The influence of the land-to-sea macroevolutionary transition on vertebral column disparification in Pinnipedia.

The repeated returns of vertebrates to the marine ecosystems since the Triassic serve as an evolutionary model to understand macroevolutionary change. Here we investigate the effects of the land-to-sea transition on disparity and constraint of the vertebral column in aquatic carnivorans (Carnivora; Pinnipedia) to assess how their functional diversity and evolutionary innovations influenced major radiations of crown pinnipeds. We use three-dimensional geometric morphometrics and multivariate analysis for high-dimensional data under a phylogenetic framework to quantify vertebral size and shape in living and extinct pinnipeds. Our analysis demonstrates an important shift in vertebral column evolution by 10-12 million years ago, from an unconstrained to a constrained evolutionary scenario, a point of time that coincides with the major radiation of crown pinnipeds. Moreover, we also demonstrate that the axial skeleton of phocids and otariids followed a different path of morphological evolution that was probably driven by their specialized locomotor strategies. Despite this, we found a significant effect of habitat preference (coastal versus pelagic) on vertebral morphology of crown taxa regardless of the family they belong. In summary, our analysis provides insights into how the land-to-sea transition influenced the complex evolutionary history of pinniped vertebral morphology.

The impact of the land-to-sea transition on evolutionary integration and modularity of the pinniped backbone.

In this study, we investigate how the terrestrial-aquatic transition influenced patterns of axial integration and modularity in response to the secondary adaptation to a marine lifestyle. We use 3D geometric morphometrics to quantify shape covariation among presacral vertebrae in pinnipeds (Carnivora; Pinnipedia) and to compare with patterns of axial integration and modularity in their close terrestrial relatives. Our results indicate that the vertebral column of pinnipeds has experienced a decrease in the strength of integration among all presacral vertebrae when compared to terrestrial carnivores (=fissipeds). However, separate integration analyses among the speciose Otariidae (i.e., sea lions and fur seals) and Phocidae (i.e., true seals) also suggests the presence of different axial organizations in these two groups of crown pinnipeds. While phocids present a set of integrated "thoracic" vertebrae, the presacral vertebrae of otariids are characterized by the absence of any set of vertebrae with high integration. We hypothesize that these differences could be linked to their specific modes of aquatic locomotion -i.e., pelvic vs pectoral oscillation. Our results provide evidence that the vertebral column of pinnipeds has been reorganized from the pattern observed in fissipeds but is more complex than a simple "homogenization" of the modular pattern of their close terrestrial relatives.

Evolutionary ecomorphology for the twenty-first century: examples from mammalian carnivores.

Carnivores (cats, dogs and kin) are a diverse group of mammals that inhabit a remarkable range of ecological niches. While the relationship between ecology and morphology has long been of interest in carnivorans, the application of quantitative techniques has resulted in a recent explosion of work in the field. Therefore, they provide a case study of how quantitative techniques, such as geometric morphometrics (GMM), have impacted our ability to tease apart complex ecological signals from skeletal anatomy, and the implications for our understanding of the relationships between form, function and ecological specialization. This review provides a synthesis of current research on carnivoran ecomorphology, with the goal of illustrating the complex interaction between ecology and morphology in the skeleton. We explore the ecomorphological diversity across major carnivoran lineages and anatomical systems. We examine cranial elements (skull, sensory systems) and postcranial elements (limbs, vertebral column) to reveal mosaic patterns of adaptation related to feeding and hunting strategies, locomotion and habitat preference. We highlight the crucial role that new approaches have played in advancing our understanding of carnivoran ecomorphology, while addressing challenges that remain in the field, such as ecological classifications, form-function relationships and multi-element analysis, offering new avenues for future research.

Elbow-joint morphology in the North American 'cheetah-like' cat Miracinonyx trumani.

