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Tropical mountain forests are hotspots of biodiversity that are widely threatened by human population pressure and climate change. However, the cryptogamic species richness of many tropical mountain regions is insufficiently known, the poorly understood biodiversity of tropical African lichens being a prime example. To study the diversity of the genus Peltigera (Ascomycota, Lecanoromycetes) in East Africa, we studied lichens in a wide range of habitats on the slopes of Mt Kilimanjaro in Tanzania. Ranging from savannah to alpine heath vegetation and from natural forests to agricultural environments, 13 habitat types were sampled for lichens, which were then identified based on the nuITS genetic marker and morphology. We found eight Peltigera species on the slopes of Mt Kilimanjaro, including P. alkalicola sp. nov., P. dolichorhiza, P. polydactyloides, P. praetextata, P. rufescentiformis, P. seneca, P. sorediifera and P. ulcerata. Peltigera is most common and species-rich in the subalpine Erica forest zone, and four of the eight detected species were present only in the subalpine and alpine vegetation zones. Peltigera alkalicola was identified as a previously undescribed species, growing on trachybasaltic lava in the subalpine and alpine zones of Mt Kilimanjaro. The species resembles P. lepidophora but differs by possessing smaller thalli and peltate isidia that are distinctly dark on the lighter, tomentose lamina. Based on data from the NCBI GenBank, P. alkalicola probably also occurs in Alaska (USA) and Ningxia (China). This suggests that even though the species might generally be rare, it may have a global distribution in extreme mountain environments. For the first time, we report P. sorediifera from Tanzania and P. seneca from Africa.

Bronchopulmonary dysplasia is the most frequent adverse outcome of prematurity. Before implementation of antenatal steroids and surfactant therapy, bronchopulmonary dysplasia was mostly characterized by fibrotic, scarred, and hyper-inflated lungs due to pulmonary injury following mechanical ventilation and oxygen toxicity. With advances in neonatal medicine, this "old" bronchopulmonary dysplasia has changed to a "new" bronchopulmonary dysplasia characterized by an arrest in lung growth, leading to alveolar simplification and pulmonary vascular dysangiogenesis. While the old definition was based on the need for oxygen supplementation at a postnatal age of 28 days or at a corrected gestational age of 36 weeks, the newer definition looks at the mode of respiratory support required (eg, invasive versus noninvasive) and is then graded as mild, moderate, or severe. Patients with bronchopulmonary dysplasia may present with significantly impaired pulmonary function, reactive airway disease, or exercise intolerance. Over time, these patients may develop asthma or chronic obstructive pulmonary disease. The most serious long-term complication is the development of pulmonary vascular disease and pulmonary hypertension. Medical treatment often includes diuretics, steroids, bronchodilators, or oxygen supplementation and in the presence of pulmonary hypertension medication to decrease the pulmonary vascular resistance. Perioperative anesthetic risk is increased in children with pulmonary hypertension. These patients might require additional diagnostic imaging and plans for increased resource allocation such as postoperative intensive care admission.

International audience; Amber is renowned for the exceptional preservation state of its inclusions, allowing detailed morphological analysis and providing relevant environmental, palaeoecological, geographical, and geological information. Amber deposits predominantly known from North America, Europe, and Asia, are considered to be rare on the continents that formed Gondwana. The recent discovery of fossiliferous amber deposits in Ethiopia therefore provides an inimitable opportunity to close gaps in the fossil record of African terrestrial biota, and to study organisms otherwise rare in the fossil record. Here we show that diverse cryptogams are preserved in highest fidelity in Miocene Ethiopian amber. We describe gametophyte fragments of four liverworts: Thysananthus aethiopicus sp. nov. (Porellales, Lejeuneaceae), Lejeunea abyssinicoides sp. nov. (Porellales, Lejeuneaceae), Frullania shewanensis sp. nov. (Porellales, Frullaniaceae), and Frullania palaeoafricana sp. nov. (Porellales, Frullaniaceae). Furthermore, we describe a pleurocarpous moss of the extant genus Isopterygium (Hypnales, Pylaisiadelphaceae) and a lichen representing the order Lecanorales. These new specimens represent the first amber fossils of liverworts, mosses, and lichens from the African continent and render Ethiopian amber one of the few worldwide amber deposits preserving bryophytes (mosses and liverworts) or lichens. Fossil species of Thysananthus were recorded in Eocene Baltic and Oligocene Bitterfeld as well as Miocene Dominican and probably also Miocene Mexican ambers. Fossils which can unequivocally be assigned to Lejeunea have only been found in Dominican amber, so far. Neotropical ambers contain only one taxon of Frullania to date, while the genus is most diverse in Baltic, Bitterfeld, and Rovno ambers, formed in temperate regions. The new fossils support a tropical to subtropical origin of Ethiopian amber. The new African liverwort fossils are included in an updated list of leafy liverworts described from worldwide Cenozoic ambers to date.

