogates (with whom the clinic works in close cooperation) are maximally protected.

Tell us about the improving trends of late.

The newly emerging trend is that an ever-increasing number of men address our clinic.

Even before marriage, the couples conduct research and check on their health. Egg and embryo freezing methods are also becoming popular- all these are vital turning points!

What are your last thoughts or advice for patients?

This century has brought to light that the ecological situation and a stressful backdrop work against us. Even with Wi-Fi, the spermogram concentration is weakened and the indicators are corrupted.

Consequently, there are many things to consider in terms of pregnancy. Timely referral to a doctor will prevent many problems.

09 December 2019 17:47

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Innova Invitro The Place Where Parenting Dreams Come True - Georgia Today