The North American cheetah-like cat Miracinonyx trumani is an extinct species that roamed the Pleistocene prairies 13 000 years ago. Although M. trumani is more closely related to the cougar (Puma concolor) than to the living cheetah (Acinonyx jubatus), it is believed that both A. jubatus and M. trumani possess a highly specialized skeleton for fast-running, including limbs adapted for speed at the expense of restricting the ability of prey grappling. However, forelimb dexterity of M. trumani has not been yet investigated. Here, we quantify the 3D-shape of the humerus distal epiphysis as a proxy for elbow-joint morphology in a sample of living cats to determine whether the extinct M. trumani was specialized to kill open-country prey using predatory behaviour based on fast running across the prairies and steppe terrains of the North American Pleistocene. We show that M. trumani had an elbow morphology intermediate to that of P. concolor and A. jubatus, suggesting that M. trumani had a less specialized pursuit predatory behaviour than A. jubatus. We propose that M. trumani probably deployed a unique predatory behaviour without modern analogues. Our results bring into question the degree of ecomorphological convergence between M. trumani and its Old World vicar A. jubatus.

Intravertebral vs. intervertebral integration and modularity in the vertebral column of mammalian carnivorans.

The vertebral column is a multicomponent structure whose organization results from developmental and functional demands. According to their distinct somitic origins, individual vertebrae exhibit intravertebral modularity between the centrum and neural spine. However, vertebrae are also organized into larger units called intervertebral modules that result from integration between adjacent vertebrae due to locomotory demands or from common developmental origins due to resegmentation. A previous hypothesis suggested that the boundaries of intervertebral modules coincide with changes in the patterns of intravertebral integration. Here, we explicitly test whether the patterns of modularity and integration between the centrum and neural spine (i.e., intravertebral) in the boundary vertebrae among previously defined intervertebral modules change with respect to those in the vertebrae within intervertebral modules. We quantified intravertebral modularity patterns and quantified the strength of intravertebral integration for each vertebra of the presacral region in 41 species of carnivoran mammals using 3D geometric morphometrics. Our results demonstrate a significant intravertebral modular signal between the centrum and neural spine in all post-cervical vertebrae, including the boundary vertebrae among intervertebral modules. However, the strength of intravertebral integration decreases at the boundary vertebrae. We also found a significant correlation between the degree of intravertebral integration and intervertebral integration. Following our results, we hypothesize that natural selection does not override the integration between the centrum and neural spine at the boundary vertebrae, a pattern that should be influenced by their distinct somitic origins and separate ossification centers during early development. However, natural selection has probably influenced (albeit indirectly) the integration between the centrum and neural spine in the vertebrae that compose the intervertebral modules.

Body-axis organization in tetrapods: a model-system to disentangle the developmental origins of convergent evolution in deep time.

Convergent evolution is a central concept in evolutionary theory but the underlying mechanism has been largely debated since On the Origin of Species. Previous hypotheses predict that developmental constraints make some morphologies more likely to arise than others and natural selection discards those of the lowest fitness. However, the quantification of the role and strength of natural selection and developmental constraint in shaping convergent phenotypes on macroevolutionary timescales is challenging because the information regarding performance and development is not directly available. Accordingly, current knowledge of how embryonic development and natural selection drive phenotypic evolution in vertebrates has been extended from studies performed at short temporal scales. We propose here the organization of the tetrapod body-axis as a model system to investigate the developmental origins of convergent evolution over hundreds of millions of years. The quantification of the primary developmental mechanisms driving body-axis organization (i.e. somitogenesis, homeotic effects and differential growth) can be inferred from vertebral counts, and recent techniques of three-dimensional computational biomechanics have the necessary potential to reveal organismal performance even in fossil forms. The combination of both approaches offers a novel and robust methodological framework to test competing hypotheses on the functional and developmental drivers of phenotypic evolution and evolutionary convergence.

Serial disparity in the carnivoran backbone unveils a complex adaptive role in metameric evolution.

Organisms comprise multiple interacting parts, but few quantitative studies have analysed multi-element systems, limiting understanding of phenotypic evolution. We investigate how disparity of vertebral morphology varies along the axial column of mammalian carnivores - a chain of 27 subunits - and the extent to which morphological variation have been structured by evolutionary constraints and locomotory adaptation. We find that lumbars and posterior thoracics exhibit high individual disparity but low serial differentiation. They are pervasively recruited into locomotory functions and exhibit relaxed evolutionary constraint. More anterior vertebrae also show signals of locomotory adaptation, but nevertheless have low individual disparity and constrained patterns of evolution, characterised by low-dimensional shape changes. Our findings demonstrate the importance of the thoracolumbar region as an innovation enabling evolutionary versatility of mammalian locomotion. Moreover, they underscore the complexity of phenotypic macroevolution of multi-element systems and that the strength of ecomorphological signal does not have a predictable influence on macroevolutionary outcomes.