The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.

Selaginella (Selaginellales, Selaginellaceae) is the most speciose genus of lycophytes and, with approximately 750 recognized present-day species, also one of the largest genera of vascular plants. However, the evolutionary history of this species richness remains largely unresolved. Recent research suggests that Selaginella was diverse already in the mid-Cretaceous and shows that S. subg. Stachygynandrum dates back at least to the incipient Angiosperm Terrestrial Revolution some 100 million years ago. Here, we describe 20 new fossil-species of Selaginella based on fertile shoots and spores preserved in mid-Cretaceous Kachin amber from Myanmar and emend the previously described S. cretacea. Ten of the species (S. ciliifera, S. cretacea, S. grimaldii, S. heterosporangiata, S. longifimbriata, S. minutissima, S. ohlhoffiorum, S. patrickmuelleri, S. villosa, S. wangxinii) represent S. subg. Stachygynandrum because they possess anisophyllous strobili. The other eleven species have isophyllous strobili. Two of them (S. isophylla, S. wunderlichiana) are tentatively assigned to S. subg. Ericetorum, whereas the others (S. amplexicaulis, S. aurita, S. heinrichsii, S. konijnenburgiae, S. obscura, S. ovoidea, S. pellucida, S. tomescui, S. wangboi) cannot be placed into any fossil or extant subgenus. The fossils described in this study nearly duplicate the documented record of free-sporing plants from Kachin amber. The abundance and diversity of cryptogams, along with the absence of xerophytes among the taxa, is suggestive of constantly high humidity in the understory of the source forests of this amber.

Background Understanding the natural variability of plant resins is crucial for evaluating the chemical information stored in ambers that may support inferring palaeoenvironmental conditions. However, even among extant resin-producing plants, the variation of resinous exudates within and between tree genera and species is still poorly understood. Methods We analysed plant exudates from across the Araucariaceae in New Caledonia using Fourier-transform infrared spectroscopy in attenuated total reflection mode (FTIR-ATR). Both, wild (in situ) and arboretum grown (ex situ) populations were used to uncover the effects of intergeneric, inter- and intraspecific variation of the araucariacean plants on the resin chemistry. Results We show that even resins from the same species in the same habitat do have natural (intraspecific) chemical variation. Some of the variation can result from the degree of resin polymerisation, but this is not the only source of variation. Wild sourced resins have greater natural intraspecific chemical variation than the arboretum sourced ones. Interspecific and intergeneric differences were not easy to distinguish in the resins sampled. This has strong implications for the evaluation of the chemical information from worldwide ambers: multiple samples should be analysed to give a more accurate picture of the natural chemical variation present and how this may or may not overlap with the chemistries of other resin types. Additionally we discovered that the Araucariacean species can produce up to three distinct types of exudate (gum, resin, and gum resin). This is the first time that gum resins have been identified and characterized with FTIR-ATR. We also provide a guide on how to distinguish the exudate types when using FTIR-ATR.

Resinicolous fungi constitute a heterogeneous assemblage of fungi that live on fresh and solidified plant resins. The genus Sarea includes, according to current knowledge, two species, S. resinae and S. difformis. In contrast to other resinicolous discomycetes, which are placed in genera also including non-resinicolous species, Sarea species only ever fruit on resin. The taxonomic classification of Sarea has proven to be difficult and currently the genus, provisionally and based only on morphological features, has been assigned to the Trapeliales (Lecanoromycetes). In contrast, molecular studies have noted a possible affinity to the Leotiomycetes. Here we review the taxonomic placement of Sarea using sequence data from seven phylogenetically informative DNA regions including ribosomal (ITS, nucSSU, mtSSU, nucLSU) and protein-coding (rpb1, rpb2, mcm7) regions. We combined available and new sequence data with sequences from major Pezizomycotina classes, especially Lecanoromycetes and Leotiomycetes, and assembled three different taxon samplings in order to place the genus Sarea within the Pezizomycotina. Based on our data, none of the applied phylogenetic approaches (Bayesian Inference, Maximum Likelihood and Maximum Parsimony) supported the placement of Sarea in the Trapeliales or any other order in the Lecanoromycetes. A placement of Sarea within the Leotiomycetes is similarly unsupported. Based on our data, Sarea forms an isolated and highly supported phylogenetic lineage within the " Leotiomyceta". From the results of our multilocus phylogenetic analyses we propose here a new class, order, and family, Sareomycetes, Sareales and Sareaceae in the Ascomycota to accommodate the genus Sarea. The genetic variability within the newly proposed class suggests that it is a larger group that requires further infrageneric classification.

