Liver stiffness predicts progression to liver-related events in patients with chronic liver disease - A cohort study of 14 414 patients.

BACKGROUND & AIMS: Liver stiffness measurement (LSM) by vibration-controlled transient elastography (VCTE) is a non-invasive diagnostic biomarker of liver fibrosis. It is uncertain if LSM can predict risk for future liver-related outcomes in large, heterogenous populations. METHODS: This Swedish multi-centre cohort study included patients (n = 14 414) from 16 sites who underwent LSM by VCTE between 2008 and 2020. Outcomes were ascertained from national registers. We investigated progression to cirrhosis with portal hypertension or hepatocellular carcinoma (HCC), separately. Cox regression was used to obtain hazard ratios (HRs). Harrel's C-index was used to measure discrimination of VCTE. RESULTS: Included patients had a median age of 46 (interquartile range 34-57), median LSM of 5.9 kPa (4.6-8.0), 59% were male, and the majority had hepatitis C (50.1%). During a median follow-up of 5.9 (4.3-8.0) years, 402 patients (2.7%) developed cirrhosis with portal hypertension. In patients with an LSM ≥25 kPa, 28.7% developed cirrhosis with portal hypertension within 5 years of follow-up, while only .6% of patients with an LSM <10 kPa did. This translated to a HR of 48.3 (95% confidence interval = 37.6-62.0). VCTE had a high discriminative ability, with C-indices above .80 for most liver diseases, including .82 for MASLD. Similar findings were seen for incident HCC. CONCLUSIONS: Increased LSM by VCTE was associated with an increased risk of progression to both cirrhosis with portal hypertension, and to HCC, and had a high discriminative ability across different aetiologies of chronic liver diseases. These results support the use of VCTE to guide follow-up and treatment decisions.

Size, connectivity and edge effects of stream habitats explain spatio-temporal variation in brown trout (Salmo trutta) density.

Ecological theory postulates that the size and isolation of habitat patches impact the colonization/extinction dynamics that determine community species richness and population persistence. Given the key role of lotic habitats for life-history completion in rheophilic fish, evaluating how the distribution of swift-flowing habitats affects the abundance and dynamics of subpopulations is essential. Using extensive electrofishing data, we show that merging island biogeography with meta-population theory, where lotic habitats are considered as islands in a lentic matrix, can explain spatio-temporal variation in occurrence and density of brown trout (Salmo trutta). Subpopulations in larger and less isolated lotic habitat patches had higher average densities and smaller between-year density fluctuations. Larger lotic habitat patches also had a lower predicted risk of excessive zero-catches, indicative of lower extinction risk. Trout density further increased with distance from the edge of adjacent lentic habitats with predator (Esox lucius) presence, suggesting that edge- and matrix-related mortality contributes to the observed patterns. These results can inform the prioritization of sites for habitat restoration, dam removal and reintroduction by highlighting the role of suitable habitat size and connectivity in population abundance and stability for riverine fish populations.

Let it flow: Modeling ecological benefits and hydropower production impacts of banning zero-flow events in a large regulated river system.

Hydropeaking, defined as rapid and frequent changes in flow to optimize hydropower production, is an increasingly common procedure negatively affecting lotic habitats in riverine ecosystems. An important aspect of hydropeaking is zero-flow events, occurring when hydropower stations are stopped due to low energy demand or low electricity prices. We quantified the ecological benefits and consequences for hydropower production of restricting zero-flow events. The 19 major hydropower stations in the Ume River system in northern Sweden stand still with no discharge 9% to 55% of the time a hydrologically normal year, transforming lotic habitat to stagnant water. The duration of zero-flow events is exacerbated in dry years, with no discharge for 28% of the time in a typical station, to be compared with 7% in a wet year. Zero-flow events affect the behavior of fish, altering the fish community, and potentially result in low oxygen levels and low food supply to filter-feeding macroinvertebrates. We modelled the consequences of restricting zero-flow events by introducing minimum flows equaling mean annual low flow or higher for the entire Ume River catchment. The measure would result in an additional 240 ha of shallow lotic habitat with gravel to boulder streambeds having flow velocity exceeding 0.1 m/s, i.e. suitable for lotic species such as grayling Thymallus thymallus. In addition, the measure would enable creating another 107 ha of similar habitat after structural rehabilitation of river reaches. All measures would result in a mean loss of hydropower production of 0.5% per year for the entire river system, 98% of which would occur between May and October when the demand for electricity is lower. Hydropower production would also be partly moved from daytime to nighttime. As zero-flow events are common in several other river systems, restrictions on their frequency and duration could be implemented in many areas.

