Ecological barriers mediate spatiotemporal shifts of bird communities at a continental scale.

Species' range shifts and local extinctions caused by climate change lead to community composition changes. At large spatial scales, ecological barriers, such as biome boundaries, coastlines, and elevation, can influence a community's ability to shift in response to climate change. Yet, ecological barriers are rarely considered in climate change studies, potentially hindering predictions of biodiversity shifts. We used data from two consecutive European breeding bird atlases to calculate the geographic distance and direction between communities in the 1980s and their compositional best match in the 2010s and modeled their response to barriers. The ecological barriers affected both the distance and direction of bird community composition shifts, with coastlines and elevation having the strongest influence. Our results underscore the relevance of combining ecological barriers and community shift projections for identifying the forces hindering community adjustments under global change. Notably, due to (macro)ecological barriers, communities are not able to track their climatic niches, which may lead to drastic changes, and potential losses, in community compositions in the future.

Laboratory Results of a Real-Time SHM Integrated System on a P180 Full-Scale Wing-Box Section.

The final objective of the study herein reported is the preliminary evaluation of the capability of an original, real-time SHM system applied to a full-scale wing-box section as a significant aircraft component, during an experimental campaign carried out at the Piaggio Lab in Villanova D'Albenga, Italy. In previous works, the authors have shown that such a system could be applied to composite beams, to reveal damage along the bonding line between a longitudinal stiffening element and the cap. Utilizing a suitable scaling process, such work has then been exported to more complex components, in order to confirm the outcomes that were already achieved, and, possibly, expanding the considerations that should drive the project towards an actual implementation of the proposed architecture. Relevant topics dealt with in this publication concern the application of the structural health monitoring system to different temperature ranges, by taking advantage of a climatic room operating at the Piaggio sites, and the contemporary use of several algorithms for real-time elaborations. Besides the real-time characteristics already introduced and discussed previously, such further steps are essential for applying the proposed architecture on board an aircraft, and to increase reliability aspects by accessing the possibility of comparing different information derived from different sources. The activities herein reported have been carried out within the Italian segment of the RESUME project, a joint co-operation between the Ministry of Defense of Israel and the Ministry of Defense of Italy.

Range shifts of overwintering birds depend on habitat type, snow conditions and habitat specialization.

Climatic warming is forcing species to shift their ranges poleward, which has been demonstrated for many taxa globally. Yet, the influence of habitat types on within- and among-species variations of distribution shifts has rarely been studied, especially during the non-breeding season. Here, we investigated habitat-specific shift distances of northern range margins and directions of the distribution center based on long-term data of overwintering birds in Finland. Specifically, we explored influences of habitat type, species' snow depth tolerance, species' climatic niche and habitat specialization on range shifts during the past 40 years in 81 bird species. Birds overwintering in arable land shifted more clearly toward north compared to birds of the same species in rural and forest habitats, while the northern range margin shift distances did not significantly differ among the habitat types. Range shifts were more linked with the species' snow depth tolerance rather than species' climatic niche. Snow depth tolerance of species was negatively associated with the eastward shift direction across all habitats, while we found habitat-specific patterns with snow depth for northward shift directions and northern margin shift distances. Species with stronger habitat specializations shifted more strongly toward north as compared to generalist species, whereas the climatic niche of bird species only marginally correlated with range shifts, so that cold-dwelling species shifted longer distances and more clearly eastward. Our study reveals habitat-specific patterns linked to snow conditions for overwintering boreal birds and highlights the importance of habitat availability and preference in climate driven range shifts.

Habitat amount mediates the effect of fragmentation on a pollinator's reproductive performance, but not on its foraging behaviour.

Agricultural intensification, with its associated habitat loss and fragmentation, is among the most important drivers of the ongoing pollination crisis. In this quasi-experimental study, conducted in intensively managed vineyards in southwestern Switzerland, we tested the separate and interdependent effects of habitat amount and fragmentation on the foraging activity and reproductive performance of bumblebee Bombus t. terrestris colonies. Based on a factorial design, we selected a series of spatially replicated study sites across a dual gradient of habitat amount (area of ground-vegetated vineyards) and fragmentation (density of ground-vegetated vineyard fields) in a landscape predominantly consisting of vineyards with bare grounds. The foraging activity of individual bumblebees was measured using the radio frequency identification (RFID) technology, and we assessed final colony size to measure reproductive performance. We found an interactive effect of habitat amount and fragmentation on colony size. More specifically, the degree of fragmentation had a negative effect on bumblebee colony size when the amount of habitat was low, while it had a weak positive effect on colony size in landscapes with high amounts of habitat. At the level of individual vineyard fields, ground vegetation cover exerted a positive effect on bumblebee colony size. Fragmentation, but not habitat amount, significantly influenced foraging activity, with more foraging trips in sites with lower degrees of fragmentation. Our results emphasise the importance of studying the separate and interdependent effects of habitat amount and fragmentation to understand their influence on pollinators, providing guidance for optimising the spatial configuration of agricultural landscapes from a biodiversity viewpoint.