Fruticose lichens of the genus Usnea Dill. ex Adans. (Parmeliaceae), generally known as beard lichens, are among the most iconic epiphytic lichens in modern forest ecosystems. Many of the c. 350 currently recognized species are widely distributed and have been used as bioindicators in air pollution studies. Here we demonstrate that usneoid lichens were present in the Palaeogene amber forests of Europe. Based on general morphology and annular cortical fragmentation, one fossil from Baltic amber can be assigned to the extant genus Usnea. The unique type of cortical cracking indirectly demonstrates the presence of a central cord that keeps the branch intact even when its cortex is split into vertebrae-like segments. This evolutionary innovation has remained unchanged since the Palaeogene, contributing to the considerable ecological flexibility that allows Usnea species to flourish in a wide variety of ecosystems and climate regimes. The fossil sets the minimum age for Usnea to 34 million years (late Eocene). While the other similar fossils from Baltic and Bitterfeld ambers cannot be definitely assigned to the same genus, they underline the diversity of pendant lichens in Palaeogene amber forests.

BACKGROUND: Professional musicians frequently suffer from musculoskeletal complaints and disorders (MCD), which can be treated by osteopathic manipulative treatment (OMT). The aim of this systematic review was to evaluate the effectiveness and efficacy of OMT in adult musicians. METHODS: A systematic literature search included the electronic databases PubMed/MEDLINE, Medpilot, EBSCOhost, BioMedCentral, OSTMED-Dr, osteopathic-research.com, PEDro, hand searches, and contact to European osteopathic academies. Interventional and observational studies published between January 1999 and January 2019, of professional or amateur musicians who were either healthy or had MCD treated by OMT, were included. The quality of the randomized controlled trials (RCTs) was assessed by the Physiotherapy Evidence Database (PEDro) Scale ranging between 0 and 10 points. RESULTS: Only 5 studies were identified investigating OMT in musicians, including 1 RCT (cross-over design), 3 clinical controlled trials, and 1 case report. The internal validity of the RCT was assessed as 6 points. OMT was reported to have a positive impact on healthy singers, improving phonation time, voice quality, and voice range. It also improved the cervical range of motion in violinists. No adverse events were observed, although only the cross-over RCT reported partly an assessment of adverse events. CONCLUSIONS: The evidence for OMT in adult musicians is very limited. Prospective controlled clinical trials investigating OMT in musicians are required.

Abstract. Musicians suffering from music performance anxiety (MPA) fear and/or avoid performing situations. While performing, they often experience physiological (like increased heart rate or sweating), cognitive (for example fear of control loss), behavioral (like making mistakes or avoiding performances) and emotional symptoms (mostly fear) leading to high distress. About a quarter of all professional musicians suffer from MPA. In studies, cognitive behavioral therapy and beta blockers were effective options for treating MPA. Other treatments and preventive methods are presented.

Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents. We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force. Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a 'light breakfast' may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.

Hintergrund Padiatrische Notfallbander (PNB) unterstutzen medizinisches Notfallpersonal bei der Versorgung von padiatrischen Notfallpatienten. Ein kurzlich veroffentlichter digitaler Algorithmus zur langenbasierten Gewichtsschatzung war im Vergleich zu den auf dem Markt erhaltlichen Bandern praziser. Um diesen digitalen Algorithmus klinisch zu testen, wurde ein Prototyp eines elektronischen PNB (ePER) entwickelt. Ziel Das Ziel dieser Studie war es, das ePER mit zwei bekannten papierbasierten, analogen PNB hinsichtlich Zeitbedarf und Prazision in einem padiatrischen Notfallszenario zu vergleichen. Methoden Mitarbeiter der Anasthesieabteilung des Universitats-Kinderspitals Zurich wurden gebeten, in randomisierter Reihenfolge mittels der beiden PNB und des ePER in einem simulierten Notfallszenario an padiatrischen Notfallpuppen die Parameter Gewicht, Defibrillationsenergie, Adrenalindosis und Grose des endotrachealen Tubus zu bestimmen. Jeder Ablauf wurde mit einem digitalen Rekorder aufgezeichnet. Aus diesen Aufzeichnungen wurden die Zeit bis zur Nennung der jeweiligen Parameter und deren Korrektheit ermittelt. Ergebnisse Das Auffinden der definierten Parameter war mit dem ePER schneller als mit den konventionellen PNB (30 s vs. 47 s bzw. 51 s; beide p