Phenotypic integration in the carnivoran backbone and the evolution of functional differentiation in metameric structures.

Explaining the origin and evolution of a vertebral column with anatomically distinct regions that characterizes the tetrapod body plan provides understanding of how metameric structures become repeated and how they acquire the ability to perform different functions. However, despite many decades of inquiry, the advantages and costs of vertebral column regionalization in anatomically distinct blocks, their functional specialization, and how they channel new evolutionary outcomes are poorly understood. Here, we investigate morphological integration (and how this integration is structured [modularity]) between all the presacral vertebrae of mammalian carnivorans to provide a better understanding of how regionalization in metameric structures evolves. Our results demonstrate that the subunits of the presacral column are highly integrated. However, underlying to this general pattern, three sets of vertebrae are recognized as presacral modules-the cervical module, the anterodorsal module, and the posterodorsal module-as well as one weakly integrated vertebra (diaphragmatic) that forms a transition between both dorsal modules. We hypothesize that the strength of integration organizing the axial system into modules may be associated with motion capability. The highly integrated anterior dorsal module coincides with a region with motion constraints to avoid compromising ventilation, whereas for the posterior dorsal region motion constraints avoid exceeding extension of the posterior back. On the other hand, the weakly integrated diaphragmatic vertebra belongs to the "Diaphragmatic joint complex"-a key region of the mammalian column of exceedingly permissive motion. Our results also demonstrate that these modules do not match with the traditional morphological regions, and we propose natural selection as the main factor shaping this pattern to stabilize some regions and to allow coordinate movements in others.

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study.

BACKGROUND: COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders. METHODS: Impact of COVID-19 on Pediatric Emergency Room (ICOPER) was a retrospective multicentre observational study including 23 Italian EDs.All the children <18 years admitted, between March 9th and May 3rd 2020 stratified by age, priority code, cause of admission and outcome have been included and compared to those admitted in the same period of 2019.Our objectives were to assess the characteristics of pediatric admissions to EDs since COVID-19 outbreak until the end of lockdown, and to describe the features of critical children. FINDINGS: 16,426 children were admitted in 2020, compared to 55,643 in 2019 (-70·48%). Higher reduction was reported in hospitals without Pediatric Intensive Care Unit (PICU) (-73·38%) than in those with PICU (-64·08%) (P<0·0001). Admissions with low priority decreased more than critical ones (-82·77% vs. 44·17% respectively; P<0·0001). Reduction of discharged patients was observed both in hospitals with (-66·50%) and without PICU (-74·65%) (P<0·0001). No difference in the duration of symptoms before admission was reported between 2019 and 2020, with the majority of children accessing within 24 h (55·08% vs. 57·28% respectively; P = 0·2344). INTERPRETATION: Admissions with low priority decreased significantly more than those with high priority; we suppose that the fear of being infected in hospital maybe overcame the concerns of caregivers. Compared to 2019, no significant referral delay by caregivers was reported. Our data suggest the need of adaptation of EDs and primary care services to different needs of children during COVID-9 pandemic.

Two-stage bone-and-strut technique in the treatment of septic non-unions in the upper limb.

