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[Aim]: How population density varies across animal species in the context of environ-mental gradients, and associated migratory strategies, remains poorly understood. The recent influx of avian trait data and population density estimates allows these patterns to be described and explored in unprecedented detail. This study aims to identify the main macroecological drivers of population density in birds., [Location]: Global., [Time period]: 1970–2021., [Major taxa studied]: Birds (Aves), [Methods]: We collated a dataset of 5072 local population density estimates for 1853 species and modelled popula.tion density as a function of trait and environmental predictors in a Bayesian framework accounting for phylogenetic and spatial autocor-relation. We explored the influence of body mass, diet, primary lifestyle, mating sys-tem, nesting behaviour, territoriality, and migratory behaviour on population density, accounting for a range of environmental variables, including preferred habitat type, primary productivity, precipitation and temperature. Based on this empirical baseline, we then predicted the mean population density for 9089 species of birds and esti-mated global geographic patterns of bird population density., [Results]: Population density was lower in species with larger body mass and higher trophic levels, and also declined in territorial species, migratory species, brood para-sites and species inhabiting resource- poor habitat types (e.g., deserts). Conversely, population density increased in cooperative breeders. Environmental drivers were most influential for migratory birds, with precipitation and temperature both associ-ated with higher population density. Overall, bird population densities were higher at lower latitudes., [Main conclusions]: Our results support previous findings on the role of body mass, diet and environmental gradients, but also reveal novel species-specific drivers of avian densities related to reproduction, migration and resource-holding behaviour. Substantial fine-scale variation remains unexplained. We provide a global dataset of population density predictions for use in macroecological analyses and conservation assessments., L.S. was supported by the MUR Rita Levi Montalcini program, A.B.-L. was supported by an EMERGIA grant (EMERGIA20_00252) funded by the Junta de Andalucía, and by a Ramón y Cajal grant (RYC2021-031737-I) funded by MCIN/AEI/10.13039/501100011033 and by the EU “NextGenerationEU”/PRTR, and CTC was supported by a Marie Skłodowska-Curie Individual Fellowship (no. 891052). Open Access Funding provided by Universita degli Studi di Roma La Sapienza within the CRUI-CARE Agreement.

Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare-associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status.We analyzed a retrospective cohort of children ≤18 years from the National Surgical Quality Improvement Program (2012-2019) database who underwent inpatient orthopedic surgery. We used Cox proportional regression model to estimate the hazard ratio for the association between neurologic disorders and postoperative pneumonia. In addition, we included an interaction term between body mass index and neurologic disorders to evaluate the moderating effect of obesity status and then performed stratified analyses to compare the magnitude of hazard ratios across body mass index subgroups.A total of 60 745 children underwent inpatient orthopedic surgery during the study period, of whom 43.6% were healthy weight and 30.8% overweight/obese. The median age was 13 years (Interquartile range: 8-15). The incidence of postoperative pneumonia was higher among healthy weight patients with neurologic disorders than healthy weight patients without any neurologic disorders [Hazard ratio: 3.55 vs. 0.34]. Furthermore, the association between neurologic disorders and postoperative pneumonia was strongest among overweight patients than healthy weight or obese patients [Hazard ratio:11.88 vs. 9.45 vs. 4.40]. This observation was consistent across the various neurologic disorders analyzed.Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an 'obesity paradox'. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.

Acetaminophen is routinely used for perioperative analgesia in children undergoing major surgical procedures. There are few estimates of acetaminophen pharmacokinetic parameters in children with congenital heart disease, especially those with cyanotic heart disease.The current study prospectively investigated differences in acetaminophen pharmacokinetics following surgery using cardiopulmonary bypass in children with cyanotic and acyanotic congenital heart disease.Children (2-6 years, 9-23 kg) presenting for median sternotomy for Fontan palliation (cyanotic patients) or two ventricle surgical repair (acyanotic patients) were eligible for inclusion. A single intravenous dose of acetaminophen (15 mg/kg) was administered at the start of sternal closure after separation from cardiopulmonary bypass. The time-course of acetaminophen concentrations were described using non-linear mixed effects models. One and two-compartment disposition models with first-order elimination were tested. Pharmacokinetic parameter estimates were scaled using allometry and standardized to a 70 kg person.There were 208 acetaminophen concentrations assayed from 30 children, 15 with cyanotic, and 15 with acyanotic heart disease. A 2-compartment model best described acetaminophen PK. Parameter estimates (population parameter variability, PPV%; 95% confidence interval, CI) were clearance CL 15.3 L.h-1.70 kg-1 (22.2%; 13.8-16.7), intercompartment clearance Q 45.4 L.h-1.70 kg-1 (22.4%; 25.2-61.9), central volume of distribution V1 33.5 L.70 kg-1 (23.2%; 25.9-38.8), peripheral volume of distribution V2 32.1 L.70 kgAcetaminophen pharmacokinetics were characterized using a 2-compartment model with first-order elimination following cardiac bypass surgery in children. Population pharmacokinetic parameter estimates were similar to other studies in children. No differences were detected between patients with cyanotic and acyanotic heart disease.