Diverse temperate forest types and a high atmospheric humidity have recently been suggested for the Eocene source area of Baltic amber. However, ferns are astonishingly rare as inclusions in this amber, which is in contrast to other seed‐free land plants, fungi, and lichens. Moreover, the identities of some of the few described putative fern taxa are dubious, and some fossils were even assigned to the Paleozoic seed fern genera Alethopteris, Pecopteris and to the form genus Sphenopteris containing Paleozoic and Mesozoic fern‐like leaf fossils. Here, we review previously described fern inclusions from Baltic amber and identify further fern‐like leaf inclusions as belonging to the extant angiosperm genus Comptonia (sweet ferns, Myricaceae). We conclude that only one taxon, Matonia striata (Matoniaceae), can with confidence be identified as a Polypodiopsida representative. Although “Pecopteris” humboldtiana is so far only known as sterile foliage, its leaf morphology strongly suggests that also this taxon belongs to the Polypodiopsida rather than to any other tracheophyte lineage. We propose accommodating “Pecopteris” humboldtiana in the new genus Berendtiopteris. “Alethopteris” serrata and “Sphenopteris” phyllocladoides are not to be regarded as evidence of ferns from Baltic amber. Reinvestigation of the holotypes of these two taxa did not reveal to which tracheophyte lineages these fossils belong. We suggest that the scarcity of fern remains from Baltic amber may reflect both a relatively low fern diversity in the source area of the fossil resin, and an absence or rarity of epiphytic and climbing ferns as observed in modern temperate forest ecosystems.

Divergence time estimates suggest that most clades constituting the fern family Pteridaceae (Polypodiales) were in existence by the Early Cretaceous. However, fossil evidence to corroborate this remains exceedingly rare. Burmese amber is an important source of new information on the radiation of derived fern lineages during the Cretaceous Terrestrial Revolution. This study describes Heinrichsia cheilanthoides gen. et sp. nov., a fern with suggested affinities to Pteridaceae, based on fertile foliage portions preserved in Early Cretaceous (~100 Ma) amber from Myanmar. Heinrichsia cheilanthoides is characterized by a pinnate‐pinnatifid frond that bears apical, marginal sori protected by a pseudoindusium. Sporangia are of the polypod type and contain tetrahedral‐globose, trilete spores with a striate perine. This discovery provides a new calibration point to test and refine molecular clock‐based concepts of the evolutionary history of the Pteridaceae. Heinrichsia cheilanthoides further substantiates the suggestion that the Cretaceous forests of Myanmar were home to a rich fern flora.