Aim To report the results of a two-stage reconstruction of septic non-unions of the upper limb using the bone-and-strut technique with a follow-up of more than two years. Methods A total of 19 patients (12 males and seven females; age 27 to 85 years) were included in this cohort study. The evaluation endpoint was set at 24 months. Radiographic union, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, pain and return to work were assessed. All patients were treated with debridement and antibiotic therapy. At a second stage, the nonunion focus was filled with a cancellous bone allograft. Stability was provided using a locking plate and a bone strut. Results After 24 months, the QuickDASH scores improved from a median of 28 (interquartile range, 13 - 35 points), to a median of 78 (interquartile range, 70 - 89 points). Mean pain scores improved from 8.1 (range, 0.3-10) to 0.6 (range 0-2). Radiographic and clinical union was seen in all patients. The majority of patients returned to work or previous activities when retired. A new neurological deficit, recurrence of infection, or other surgery-related adverse events were not observed. Conclusion The two-stage bone-and-strut technique is a safe and effective technique in the treatment of septic non-unions of the upper limb. The union rate is high, the complication rate is acceptable and return return-to-work is high. Recurrence of infectious sequelae during a follow-up period of at least two years was not seen. The patient-reported outcomes increased significantly.

Admisiones por bronquiolitis en 13 unidades de cuidados intensivos pediátricos del Uruguay: ¿es igual en Montevideo que en el interior? / Bronchiolitis admissions in 13 pediatric intensive care units in Uruguay: is it the same in Montevideo (capital city) and the provinces? / Internações por bronquiolite em 13 unidades de terapia intensiva pediátrica do Uruguai: são iguais em Montevidéu e no Interior do país?

Resumen: Objetivos: describir las características clínicas y epidemiológicas de niños admitidos por bronquiolitis en 13 unidades de cuidados intensivos pediátricos (UCIP) del Uruguay y comparar los resultados asistenciales finales entre UCIP de Montevideo (UM) y del interior del país (UI). Material y método: estudio observacional retrospectivo multicéntrico de los registros ingresados a base de datos prospectiva de LARed Network. Se incluyeron niños mayores de 1 mes y menores de 2 años admitidos en el período 1 de mayo de 2017 y 30 de abril de 2019 con diagnóstico de bronquiolitis comunitaria. Se analizaron datos demográficos, clínicos, así como intervenciones y desenlaces al alta. Resultados: se analizaron 666 casos. No se detectaron diferencias significativas de comorbilidades ni en el soporte respiratorio al ingreso. En UI los pacientes fueron derivados con más frecuencia desde otro hospital. La distancia y tiempo medio, así como el porcentaje de traslados mayor de 50 km, fue también mayor. En UI los pacientes tuvieron mayor gravedad clínica y gasométrica al ingreso. El perfil radiológico y etiológico fue similar. Virus respiratorio sincicial (VRS) aislado > 50%. La indicación global de corticoides superó el 25% y el de broncodilatadores el 85%. La prescripción de antibióticos y adrenalina nebulizada fue mayor en UI. La cánula nasal de alto flujo (CNAF) fue globalmente el método de soporte respiratorio más utilizado, aunque se observó un mayor uso de ventilación mecánica invasiva (VMI) y CPAP en UI (47% vs 28% en UM). No hubo diferencias en el número de complicaciones por VMI o ventilación no invasiva, ni en el uso de terapias de rescate. Tampoco se notaron diferencias significativas en la duración de la estadía en UCIP, ni en la mortalidad absoluta y ajustada, y hubo un solo caso de nueva morbilidad. Conclusiones: los niños admitidos en UI tuvieron mayor gravedad al ingreso y más factores de riesgo relacionados con mal pronóstico en el traslado, recibiendo más antibióticos y soporte invasivo que aquellos ingresados en UM. El CNAF fue el tipo de soporte respiratorio más utilizado en el país. Se detectó alto porcentaje de prescripción de terapias no recomendadas, como broncodilatadores y corticoides. La mortalidad y complicaciones fueron bajas, así como la generación de morbilidad residual.