Although neuraxial techniques such as caudal and epidural anesthesia were initially the predominant regional anesthetic technique used to provide postoperative analgesia in children, there has been a transition to the use of peripheral nerve blockade such as the quadratus lumborum block (QLB). We present preliminary experience with QL catheters for continuous postoperative analgesia in a cohort of pediatric patients following colorectal surgery.After institutional review board (IRB) approval, we retrospectively reviewed the records of patients who underwent major colorectal surgery and received QL catheters for postoperative analgesia. The postoperative pain control data consisted of QL catheter characteristics, anesthetic agents, adjuncts, pain scores, and opioid consumption during the postoperative period.The study cohort included eight pediatric patients, ranging in age from 1 to 19 years (median age 11.8 years). The QL catheters were placed in the operating room after the induction of anesthesia. Comorbid conditions in the cohort that were contraindications to neuraxial anesthesia included spinal/vertebral malformations, presence of a ventriculoperitoneal (VP) shunt, anal atresia, tracheo-esophageal fistula (VACTERL) association, and coagulation disturbances. All patients underwent complex colorectal or genito-urologic procedures. Bilateral QL catheters were placed in six patients, and unilateral catheters were placed in two patients. Four patients received 0.5% ropivacaine and four patients received 0.2% ropivacaine of an initial bolus. The local anesthetic used for continuous infusion was 0.2% ropivacaine in five patients, 0.1% ropivacaine in two patients, and 1.5% chloroprocaine in one patient, with a median infusion rate of 0.11 mL/kg/h. QL catheter infusions were supplemented with intravenous opioids delivered by patient-controlled or nurse-controlled analgesia. The median opioid requirements in oral morphine milligram equivalents (MME) were 1.2, 1.0, 1.1, 0.5, and 0.6 MME/kg on postoperative days 1 - 5. Daily median pain scores were ≤ 2 during the 5-day postoperative course. All catheters functioned successfully and were in place for a median of 79.3 h. Other than early inadvertent removal of two catheters, no adverse effects were noted.Although our preliminary data suggest the efficacy of QL catheters in providing prolonged postoperative analgesia for up to 3 - 5 days following colorectal procedures, attention needs to be directed at measures to ensure that the catheter is secured to avoid inadvertent removal.

AIM: The world's islands support disproportionate levels of endemic avian biodiversity despite suffering numerous extinctions. While intensive recent research has focused on island bird conservation or extinction, few global syntheses have considered these factors together from the perspective of morphological trait diversity. Here, we provide a global summary of the status and ecology of extant and extinct island birds, the threats they face and the implications of species loss for island functional diversity. LOCATION: Global. TAXON: Birds. METHODS: We provide a review of the literature on threatened and extinct island birds, with a particular focus on global studies that have incorporated functional diversity. Alongside this, we analyse IUCN Red List data in relation to distribution, threats and taxonomy. Using null models and functional hypervolumes, in combination with morphological trait data, we assess the functional diversity represented by threatened and extinct island endemic birds. RESULTS AND MAIN CONCLUSIONS: We find that almost half of all island endemic birds extant in 1500 CE are currently either extinct or threatened with extinction, with the majority of threatened extant species having declining population trends. We also found evidence of 66 island endemic subspecies extinctions. The primary threats to extant island endemic birds currently are agriculture, biological resource use, and invasive species. While there is overlap between the hotspots of threatened and extinct island endemics birds, there are some notable differences, including the Philippines and Indonesia, which support a substantial number of threatened species but have no recorded post-1500 CE bird extinctions. Traits associated with threatened island endemic birds are large body mass, flightlessness, aquatic predator, omnivorous and vertivorous trophic niches, marine habitat affinity, and, paradoxically, higher dispersal ability. Critically, we find that threatened endemics (i) occupy distinct areas of beak morphospace, and (ii) represent substantial unique areas of the overall functional space of island endemics. We caution that the loss of threatened species may have severe effects on the ecological functions birds provide on islands. Government of Catalonia, Grant/Award Number: 2020 BP 00067. info:eu-repo/semantics/publishedVersion