The number of available liverwort fossils substantially increased within the past decade, which is mainly due to new findings from Cretaceous and Cenozoic amber deposits. Many of them, however, are fragmentary and not predestined for consideration in evolutionary analyses. Here, we list those liverwort fossils that we suggest as suitable for calibrating phylogenetic reconstructions, along with brief descriptions, justification of their use, and age information. Our recommendations are based on thorough microscopic investigation of available fossils from worldwide amber collections including recent findings. We recommend that the following 42 fossil taxa can be used as confident minimum age constraints in phylogenetic reconstructions: Acrolejeunea ucrainica (35 Ma), Anastrophyllum rovnoi (35 Ma), Bazzania polyodus (34 Ma), Blepharolejeunea obovata (15 Ma), the genus Bryopteris with B. bispinosa and B. succinea (15 Ma), Calypogeia stenzeliana (34 Ma), Cephaloziella nadezhdae (35 Ma), the genus Ceratolejeunea with C. antiqua, C. palaeomexicana, and C. sublaetefusca (15 Ma), Cheilolejeunea latiloba (34 Ma), Cheirorhiza brittae (158 Ma), Cololejeunea sp. (15 Ma), Cyclolejeunea archaica (15 Ma), Dibrachiella grollei (15 Ma), Diettertia montanensis (112 Ma), Drepanolejeunea eogena (15 Ma), the genus Frullania with F. baerlocheri, F. cretacea, and F. partita (99 Ma), Frullania subgen. Frullania with F. casparyi (34 Ma) and F. riclefgrollei (35 Ma), F. subgen. Trachycolea with F. rovnoi (35 Ma) and F. schumannii (34 Ma), Gackstroemia cretacea (99 Ma), Geocalyx heinrichsii (34 Ma), the genus Lejeunea with L. hamatiloba, L. miocenica, L. resinata, and L. urbanioides (15 Ma), Lopholejeunea subnigricans (15 Ma), Marchantites cyathodoides (228 Ma), Marchesinia brachiata (15 Ma), Metzgeriothallus sharonae (383 Ma), Microlejeunea nyiahae (52 Ma), Neurolejeunea macrostipula (15 Ma), Nipponolejeunea europaea (34 Ma), Notoscyphus balticus (34 Ma), Odontoschisma (sect. Iwatsukia) dimorpha (34 Ma), Plagiochila groehnii (34 Ma), Porella subgrandiloba (34 Ma), Protolophozia kutscheri (34 Ma), Radula (subgen. Odontoradula) cretacea (99 Ma), R. (subgen. Amentuloradula) heinrichsii (99 Ma), Scapania hoffeinsiana (34 Ma), Solenostoma berendtii (34 Ma), Spruceanthus polonicus (34 Ma), Stictolejeunea squamata (15 Ma), Tetralophozia groehnii (34 Ma), Thysananthus auriculatus (15 Ma), Thysananthus contortus (34 Ma). Furthermore, we transfer Lophozia kutscheri to Protolophozia, Archilejeunea grollei to Dibrachiella, Frullania ucrainica to Acrolejeunea, and Mastigolejeunea extincta to Spruceanthus, based on new fossil evidence and morphological revisions.

INTRODUCTION Maternal-infant equilibrium occurs when cord blood docosahexaenoic acid (DHA) is less than or equal to maternal DHA at delivery. Equilibrium may be an indicator of sufficient DHA for optimal fetal and infant neurodevelopment. The purpose of this study was to test the effect of maternal DHA supplementation on equilibrium status and fetal neurodevelopment. METHODS Women enrolled between 12 and 20 weeks gestation and were randomized to 200 or 800 mg DHA/day until delivery. Maternal red blood cell (RBC) phospholipids were measured at enrollment, 32 weeks, delivery, and in cord blood at delivery. Fetal neurodevelopment was measured at 32 and 36 weeks gestation. Intent-to-treat analyses were conducted to test differences in equilibrium status by group. Fetal outcomes were assessed by equilibrium status and group. RESULTS Three hundred women enrolled and 262 maternal-infant dyads provided blood samples at delivery. No maternal-infant dyads with maternal RBC-DHA ≤ 6.96% at delivery achieved equilibrium. The incidence of equilibrium was significantly higher in the 800 mg group. There was no effect of maternal group or equilibrium status on fetal neurodevelopment. CONCLUSION The significance of maternal-infant DHA equilibrium remains unknown. Ongoing research will test the effect of treatment group, equilibrium, and nutrient status on infant behavior and brain function. IMPACT Pregnant women who received a higher dose of docosahexaenoic acid (DHA) were more likely to achieve maternal-infant DHA equilibrium at delivery. Equilibrium status had no effect on fetal neurodevelopment in this sample. While DHA is crucial for early life neurodevelopment, the significance of achieving maternal-infant equilibrium above the lower threshold is uncertain. There is a lower threshold of maternal DHA status where maternal-infant DHA equilibrium never occurs. The lack of equilibrium associated with low maternal DHA status may indicate insufficient maternal status for optimal placental transfer.

The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.