Summary: Objectives: to describe the clinical and epidemiological characteristics of children admitted for bronchiolitis in 13 Pediatric Intensive Care Units (UCIP) in Uruguay and compare the final care outcomes between Montevideo (UM) and Interior of the country (IU). Method: multicenter, retrospective, observational study of data entered in the LARed Network prospective database. Children over 1 month and younger than 2 years admitted between May 1, 2017 and April 30, 2019 with a diagnosis of Community Bronchiolitis were included in the study. Demographic and clinical data were analyzed, as well as interventions and discharge outcomes. Results: 666 cases were analyzed. No significant differences in comorbidity and respiratory support were detected at admission. In IU patients were referred more frequently from another hospital. The distance and average time, as well as the percentage of transfers greater than 50 km, was also higher. In IU, patients had greater clinical and gasometrical severity at admission. The radiological and etiological profile was similar (VRS at > 50%). The overall indication of corticosteroids exceeded 25% and that of bronchodilators exceeded 85%. The prescription for antibiotics and nebulized adrenaline was higher in IU. The high flow nasal cannula (HFNC) was globally the most widely used respiratory support method, although increased use of invasive mechanical ventilation (IMV) and CPAP in IU (43% vs 28% in UM) was observed. There were no differences in the number of complications from IVF or non-invasive ventilation, nor in the use of rescue therapies. There were also no significant differences in the length of stay at UCIP or in absolute and adjusted mortality and there was only one case of new morbidity. Conclusions: children admitted to IU had higher severity scores and more transfer-related risk factors, received more antibiotics and invasive support. HFNC was the most widely used type of respiratory support in the country. A high prescription of non-recommended therapies such as bronchodilators and corticosteroids was detected. Mortality and complications were low, as were the generation of new morbidity.

Resumo: Objetivos: descrever as características clínicas e epidemiológicas de crianças internadas por bronquiolite em 13 Unidades de Terapia Intensiva Pediátrica (UTIP) do Uruguai e comparar os resultados finais do atendimento entre UTIP de Montevidéu (UM) e do Interior do país (IU). Material e métodos: estudo observacional retrospectivo multicêntrico dos dados inseridos no banco de dados prospectivo da Rede LARed. Foram incluídas crianças maiores de 1 mês e menores de 2 anos internadas no período de 1º de maio de 2017 a 30 de abril de 2019 com diagnóstico de bronquiolite comunitária. Dados demográficos e clínicos, bem como intervenções e desfechos na alta, foram analisados. Resultados: foram analisados 666 casos. Não foram detectadas diferenças significativas nas comorbidades ou no suporte respiratório na admissão. No IU, os pacientes foram encaminhados com maior frequência a outro hospital. A distância e o tempo médios, assim como o percentual de transferências superiores a 50 km, também foram maiores. No IU, os pacientes apresentaram maior gravidade clínica e gasométrica na admissão. O perfil radiológico e etiológico foi semelhante. O vírus sincicial respiratório (RSV) foi isolado em > 50%. A indicação global de corticosteroides ultrapassou 25% e a de broncodilatadores 85%. A prescrição de antibióticos e adrenalina nebulizada foi maior no IU. A cânula nasal de alto fluxo (CNAF) foi o método de suporte respiratório mais utilizado, embora tenha sido observado um maior uso de ventilação mecânica invasiva (VMI) e CPAP no IU (47% vs 28% em UM). Não houve diferenças no número de complicações devido à VMI ou Ventilação Não Invasiva, ou no uso de terapias de resgate. Também não foram observadas diferenças significativas no tempo de internação na UTIP ou na mortalidade absoluta e ajustada, havendo apenas um caso de nova morbidade. Conclusões: as crianças admitidas no IU apresentaram maior gravidade na admissão e mais fatores de risco relacionados ao mau prognóstico na transferência, recebendo mais antibióticos e suporte invasivo do que as internadas em UM. O CNAF foi o tipo de suporte respiratório mais utilizado no país. Detectou-se alto percentual de prescrição de terapias não recomendadas, como broncodilatadores e corticosteroides. A mortalidade e as complicações foram baixas, assim como a geração de morbidade residual.

Reduced PICU respiratory admissions during COVID-19.

BACKGROUND: The COVID-19 pandemic reached the Southern Hemisphere in the autumn of 2020, thus coinciding with its expected annual viral respiratory season. The potential impact of national strategies aimed at mitigating COVID-19 during the pandemic on the incidence of other critical viral lower respiratory tract infections (LRTIs) in children is unknown. METHODS: We analysed admission data for LRTIs from 22 paediatric intensive care units (PICUs) in four countries, part of a large international Latin American registry of children with acute respiratory failure (Red Colaborativa Pediátrica de Latinoamérica [LARed Network]). RESULTS: Between January and August, there were 83% fewer PICU admissions for LRTIs in 2020 compared to the 2018/2019 average over the same period. Similar decreases were noted for PICU admissions due to respiratory syncytial virus and influenza (92% and 78%, respectively). CONCLUSION: We observed a striking reduction in PICU admissions due to viral LRTIs over winter, during the COVID-19 pandemic in South America.