Severe obesity, defined as body mass index (BMI) ≥ 40 kg/mWe assembled a retrospective cohort of patients ≥ 65 years who underwent inpatient surgical procedures and were either severely obese or normal weight (BMI 18.6 - 24.9 kg/mWe studied 34,936 patients who were ≥ 65 years of age. The incidence of PPMV was 2.0% (624/31,700) in normal weight patients and 2.8% (92/3,236) in severely obese patients (odds ratio (OR): 1.46; 95% confidence interval (CI): 1.17 - 1.82, P = 0.001). Multivariable analysis, controlling for confounders, estimated a 56% relative increase in the risk of PPMV in severely obese patients, relative to their normal weight peers (OR: 1.56; 95% CI: 1.22 - 1.99, P = 0.001). In normal weight patients, the risk of mortality was multiplied by 23 times in patients who required PPMV (39.6% vs. 2.64%; OR: 23.10; 95% CI: 18.96 - 28.16; P0.001). In severely obese patients, PPMV multiplied the risk of mortality by 25 times (30.4% vs. 1.6%; OR: 25.26, 95% CI: 13.44 - 47.50; P0.001).Severe obesity increased the odds of PPMV. Although the incidence of PPMV was low, its requirement conferred up to 25 times greater risk of postoperative mortality, underscoring the need for perioperative mitigation strategies to minimize PPMV risk in elderly patients undergoing vascular surgery.

Delirium is associated with increased length of stay, duration of mechanical ventilation, in-hospital mortality, and cost. Independent predictors of delirium include age2 years, developmental delay, severity of illness, mechanical ventilation, and administration of benzodiazepines and anticholinergic medications. Although patients receiving noninvasive ventilation (NIV) may have been included in prior studies, there are no data specifically focusing on delirium in children receiving NIV. Our primary aim was to investigate the prevalence of delirium in patients on NIV in the pediatric intensive care unit (PICU) and evaluate potentially modifiable risk factors for delirium.This was a single-center, retrospective study evaluating the prevalence of delirium as established by the Cornell Assessment of Pediatric Delirium (CAPD). We evaluated PICU patients ≤ 18 years old with respiratory insufficiency requiring ≥ 48 h of NIV. Patients receiving invasive mechanical ventilation were excluded from the analysis.There were 202 patients that received ≥ 48 h of NIV during the study period. Of these patients, 43 patients had at least one CAPD score documented while on NIV. There were a total of 143 days on NIV and 137 days with CAPD documentation. The prevalence of delirium, defined as a CAPD score ≥ 9, was 67.4% (29 of 43 patients). Sixty-nine percent of the patients who experienced delirium received benzodiazepines, compared with 14% who did not experience delirium (P = 0.001). Most patients (83.7%) in this cohort received dexmedetomidine. Of patients who received dexmedetomidine and had delirium, 68% received benzodiazepines compared to 25% in the non-delirious group (P = 0.046).Delirium is common in young pediatric patients receiving NIV. As previously shown in the invasive mechanical ventilation population, benzodiazepine exposure continues to be a potentially modifiable risk factor for delirium.

Pneumonia is the third most common surgical complication after urinary tract infection and wound infections. In addition to increased mortality, patients who develop postoperative pneumonia have a higher risk of prolonged hospital stay, intensive care unit (ICU) admissions, and higher healthcare costs. Obesity and chronic obstructive pulmonary disease (COPD) are both independent risk factors for the development and severity of postoperative pneumonia, although the combined effect of these comorbidities is unknown. Therefore, we evaluated whether the combination of severe obesity and COPD is associated with an increased risk of postoperative pneumonia.We performed a multicenter retrospective cohort study of 365,273 patients aged 18 - 64 years who were either severely obese (body mass index (BMI) ≥ 40 kg/mThe co-occurrence of severe obesity and COPD appeared to have a protective effect on the risk of postoperative pneumonia. In the presence of COPD, patients with severe obesity were 14% less likely to develop pneumonia compared to their normal-weight counterparts (2.9% vs. 4.4%; adjusted relative risk (RR): 0.76; 95% confidence interval (CI): 0.60, 0.95). In addition, in the presence of COPD, severe obesity conferred a lower risk for requiring an extended length of stay (37.6% vs. 47.9%; adjusted RR: 0.83; 95% CI: 0.78, 0.89).Counterintuitively, the co-occurrence of severe obesity with COPD appeared to buffer the negative impact of COPD on postoperative pneumonia, unplanned tracheal reintubation, and prolonged hospital stay after noncardiac surgery. These findings are consistent with the obesity paradox and warrant further investigations.