The Zhangpu biota provides a new insight into biodiversity redistribution during the Mid-Miocene Climatic Optimum., During the Mid-Miocene Climatic Optimum [MMCO, ~14 to 17 million years (Ma) ago], global temperatures were similar to predicted temperatures for the coming century. Limited megathermal paleoclimatic and fossil data are known from this period, despite its potential as an analog for future climate conditions. Here, we report a rich middle Miocene rainforest biome, the Zhangpu biota (~14.7 Ma ago), based on material preserved in amber and associated sedimentary rocks from southeastern China. The record shows that the mid-Miocene rainforest reached at least 24.2°N and was more widespread than previously estimated. Our results not only highlight the role of tropical rainforests acting as evolutionary museums for biodiversity at the generic level but also suggest that the MMCO probably strongly shaped the East Asian biota via the northern expansion of the megathermal rainforest biome. The Zhangpu biota provides an ideal snapshot for biodiversity redistribution during global warming.

Objective This study compared the percent change in systolic blood pressure and the incidence of adverse cardiac events (ACEs; defined as cardiac arrest, cardiopulmonary resuscitation, arrhythmias, or ST-segment changes) during anesthesia induction in patients with Williams syndrome (WS) before and after implementation of a perioperative management strategy. Design Retrospective observational cohort study. Setting Single quaternary academic referral center. Participants The authors reviewed the records of all children with WS at the authors’ institution who underwent general anesthesia for cardiac catheterization, diagnostic imaging, or any type of surgery between November 2008 and August 2019. The authors identified 142 patients with WS, 48 of whom underwent 118 general anesthesia administrations. A historic group (HG) was compared with the intervention group (IG). Interventions Change in perioperative management (three-stage risk stratification: preoperative intravenous hydration, intravenous anesthesia induction, and early use of vasoactives). Measurements and Main Results The authors determined event rates within 60 minutes of anesthesia induction. Standardized mean difference (SMD) was calculated (SMD >0.2 suggests clinically meaningful difference). Sixty-seven general anesthesia encounters were recorded in the HG (mean age, 4.8 years; mean weight, 16.3 kg) and 51 in the IG (mean age, 6.0 years; mean weight, 18.2 kg). The change in systolic blood pressure was –17.5% (–30.0, –5.0) in the HG versus –9% (–18.0, 5.0) in the IG (p = 0.015; SMD = 0.419), and the incidence of ACEs was 6% in the HG and 2% in the IG (p = 0.542; SMD = 0.207). Conclusions Preoperative risk stratification, preoperative intravenous hydration, intravenous induction, and early use of continuous vasoactives resulted in greater hemodynamic stability, with a 2% incidence of ACEs.

International audience; Amber, a natural polymer, is fossil tree resin derived from diverse botanical sources with varying chemical compositions. As such, all amber is susceptible to the effects of light, temperature, relative humidity, and oxygen, as well as exposure to certain chemicals, and will deteriorate over time in collections if left unprotected. Here we review approaches for the conservation, preparation, and imaging of amber specimens and their inclusions, and address indications and causes of amber degradation, as well as recommendations for a suitable storage environment. We also provide updated preparation and embedding protocols, discuss several techniques for imaging inclusions, and address digitization efforts. A stable storage environment is essential to mitigate or avoid deterioration of amber, which often manifests as crazing, spalling, breaking and colour changes. Based on previous conservation studies of fossil resins, we generally recommend storage in a climate-monitored environment with a relative humidity of ca. 50%, 18 °C, and stress that light exposure must be kept to a minimum. For stabilization and anoxic sealing, amber specimens should ideally be embedded in an artificial epoxide resin (EpoTek 301-2 or similar is currently recommended). Amber should not be treated with or stored in vegetable or mineral oils (even for a short time for examination or photography), or come into contact with alcohol, disinfecting agents, hydrogen peroxide, or other destructive solvents or mixtures, since any of these materials can irreversibly damage the amber. Most photography of inclusions for research and digitization purposes can be successfully accomplished using light microscopy. Scanning electron microscopy (SEM) is sometimes used to uncover fine details, but is an invasive method. However, X-ray based methods (utilizing micro computed tomography, or micro-CT) are becoming more frequently used and increasingly indispensable in the examination of minute internal structures of inclusions, and to fully visualize important structures in opaque amber. Micro-CT makes it possible to digitize an inclusion three-dimensionally, and thus enables digital specimen ‘loans.’ Light microscopal images are still widely used in the digitization of amber specimens and are an essential alternative to micro-CT imaging when resources or time are limited. Overall, due to the vulnerability of all fossil resins, we recommend that conservation of amber samples and their inclusions be prioritized.