Postcranial elements of small mammals as indicators of locomotion and habitat.

Many studies have shown a correlation between postcranial anatomy and locomotor behavior in mammals, but the postcrania of small mammals (<5 kg) is often considered to be uninformative of their mode of locomotion due to their more generalized overall anatomy. Such small body size was true of all mammals during the Mesozoic. Anatomical correlates of locomotor behavior are easier to determine in larger mammals, but useful information can be obtained from the smaller ones. Limb bone proportions (e.g., brachial index) can be useful locomotor indicators; but complete skeletons, or even complete long bones, are rare for Mesozoic mammals, although isolated articular surfaces are often preserved. Here we examine the correlation of the morphology of long bone joint anatomy (specifically articular surfaces) and locomotor behavior in extant small mammals and demonstrate that such anatomy may be useful for determining the locomotor mode of Mesozoic mammals, at least for the therian mammals.

Morphological evolution of the carnivoran sacrum.

The sacrum is a key piece of the vertebrate skeleton, since it connects the caudal region with the presacral region of the vertebral column and the hind limbs through the pelvis. Therefore, understanding its form and function is of great relevance in vertebrate ecomorphology. However, it is striking that morphometric studies that quantify its morphological evolution in relation to function are scarce. The main goal of this study is to investigate the morphological evolution of the sacrum in relation to its function in the mammalian order Carnivora, using three-dimensional (3D) geometric morphometrics. Principal component analysis under a phylogenetic background indicated that changes in sacrum morphology are mainly focused on the joint areas where it articulates with other parts of the skeleton allowing resistance to stress at these joints caused by increasing muscle loadings. In addition, we demonstrated that sacrum morphology is related to both the length of the tail relativised to the length of the body, and the length of the body relativised to body mass. We conclude that the sacrum in carnivores has evolved in response to the locomotor requirements of the species analysed, but in locomotion, each family has followed alternative morphological solutions to address the same functional demands.

Developmental Constraints Do Not Influence Long-Term Phenotypic Evolution of Marsupial Forelimbs as Revealed by Interspecific Disparity and Integration Patterns.

Marsupials show a smaller range of forelimb ecomorphologies than placental mammals, and it is hypothesized that this results from macroevolutionary constraints imposed by the specialized reproductive biology of marsupials. Specifically, the accelerated development of the marsupial forelimb allows neonates to crawl to the mother's pouch but may constrain adult morphology. This hypothesis makes three main predictions: (i) that marsupial forelimbs should show less interspecific disparity than their hindlimbs, (ii) that morphological integration within the marsupial forelimb is stronger than integration between limbs, and (iii) that these patterns should be strongest in diprotodontians, which undergo the most rigorous crawls as neonates. We use a three-dimensional geometric morphometric data set of limb bones for 51 marsupial species to test these predictions. We find that (i) marsupial forelimbs and hindlimbs show similar disparities, (ii) no clear differences in integration exist either within or between limbs, and (iii) the same patterns occur in diprotodontians as in other marsupials, even correcting for lineage age. Therefore, there is currently little evidence that the developmental biology of marsupials has constrained their macroevolutionary patterns. It is possible that functional selection can overcome the effects of developmental constraint on macroevolutionary timescales. Our findings suggest that the role of developmental constraints in explaining the limited phenotypic variability of marsupials (compared with that of placentals) should be reconsidered.

Phenotypic integration and modularity drives skull shape divergence in the Arctic fox (Vulpes lagopus) from the Commander Islands.