Anuranjan Ghimire,1 Gregory S Maves,1,2 Stephani S Kim,1,2 Vidya T Raman,1,2 Joseph D Tobias1,2 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Anesthesiology & Pain Medicine, the Ohio State University College of Medicine, Columbus, OH, USACorrespondence: Anuranjan Ghimire, Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH, 43235, USA, Tel +1 614-722-4200, Fax: +1 614-722-4203, Email Anuranjan.Ghimire@nationwidechildrens.orgIntroduction: Cancellation of surgery or delay on the day of service is a huge burden for the patient, family, and healthcare system. Preventable delays impact efficiency and workflow, which may increase costs due to overtime and idle rooms during peak hours. Non-compliance to nil per os (NPO) guidelines remains one of the most common preventable causes for surgical cancellations. The current study sought to investigate and understand patient factors that may be associated with non-compliance to NPO guidelines.Methods: After IRB approval, a retrospective review of completed and cancelled pediatric procedures requiring the use of anesthesia over a 5-year period was performed. Emergency procedures and inpatient surgeries were excluded. Data regarding patient demographics and surgical service were extracted from the electronic medical records for comparison. A logistic regression model was used to identify factors associated with cancellations due to NPO non-compliance.Results: There were 825 cancellations due to NPO non-compliance of 144,049 cases for an incidence of 0.57% over the 5-year period. Patients in the 6– 12 year old age range and those who self-identified as non-White or non-English speaking had a higher incidence of cancelling due to NPO non-compliance. Compared to ear, nose, and throat (ENT) procedures, cancellations due to NPO non-compliance were more likely in radiology, dental, and urology procedures.Discussion: Many factors may impact a family’s compliance with NPO guidelines. Patient-related factors included those who self-identified as non-White or non-English speaking. Patients having ENT surgery were less likely to have NPO non-compliance than those having radiologic procedures, dental surgery, or urologic surgery. Future interventions focused on these groups may be most effective in limiting day of surgery cancellations.Keywords: nil per os, pediatric anesthesia, cancellation

Species sensitivity to forest fragmentation varies latitudinally, peaking in the tropics. A prominent explanation for this pattern is that historical landscape disturbance at higher latitudes has removed fragmentation-sensitive species or promoted the evolution of more resilient survivors. However, it is unclear whether this so-called extinction filter is the dominant driver of geographic variation in fragmentation sensitivity, particularly because climatic factors may also cause latitudinal gradients in dispersal ability, a key trait mediating sensitivity to habitat fragmentation. Here we combine field survey data with a morphological proxy for avian dispersal ability (hand-wing index) to assess responses to forest fragmentation in 1,034 bird species worldwide. We find that fragmentation sensitivity is strongly predicted by dispersal limitation and that other factors—latitude, body mass and historical disturbance events—have relatively limited explanatory power after accounting for species differences in dispersal. We also show that variation in dispersal ability is only weakly predicted by historical disturbance and more strongly associated with intra-annual temperature fluctuations (seasonality). Our results suggest that climatic factors play a dominant role in driving global variation in the impacts of forest fragmentation, emphasizing the need for more nuanced environmental policies that take into account local context and associated species traits.

Anticipating species’ responses to environmental change is a pressing mission in biodiversity conservation. Despite decades of research investigating how climate change may affect population sizes, historical context is lacking and the traits which mediate demographic sensitivity to changing climate remain elusive. We use whole-genome sequence data to reconstruct the demographic histories of 263 bird species over the past million years and identify networks of interacting morphological and life-history traits associated with changes in effective population size (Ne) in response to climate warming and cooling. Our results identify direct and indirect effects of key traits representing dispersal, reproduction, and survival on long-term demographic responses to climate change, thereby highlighting traits most likely to influence population responses to on-going climate warming.One-Sentence SummaryInteracting traits influence sensitivity of bird population sizes to climate warming and cooling over the past million years.