Music performance anxiety (MPA) is one of the most common disorders among professional musicians, nevertheless, little is known about the disease. With this systematic review, prevalence, risk factors and treatment procedures for MPA were assessed, and for the first time, quality assessments were carried out for all studies using standardized assessment tools. A systematic literature search was conducted via search algorithms in the databases MEDLINE, EMBASE, CINAHL, PsycArticles, PsycInfo and ERIC. Included were case reports, case–control, cohort, cross-sectional and intervention studies examining professional musicians with MPA. For quality assessment, adapted tools of the National Heart, Lung, and Blood Institute were used. A total of 43 studies were included (10 case reports, 21 intervention, 11 cross-sectional, one cohort study). Quality ratings ranged from −11 to 6 out of a maximum of 15/16 points for cross-sectional/cohort studies and −4 to 11 out of 18 points for intervention studies. The prevalence of MPA was between 16.5% and 60%. More women than men were affected and musicians older than 45–50 years reported less MPA than younger musicians. Regarding treatment cognitive behavioural therapy (CBT) andβ-blockers were most often researched with beneficial results for CBT. However, studies with adequate control groups for CBT interventions are needed to clarify its efficacy. Studies showed methodological weaknesses, especially in the selection of participants, recording of influencing factors, blinding of interventions, randomization of participants and analysis of comorbidity. Recommendations for further research are made.

Amber is chiefly known as a preservational medium of biological inclusions, but it is itself a chemofossil, comprised of fossilised plant resin. The chemistry of today's resins has been long investigated as a means of understanding the botanical sources of ambers. However, little is known about the chemical variability of resins and consequently about that of the ambers that are derived from particular resins. We undertook experimental resin production in Araucariacean plants to clarify how much natural resin variability is present in two species, Agathis australis and Wollemia nobilis, and whether different resin exudation stimuli types can be chemically identified and differentiated. The latter were tested on the plants, and the resin exudates were collected and investigated with Fourier-transform infrared attenuated total reflection (FTIR-ATR) spectroscopy to give an overview of their chemistry for comparisons, including multivariate analyses. The Araucariacean resins tested did not show distinct chemical signatures linked to a particular resin-inducing treatment. Nonetheless, we did detect two separate groupings of the treatments for Agathis, in which the branch removal treatment and mimicked insect-boring treatment-derived resin spectra were more different from the resin spectra derived from other treatments. This appears linked to the lower resin viscosities observed in the branch- and insect-treatment-derived resins. However the resins, no matter the treatment, could be distinguished from both species. The effect of genetic variation was also considered using the same stimuli on both the seed-grown A. australis derived from wild-collected populations and on clonally derived W. nobilis plants with natural minimal genetic diversity. The variability in the resin chemistries collected did reflect the genetic variability of the source plant. We suggest that this natural variability needs to be taken into account when testing resin and amber chemistries in the future.

Motivation for this comment Recently, the Society of Vertebrate Paleontology (SVP) has sent around a letter, dated 21st April, 2020 to more than 300 palaeontological journals, signed by the President, Vice President and a former President of the society (Rayfield et al. 2020). The signatories of this letter request significant changes to the common practices in palaeontology. With our present, multi-authored comment, we aim to argue why these suggestions will not lead to improvement of both practice and ethics of palaeontological research but, conversely, hamper its further development. Although we disagree with most contents of the SVP letter, we appreciate this initiative to discuss scientific practices and the underlying ethics. Here, we consider different aspects of the suggestions by Rayfield et al. (2020) in which we see weaknesses and dangers. It is our intent to compile views from many different fields of palaeontology, as our discipline is (and should remain) pluralistic. This contribution deals with the aspects concerning Myanmar amber. Reference is made to Haug et al. (2020a) for another comment on aspects concerning amateur palaeontologists/ citizen scientists/private collectors.

Background A ‘cannot intubate, cannot oxygenate' (CICO) situation is rare in paediatric anaesthesia, but can always occur in children under certain emergency situations. There is a paucity of literature on specific procedures for securing an emergency invasive airway in children younger than 6 yr. A modified emergency front of neck access (eFONA) technique using a rabbit cadaver model was developed to teach invasive airway protection in a CICO situation in children. Methods After watching an instructional video of our eFONA technique (tracheotomy, intubation with Frova catheter over which a tracheal tube is inserted), 29 anaesthesiologists performed two separate attempts on rabbit cadavers. The primary outcome was the success rate and the performance time overall and in subgroups of trained and untrained participants. Results The overall success rate across 58 tracheotomies was 95% and the median performance time was 67 s (95% confidence interval [CI], 56–76). Performance time decreased from the first to the second attempt from 72 s (95% CI, 57–81) to 61 s (95% CI, 50–81). Performance time was 59 s (95% CI, 49–79) for untrained participants and 72 s (95% CI, 62–81) for trained participants. Clinical experience and age of the participants was not correlated with performance time, whereas the length of the tracheotomy incision showed a significant correlation (P=0.006). Conclusion This eFONA training model for children facilitates rapid skill acquisition under realistic anatomical conditions to perform an emergency invasive airway in children younger than 2 yr.