Phenotypic integration and modularity influence morphological disparity and evolvability. However, studies addressing how morphological integration and modularity change for long periods of genetic isolation are scarce. Here, we investigate patterns of phenotypic integration and modularity in the skull of phenotypically and genetically distinct populations of the Artic fox (Vulpes lagopus) from the Commander Islands of the Aleutian belt (i.e. Bering and Mednyi) that were isolated ca 10 000 years by ice-free waters of the Bering sea. We use three-dimensional geometric morphometrics to quantify the strength of modularity and integration from inter-individual variation (static) and from fluctuating asymmetry (random developmental variation) in both island populations compared to the mainland population (i.e. Chukotka) and we investigated how changes in morphological integration and modularity affect disparity and the directionality of trait divergence. Our results indicate a decrease in morphological integration concomitant to an increase in disparity at a developmental level, from mainland to the smallest and farthest population of Mednyi. However, phenotypic integration is higher in both island populations accompanied by a reduction in disparity compared to the population of mainland at a static level. This higher integration may have favoured morphological adaptive changes towards specific feeding behaviours related to the extreme environmental settings of islands. Our study demonstrates how shifts in phenotypic integration and modularity can facilitate phenotypic evolvability at the intraspecific level that may lead to lineage divergence at macroevolutioanry scales.

La colaboración para mejorar los cuidados médicos de nuestros niños. El desarrollo de una Red Pediátrica Latinoamericana: LARed / Collaboration as a tool to improve children´s healthcare through a Latin American Pediatric Network: LARed / A colaboração como ferramenta no melhoramento do cuidado médico das crianças através do desenvolvimento duma Rede Pediátrica Latino-Americana: LARed

Las redes colaborativas pediátricas son una probada y transformadora forma de acelerar la traslación de la evidencia a la práctica clínica y han estado en constante crecimiento durante el presente siglo. Han mostrado ser una herramienta para asegurar la innovación y mejoría del valor de nuestros cuidados en salud, con el poder de comprometer a los clínicos, investigadores, pacientes y familias en diferentes escenarios sanitarios. Inspirados en la experiencia de la Vermont Oxford Network, en 2014 un grupo de profesionales voluntarios e independientes de Uruguay formaron una red colaborativa de cuidados intensivos pediátricos llamada LARed. Comprometidos en mejorar la calidad y seguridad de la atención que brindaban a sus pacientes y familias, establecieron una comunidad de prácticas poderosa que se expandió exponencialmente al continente latinoamericano e involucrando a la fecha 30 centros de ocho países. Su filosofía se basa en cuatro pilares: medir, aprender, mejorar y compartir, de forma que los centros con mejores resultados se vuelven una guía hacia la excelencia del grupo en general. Para lograr sus objetivos LARed dedica sus recursos para coordinar iniciativas de investigación, educativas y de mejoría de calidad, combinando el esfuerzo colectivo entre pares y manteniendo una base de datos on-line (a la fecha con más de 2.000 niños) creada para analizar las intervenciones y los resultados de la práctica clínica del mundo real (transformando entonces la información en acción). Este reporte describe el desarrollo de LARed, explica sus objetivos, visión y misión, así como resume las actividades y programas desarrollados desde su creación.

Pediatric collaborative networks are a proven and transformational mean of accelerating the translation of evidence into clinical practice and have expanded steadily in this century. They have become a tool for innovation and improving value in healthcare, engaging clinicians, researchers, patients and families in different healthcare settings. Inspired by the Vermont Oxford Network experience, a group of Uruguayan health professional volunteers started a collaborative pediatric intensive care network called LARed in 2014. Committed to improving healthcare quality and safety, they set up a strong community that has expanded exponentially to the rest of Latin America and presently includes 30 pediatric intensive care units from 8 countries. The network's philosophy lies on 4 pillars: measure, learn, improve and share, so that the best-performing centers can become leaders in excellence to the general collaboration group. In order to better achieve these goals, LARed dedicates resources to research coordination, educational and quality improvement initiatives, combines collective peer efforts and manintains web-based online databases (over 2,000 children at present) set up to analyze real world practice interventions and outcomes, thus transforming information into action. This paper describes LARed development, explains its goals, vision and mission, and summarizes the activities and programs carried out since it was first created.