Women in anaesthesia: a scoping review.

Despite an increase in the proportion of women anaesthesiologists over time, women remain under-represented in academic and leadership positions, honour awards, and academic promotion. Current literature has identified several reasons for the observed gender disparity in anaesthesiology leadership and faculty positions, including unsupportive work environments, lack of mentorship, personal choices, childcare responsibilities, and active discrimination against women. A scoping review design was selected to examine the nature and extent of available research. Our review provides an overview of the literature that explores gender issues in anaesthesiology, identifies gaps in the literature, and appraises effective strategies to improve gender equity in anaesthesiology. We searched PubMed, MEDLINE, and EMBASE up to July 2019, and included 30 studies for analysis. Most reports used retrospective or survey methodologies. The review shows that women anaesthesiologists face gender biases in the work environment, are under-represented in various positions of leadership or influence, and as authors. Work-life demands may impose a challenge. Motivation and interest in career advancement of women anaesthesiologists have not been well studied. Several strategies have been proposed, ranging from an individual to administrative level, which may help anaesthesiologists achieve equal representation of women in the field.

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study.

PURPOSE: Arthroscopic shoulder surgery can be performed with an interscalene brachial plexus block (ISBPB) alone, ISBPB combined with general anesthesia (GA), or GA alone. Postoperative pain is typically managed with opioids; however, both GA and opioids have adverse effects which can delay discharge. This retrospective study compares the efficacy of four methods of anesthesia management for arthroscopic shoulder surgery. METHODS: Charts of all patients who underwent shoulder surgery by a single surgeon from 2012-2015 were categorized by analgesic regimen: GA only (n = 177), single-shot ISBPB only (n = 124), or pre- vs postoperative ISBPB combined with GA (ISBPB + GA [n = 72] vs GA + ISBPB [n = 52], respectively). The primary outcome measure was the time to discharge from the postanesthesia care unit (PACU). RESULTS: Mean (SD) time in the PACU ranged from 70.5 (39.9) min for ISBPB only to 111.2 (56.9) min for GA only. Use of ISBPB in any combination and regardless of timing resulted in significantly reduced PACU time, with a mean drop of 27.2 min (95% confidence interval [CI], 17.3 to 37.2; P < 0.001). The largest mean pairwise difference was between GA only and ISBPB only, with a mean difference of 40.7 min (95% CI, 25.5 to 55.8; P < 0.001). Use of ISBPB also reduced pain upon arrival at the PACU and, in some cases, upon discharge from the PACU (i.e., ISBPB only but not ISBPB + GA compared with GA). An ISBPB (alone or prior to GA) also reduced analgesic requirements. CONCLUSION: Previously reported benefits of an ISBPB for arthroscopic shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.

Landscape structure affects temporal dynamics in the bumble bee virome: Landscape heterogeneity supports colony resilience.

Virus spillovers from managed honey bees, Apis mellifera, are thought to contribute to the decline of wild pollinators, including bumble bees. However, data on the impact of such viruses on wild pollinators remain scarce, and the influence of landscape structure on virus dynamics is poorly understood. In this study, we deployed bumble bee colonies in an agricultural landscape and studied changes in the bumble bee virome during field placement under varying habitat composition and configuration using a multiscale analytical framework. We estimated prevalence of viruses and viral loads (i.e. number of viral genomic equivalent copies) in bumble bees before and after placing them in the field using next generation sequencing and quantitative PCR. The results show that viral loads and number of different viruses present increased during placement in the field and that the virus composition of the colonies shifted from an initial dominance of honey bee associated viruses to a higher number (in both viral loads and number of viruses present) of bumble bee associated viruses. Especially DWV-B, typical for honey bees, drastically decreased after the time in the field. Viral loads prior to placing colonies in the field showed no effect on colony development, suggesting low impacts of these viruses in field settings. Notably, we further demonstrate that increased habitat diversity results in a lower number of different viruses present in Bombus colonies, while colonies in areas with well-connected farmland patches decreased in their total viral load after field placement. Our results emphasize the importance of landscape heterogeneity and connectivity for wild pollinator health and that these influences predominate at fine spatial scales.

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis.

OBJECTIVES: Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction Thirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). CONCLUSION: PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.

What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine.