Substrate-size choice in European eel (Anguilla anguilla) elvers is not altered by piscivore chemical cues.

The European eel Anguilla anguilla Linnaeus 1758 is critically endangered with recruitment estimated at 5-10% of historical levels. Enhancing survival of recruits is pivotal for conservation, and restoration should consider habitat choice of elvers ascending river systems. We experimentally show that newly ascended elvers choose small pebble habitat over finer and larger substrates, regardless of the presence or absence of piscivore chemical cues, indicating no predator-induced change in substrate choice. Enriching habitats with this substrate fraction should enhance eel recruitment as well as biodiversity at large.

Learning about the history of landscape use for the future: consequences for ecological and social systems in Swedish Bergslagen.

Barriers and bridges to implement policies about sustainable development and sustainability commonly depend on the past development of social-ecological systems. Production of metals required integration of use of ore, streams for energy, and wood for bioenergy and construction, as well as of multiple societal actors. Focusing on the Swedish Bergslagen region as a case study we (1) describe the phases of natural resource use triggered by metallurgy, (2) the location and spatial extent of 22 definitions of Bergslagen divided into four zones as a proxy of cumulative pressure on landscapes, and (3) analyze the consequences for natural capital and society. We found clear gradients in industrial activity, stream alteration, and amount of natural forest from the core to the periphery of Bergslagen. Additionally, the legacy of top-down governance is linked to today's poorly diversified business sector and thus municipal vulnerability. Comparing the Bergslagen case study with other similar regions in Russia and Germany, we discuss the usefulness of multiple case studies.

Protected area as an indicator of ecological sustainability? A century of development in Europe's boreal forest.

Protected area (PA) is an indicator linked to policies on ecological sustainability. We analyzed area, size, and categories of PAs in the European boreal forest biome in Norway, Sweden, Finland, and Russia from 1900 to 2010. The PA increased from 1.5 × 10(3) ha in 1909 to 2.3 × 10(7) ha in 2010. While the total PA in the boreal biome was 10.8 %, the figures ranged from 17.2 % in the northern, 7.9 % of the middle, and 8.7 % of the southern boreal sub-regions. The median size of PAs varied from 10 to 124 ha among countries. The categories of less strictly PAs increased over time. The proportion of area occupied by PAs is an important response indicator for conservation efforts. However, the use of PA as an indicator of ecological sustainability needs to consider ecosystem representation, functional connectivity and management categories.

Social and cultural sustainability: criteria, indicators, verifier variables for measurement and maps for visualization to support planning.

Policies on economic use of natural resources require considerations to social and cultural values. In order to make those concrete in a planning context, this paper aims to interpret social and cultural criteria, identify indicators, match these with verifier variables and visualize them on maps. Indicators were selected from a review of scholarly work and natural resource policies, and then matched with verifier variables available for Sweden's 290 municipalities. Maps of the spatial distribution of four social and four cultural verifier variables were then produced. Consideration of social and cultural values in the studied natural resource use sectors was limited. The spatial distribution of the verifier variables exhibited a general divide between northwest and south Sweden, and regional rural and urban areas. We conclude that it is possible to identify indicators and match them with verifier variables to support inclusion of social and cultural values in planning.

Evidence-based knowledge versus negotiated indicators for assessment of ecological sustainability: the Swedish Forest Stewardship Council standard as a case study.

Assessing ecological sustainability involves monitoring of indicators and comparison of their states with performance targets that are deemed sustainable. First, a normative model was developed centered on evidence-based knowledge about (a) forest composition, structure, and function at multiple scales, and (b) performance targets derived by quantifying the habitat amount in naturally dynamic forests, and as required for presence of populations of specialized focal species. Second, we compared the Forest Stewardship Council (FSC) certification standards' ecological indicators from 1998 and 2010 in Sweden to the normative model using a Specific, Measurable, Accurate, Realistic, and Timebound (SMART) indicator approach. Indicator variables and targets for riparian and aquatic ecosystems were clearly under-represented compared to terrestrial ones. FSC's ecological indicators expanded over time from composition and structure towards function, and from finer to coarser spatial scales. However, SMART indicators were few. Moreover, they poorly reflected quantitative evidence-based knowledge, a consequence of the fact that forest certification mirrors the outcome of a complex social negotiation process.