As redes colaborativas pediátricas são uma forma comprovada e transformadora de acelerar a transferência de evidências para a prática clínica, e elas tem crescido constantemente durante este século. Elas transformaram-se numa ferramenta para garantir a inovação e melhorar o valor dos cuidados de saúde, e tem envolvido médicos, pesquisadores, pacientes e famílias em diferentes contextos de saúde. Inspirado pela experiência da Rede Vermont Oxford, em 2014, um grupo de profissionais da saúde voluntários e independentes do Uruguai formou uma rede colaborativa de cuidados pediátricos intensivos chamada LARed. Comprometidos com a excelência da qualidade e segurança dos cuidados prestados aos seus pacientes e familiares, eles estabeleceram uma forte comunidade de práticas que se expandiram exponencialmente para o continente latino-americano e envolveram 30 centros de oito países até o momento. Sua filosofia é baseada em 4 pilares: medir, aprender, melhorar e compartilhar, de modo que os centros com os melhores resultados se tornem um guia para a excelência do grupo em geral. Para atingir seus objetivos, a LARed dedica seus recursos para coordenar iniciativas de pesquisa, educação e melhoria da qualidade, combina o esforço coletivo entre pares e mantem um banco de dados on-line (atualizado com mais de 2000 crianças) criado para analisar intervenções e resultados da prática clínica do mundo real (transformando a informação em ação). Este paper descreve o desenvolvimento de LARed, explica seus objetivos, visão e missão e também resume as atividades e programas desenvolvidos desde a sua criação.

Non-decoupled morphological evolution of the fore- and hindlimb of sabretooth predators.

Specialized organisms are useful for exploring the combined effects of selection of functional traits and developmental constraints on patterns of phenotypic integration. Sabretooth predators are one of the most interesting examples of specialization among mammals. Their hypertrophied, sabre-shaped upper canines and their powerfully built forelimbs have been interpreted as adaptations to a highly specialized predatory behaviour. Given that the elongated and laterally compressed canines of sabretooths were more vulnerable to fracture than the shorter canines of conical-tooth cats, it has been long hypothesized that the heavily muscled forelimbs of sabretooths were used for immobilizing prey before developing a quick and precise killing bite. However, the effect of this unique adaptation on the covariation between the fore- and the hindlimb has not been explored in a quantitative fashion. In this paper, we investigate if the specialization of sabretooth predators decoupled the morphological variation of their forelimb with respect to their hindlimb or, in contrast, both limbs vary in the same fashion as in conical-tooth cats, which do not show such extreme adaptations in their forelimb. We use 3D geometric morphometrics and different morphological indices to compare the fore- and hindlimb of conical- and sabretooth predators. Our results indicate that the limb bones of sabretooth predators covary following the same trend of conical-tooth cats. Therefore, we show that the predatory specialization of sabretooth predators did not result in a decoupling of the morphological evolution of their fore- and hindlimbs. The role of developmental constraints and natural selection on this coordinate variation between the fore- and the hindlimb is discussed in the light of this new evidence.

Correlates between calcaneal morphology and locomotion in extant and extinct carnivorous mammals.

Locomotor mode is an important component of an animal's ecology, relating to both habitat and substrate choice (e.g., arboreal versus terrestrial) and in the case of carnivores, to mode of predation (e.g., ambush versus pursuit). Here, we examine how the morphology of the calcaneum, the 'heel bone' in the tarsus, correlates with locomotion in extant carnivores. Other studies have confirmed the correlation of calcaneal morphology with locomotion behaviour and habitat. The robust nature of the calcaneum means that it is frequently preserved in the fossil record. Here, we employ linear measurements and 2D-geometric morphometrics on a sample of calcanea from eighty-seven extant carnivorans and demonstrate a signal of correlation between calcaneal morphology and locomotor mode that overrides phylogeny. We used this correlation to determine the locomotor mode, and hence aspects of the palaeobiology of, 47 extinct carnivorous mammal taxa, including both Carnivora and Creodonta. We found ursids (bears), clustered together, separate from the other carnivorans. Our results support greater locomotor diversity for nimravids (the extinct 'false sabertooths', usually considered to be more arboreal), than previously expected. However, there are limitations to interpretation of extinct taxa because their robust morphology is not fully captured in the range of modern carnivoran morphology.