Since their widespread introduction more than half a century ago, intensive care units (ICUs) have become an integral part of the health care system. Although most ICUs are found in high-income countries, they are increasingly a feature of health care systems in low- and middle-income countries. The World Federation of Societies of Intensive and Critical Care Medicine convened a task force whose objective was to answer the question "What is an ICU?" in an internationally meaningful manner and to develop a system for stratifying ICUs on the basis of the intensity of the care they provide. We undertook a scoping review of the peer-reviewed and gray literature to assemble existing models for ICU stratification. Based on these and on discussions among task force members by teleconference and 2 face-to-face meetings, we present a proposed definition and classification of ICUs. An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic. A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward, whereas a level 2 ICU can provide invasive monitoring and basic life support for a short period. A level 3 ICU provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. A formal definition and descriptive framework for ICUs can inform health care decision-makers in planning and measuring capacity and provide clinicians and patients with a benchmark to evaluate the level of resources available for clinical care.

Effect of Spinach, a High Dietary Nitrate Source, on Arterial Stiffness and Related Hemodynamic Measures: A Randomized, Controlled Trial in Healthy Adults.

Diets rich in fruits and vegetables reduce risk of adverse cardiovascular events. However, the constituents responsible for this effect have not been well established. Lately, the attention has been brought to vegetables with high nitrate content with evidence that this might represent a source of vasoprotective nitric oxide. We hypothesized that short-term consumption of spinach, a vegetable having high dietary nitrate content, can affect the arterial waveform indicative of arterial stiffness, as well as central and peripheral blood pressure (BP). Using a placebo-controlled, crossover design, 27 healthy participants were randomly assigned to receive either a high-nitrate (spinach; 845 mg nitrate/day) or low-nitrate soup (asparagus; 0.6 mg nitrate/day) for 7 days with a 1-week washout period. On days 1 and 7, profiles of augmentation index, central, and brachial BP were obtained over 180 min post-consumption in 4 fasted visits. A postprandial reduction in augmentation index was observed at 180 min on high-nitrate compared to low-nitrate intervention (-6.54 ± 9.7% vs. -0.82 ± 8.0%, p = 0.01) on Day 1, and from baseline on Day 7 (-6.93 ± 8.7%, p < 0.001; high vs. low: -2.28 ± 12.5%, p = 0.35), suggesting that the nitrate intervention is not associated with the development of tolerance for at least 7 days of continued supplementation. High vs. low-nitrate intervention also reduced central systolic (-3.39 ± 5.6 mmHg, p = 0.004) and diastolic BP (-2.60 ± 5.8 mmHg, p = 0.028) and brachial systolic BP (-3.48 ± 7.4 mmHg, p = 0.022) at 180 min following 7-day supplementation only. These findings suggest that dietary nitrate from spinach may contribute to beneficial hemodynamic effects of vegetable-rich diets and highlights the potential of developing a targeted dietary approach in the management of elevated BP.

Coma blisters in children: case report and review of the literature.

Coma-induced blisters is a rare condition associated with prolonged impairment of conscious level, which is relatively well-known in adults following overdose with barbiturates. However, it has been very rarely described in children. A case of coma-bullae occurring in an 11-year-old child with meningoencephalitis is herein reported. The bullous lesions occurred on the limbs and trunks, and evolved into necrotic ulcers in a few days. No correlation with any drug overdosage was found. A skin biopsy revealed epidermal and eccrine sweat gland necrosis with abundant neutrophils, and thrombosis of the vessels in the lower dermis. A comprehensive review of the literature showed that only 5 cases of coma-bullae in children have been published so far. Coma blistering resolves spontaneously within days or weeks. Diagnosis of coma-bullae may require careful clinical-pathologic correlation to exclude other blistering diseases in children.

Cutaneous manifestations of Churg-Strauss syndrome: report of two cases and review of the literature.

Churg-Strauss syndrome (CSS) is a small-vessel vasculitis characterized by severe asthma, lung/tissues infiltrates, extravascular necrotizing granulomas, and eosinophilia. Cutaneous involvement is common but may not be highly suggestive. Two typical cases of CSS with cutaneous involvement are herein reported, both females, 37 and 54 years old, presenting with lower limbs palpable purpura and urticarial lesions of the neck, respectively. A comprehensive review of the literature showed that cutaneous manifestations occurred in 40-81% of CSS patients and were the presenting sign in 14% of the patients. Moreover, a total of 68 cases of CSS with a detailed description of the cutaneous lesions have been published. In the majority of these patients, skin lesions allowed for the histopathological diagnosis of CSS. The most common clinical features were papulo-nodules with the histological picture of extravascular Churg-Strauss granuloma followed by purpuric and/or necrotic lesions in the lower limbs corresponding to small-vessel vasculitis with eosinophils. Less common lesions included urticarial lesions and livedo reticularis. Therefore, a high index of suspicion on skin lesions and the proper lesion selection for histological examination may be very important for early diagnosis of CSS. Clinical-pathological correlation is essential, as both clinical and histological features are not pathognomonic.