Popular comparative phylogenetic models such as Brownian Motion, Ornstein-Ulhenbeck, and their extensions, assume that, at speciation, a trait value is inherited identically by the two descendant species. This assumption contrasts with models of speciation at the micro-evolutionary scale where phenotypic distributions of the descendants are sub-samples of the ancestral distribution. Various described mechanisms of speciation can lead to a displacement of the ancestral phenotypic mean among descendants and an asymmetric inheritance of the ancestral phenotypic variance. In contrast, even macro-evolutionary models that account for intraspecific variance assume symmetrically conserved inheritance of the ancestral phenotypic distribution at speciation. Here we develop an Asymmetric Brownian Motion model (ABM) that relaxes the hypothesis of symmetric and conserved inheritance of the ancestral distribution at the time of speciation. The ABM jointly models the evolution of both intra- and inter-specific phenotypic variation. It also allows the mode of phenotypic inheritance at speciation to be inferred, ranging from a symmetric and conserved inheritance, where descendants inherit the ancestral distribution, to an asymmetric and displaced inheritance, where descendants inherit divergent phenotypic means and variances. To demonstrate this model, we analyze the evolution of beak morphology in Darwin finches, finding evidence of character displacement at speciation. The ABM model helps to bridge micro- and macro-evolutionary models of trait evolution by providing a more robust framework for testing the effects of ecological speciation, character displacement, and niche partitioning on trait evolution at the macro-evolutionary scale.

Background : Epidural anesthesia in infants undergoing open abdominal surgery has the potential to reduce opioid consumption, lower pain scores, and expedite tracheal extubation. We evaluated associations between use of continuous epidural chloroprocaine and improved intra- and post-operative outcomes. Methods : This matched retrospective cohort study first identified 24 patients who between April 2018 through December 2019 were treated with a caudal catheter and epidural chloroprocaine infusion for a laparotomy at postnatal age of 6 months or less. A matched comparator group of 24 patients was derived based on age and type of surgery. Exclusion criteria were the presence of a preoperative opioid infusion, comorbidities that would preclude appropriate pain assessment, or a recent surgical procedure. Primary outcomes included opioid consumption and pain scores; we secondarily analyzed intraoperative anesthetic requirements, other systemic analgesic use, vital signs, tracheal extubation time, and procedural times. Results : Treatment with epidural anesthesia was associated with lower 5-day total postoperative opioid consumption (3.2 mg/kg vs. 19.7 mg/kg in the respective epidural vs. systemic groups, p = 0.001) and time to tracheal extubation (1.3 days vs. 3.2 days, p = 0.005). Any statistically significant differences in pain scores were not clinically meaningful. There were no differences in mean arterial pressure or intraoperative inhaled anesthetic doses. Conclusion : Continuous infusion of epidural chloroprocaine in infants following open abdominal surgery may limit exposure to systemic opioid medications while providing adequate postoperative analgesia and shortening time to tracheal extubation.

Species interactions are influenced by the trait structure of local multi-trophic communities. However, it remains unclear whether mutualistic interactions in particular can drive trait patterns at the global scale, where climatic constraints and biogeographic processes gain importance. Here we evaluate global relationships between traits of frugivorous birds and palms (Arecaceae), and how these relationships are affected, directly or indirectly, by assemblage richness, climate and biogeographic history. We leverage a new and expanded gape size dataset for nearly all avian frugivores, and find a positive relationship between gape size and fruit size, that is, trait matching, which is influenced indirectly by palm richness and climate. We also uncover a latitudinal gradient in trait matching strength, which increases towards the tropics and varies among zoogeographic realms. Taken together, our results suggest trophic interactions have consistent influences on trait structure, but that abiotic, biogeographic and richness effects also play important, though sometimes indirect, roles in shaping the functional biogeography of mutualisms.

Improved understanding of airway anatomy and refinement of equipment have led to the increased use of cuffed endotracheal tubes (ETTs) in infants and children. Despite expanded evidence on the potential advantages of cuffed ETTs in pediatric patients, there remains limited data on their use in infants less than 5 kilograms (kg). The current study retrospectively evaluates the perioperative use of cuffed ETTs in infants weighing 2-5 kg.This is a retrospective study from a tertiary care children's hospital involving a 3-year period. Data regarding anesthetic care, airway management, and postoperative course were retrospectively retrieved from the electronic medical record.The study cohort included 1162 patients, 1086 of whom had their tracheas intubated with a cuffed ETT and 76 with an uncuffed ETT. Patients were divided into two groups for analysis: 2 to3 kg and 3 to 5 kg. In both weight groups, cuffed ETTs resulted in a decreased need for more than one laryngoscopy and a change in ETT size with no increase in postoperative airway effects including stridor.These data provide additional information regarding the efficacy and safety of cuffed ETTs in neonates and infants.