Integrating spatial analyses of genomic and physiological data to understand avian responses to environmental change.

Projected rates of climate change over the next century are expected to force species to shift ranges, adapt or acclimate to evade extinction. Predicting which of these scenarios may be most likely is a central challenge for conserving biodiversity in the immediate future. Modeling frameworks that take advantage of intraspecific variation across environmental gradients can be particularly important for meeting this challenge. While these space-for-time approaches are essential for climatic and genomic modeling approaches, mechanistic models that incorporate ecological physiology data into assessing species vulnerabilities rarely include intraspecific variation. A major reason for this gap is the general lack of empirical data on intraspecific geographic variation in avian physiological traits. In this review, we outline the evidence for and processes shaping geographic variation in avian traits. We use the example of evaporative water loss to underscore the lack of research on geographic variation even in traits central to cooling costs in birds. We next demonstrate how shifting the focus of avian physiological research to intraspecific variation can facilitate greater integration with emerging genomics approaches. Finally, we outline important next steps for an integrative approach to advance understanding of avian physiological adaptation within species. Addressing the knowledge gaps outlined in this review will contribute to an improved predictive framework that synthesizes environmental, morphological, physiological, and genomic data to assess species specific vulnerabilities to a warming planet.

Characterization of Awareness and Depth of Blockade During Neuromuscular Blockade Infusions in Critically Ill Children.

OBJECTIVE: The Society of Critical Care Medicine released the first guideline for the prevention and -management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients but offered conditional recommendations for sedation practices and monitoring during neuromuscular blockade. This study aimed to characterize sedation practices, patient awareness, and depth of blockade with neuromuscular blocking agent (NMBA) infusion administration in a single pediatric and cardiac intensive care unit. METHODS: This retrospective chart review of critically ill pediatric patients queried orders for continuous infusion NMBA. Analgosedation agent(s), dose, and dose changes were assessed, along with depth of blockade monitoring via Train of Four (TOF) and awareness via Richmond Agitation and Sedation Scale (RASS). RESULTS: Thirty-one patients were included, of which 27 (87%) had a documented sedation agent infusing at time of NMBA initiation and 17 patients (54%) were receiving analgesia. The most common agents used were rocuronium (n = 28), dexmedetomidine (n = 23), and morphine (n = 14). RASS scores were captured in all patients; however, 9 patients (29%) had recorded positive scores and 1 patient (3%) never achieved negative scores. TOF was only captured for 11 patients (35%), with majority of the scores being 0 or 4. CONCLUSIONS: Majority of the study population did not receive recommended depth of blockade monitoring via TOF. Similarly, RASS scores were not consistent with deep sedation in half of the patients. The common use of dexmedetomidine as a single sedation agent calls into question the appropriateness of current sedation practices during NMBA continuous infusions.