Calicioid lichens and fungi are a polyphyletic grouping of tiny ascomycetes that accumulate a persistent spore mass (mazaedium) on top of their usually well-stalked ascomata ('mazaediate fungi'). In addition to extant forms, six fossils of the group were previously known from European Paleogene amber. Here we report nine new fossils and analyze the preserved features of all fossils to assess their applicability for dating molecular phylogenies. Many fossils are extremely well preserved, allowing detailed comparisons with modern taxa. SEM investigation reveals that even fine details of ascospore wall ultrastructure correspond to those seen in extant specimens. All fossils can confidently be assigned to modern genera: three to Calicium (Caliciaceae, Lecanoromycetes), five to Chaenotheca (Coniocybaceae, Coniocybomycetes), six to Chaenothecopsis (Mycocaliciaceae, Eurotiales), and one to Phaeocalicium (Mycocaliciaceae, Eurotiales). Several Calicium and Chaenotheca fossils are assignable to specific lineages within their genera, while the Chaenothecopsis fossils demonstrate the extent of intraspecific variation within one such lineage. Some features in the morphology of Chaenotheca succina nov. sp. seem to be ancestral as they have not been reported from modern species of the genus. (C) 2018 Elsevier Masson SAS. All rights reserved.

BACKGROUND Paediatric emergency tapes provide drug dosing based on the patient's estimated body weight. Unfortunately, published data revealed an unsatisfactory accuracy. A newly developed digital algorithm for weight estimation (CLAWAR) allowing a three-staged habitus adaptation (normal, obese, or cachectic; CLAWAR-3) demonstrated a higher accuracy for weight estimation compared to paediatric emergency tapes. However, the incidence of incorrectly evaluated habitus was 27%. A five-staged habitus adaptation with figural images was suggested by Wells et al to improve habitus and weight estimation. Therefore, CLAWAR was modified with five habitus stages including figural images (CLAWAR-5). We hypothized CLAWAR-5 improves the accuracy of weight estimation. METHODS After obtaining informed written parental consent patients were included in this single centre, prospective clinical observation trial. Body weight estimations by CLAWAR-3 and CLAWAR-5 within ±10% of the actual body weight were compared. Furthermore, the incidence of correct evaluated habitus was calculated. McNemar Tests were used for statistical analysis. Results presented as median (interquartiles), P

Amber is fossilised plant resin. It can be used to provide insights into the terrestrial conditions at the time the original resin was exuded. Amber research thus can inform many aspects of palaeontology, from the recovery and description of enclosed fossil organisms (biological inclusions) to attempts at reconstruction of past climates and environments. Here we focus on the resin itself, the conditions under which it may have been exuded, and its potential path to fossilisation, rather than on enclosed fossils. It is noteworthy that not all plants produce resin, and that not all resins can (nor do) become amber. Given the recent upsurge in the number of amber deposits described, it is time to re-examine ambers from a botanical perspective. Here we summarise the state of knowledge about resin production in modern ecosystems, and review the biological and ecological aspects of resin production in plants. We also present new observations on conifer-derived resin exudation, with a particular focus on araucarian conifer trees. We suggest that besides disease, insect attacks and traumatic wounding from fires and storms, other factors such as tree architecture and local soil conditions are significant in creating and preserving resin outpourings. We also examine the transformation of resin into amber (maturation), focusing on geological aspects of amber deposit formation and preservation. We present new evidence that expands previous understanding of amber deposit formation. Specific geological conditions such as anoxic burial are essential in the creation of amber from resin deposits. We show that in the past, the production of large amounts of resin could have been linked to global climate changes and environmental disruption. We then highlight where the gaps in our knowledge still remain and potential future research directions.

Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS2 anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS2 anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p < 0.001), and became less significant with increasing age and weight. During expiration, tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p < 0.001). Overall, the variability in measured tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients.