Deep time diversity of metatherian mammals: implications for evolutionary history and fossil-record quality

Despite a global fossil record, Metatheria are now largely restricted to Australasia and South America. Most metatherian paleodiversity studies to date are limited to particular subclades, time intervals, and/or regions, and few consider uneven sampling. Here, we present a comprehensive new data set on metatherian fossil occurrences (Barremian to end Pliocene). These data are analyzed using standard rarefaction and shareholder quorum subsampling (including a new protocol for handling Lagerstätte-like localities). Global metatherian diversity was lowest during the Cretaceous, and increased sharply in the Paleocene, when the South American record begins. Global and South American diversity rose in the early Eocene then fell in the late Eocene, in contrast to the North American pattern. In the Oligocene, diversity declined in the Americas, but this was more than offset by Oligocene radiations in Australia. Diversity continued to decrease in Laurasia, with final representatives in North America (excluding the later entry of Didelphis virginiana) and Europe in the early Miocene, and Asia in the middle Miocene. Global metatherian diversity appears to have peaked in the early Miocene, especially in Australia. Following a trough in the late Miocene, the Pliocene saw another increase in global diversity. By this time, metatherian biogeographic distribution had essentially contracted to that of today. Comparison of the raw and sampling-corrected diversity estimates, coupled with evaluation of "coverage" and number of prolific sites, demonstrates that the metatherian fossil record is spatially and temporally extremely patchy. Therefore, assessments of macroevolutionary patterns based on the raw fossil record (as in most previous studies) are inadvisable.Facultad de Ciencias Naturales y Muse

Deep time diversity of metatherian mammals: implications for evolutionary history and fossil-record quality

Despite a global fossil record, Metatheria are now largely restricted to Australasia and South America. Most metatherian paleodiversity studies to date are limited to particular subclades, time intervals, and/or regions, and few consider uneven sampling. Here, we present a comprehensive new data set on metatherian fossil occurrences (Barremian to end Pliocene). These data are analyzed using standard rarefaction and shareholder quorum subsampling (including a new protocol for handling Lagerstätte-like localities). Global metatherian diversity was lowest during the Cretaceous, and increased sharply in the Paleocene, when the South American record begins. Global and South American diversity rose in the early Eocene then fell in the late Eocene, in contrast to the North American pattern. In the Oligocene, diversity declined in the Americas, but this was more than offset by Oligocene radiations in Australia. Diversity continued to decrease in Laurasia, with final representatives in North America (excluding the later entry of Didelphis virginiana) and Europe in the early Miocene, and Asia in the middle Miocene. Global metatherian diversity appears to have peaked in the early Miocene, especially in Australia. Following a trough in the late Miocene, the Pliocene saw another increase in global diversity. By this time, metatherian biogeographic distribution had essentially contracted to that of today. Comparison of the raw and sampling-corrected diversity estimates, coupled with evaluation of "coverage" and number of prolific sites, demonstrates that the metatherian fossil record is spatially and temporally extremely patchy. Therefore, assessments of macroevolutionary patterns based on the raw fossil record (as in most previous studies) are inadvisable.Facultad de Ciencias Naturales y Muse

An evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children’s burns

Background An estimated 10%–24% of children attending emergency departments with a burn are maltreated. Objective To test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse Tool; BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment. Methods A prospective study of children presenting with burns to four UK hospitals (2015–2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score (BT-score) ≥3) was explored. Results The sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. After intervention, 28.4% (334/1174) had a BT-score ≥3 and were nearly five times more likely to be discussed with a senior clinician than those with a BT-score <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was ≥3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2. Conclusions A BT-score ≥3 encouraged discussion of cases of concern with senior colleagues and increased the referral of <5 year-olds with safeguarding concerns to children’s social care

Healthcare use by children and young adults with cerebral palsy

Aim To link routinely collected health data to a cerebral palsy (CP) register in order to enable analysis of healthcare use by severity of CP. Method The Northern Ireland Cerebral Palsy Register was linked to hospital data. Data for those on the CP register born between 1st January 1981 and 31st December 2009 and alive in 2004 were extracted, forming a CP cohort (n=1684; 57% males, 43% females; aged 0–24y). Frequencies of healthcare events, and the reasons for them, were reported according to CP severity and compared with those without CP who had had at least one hospital attendance in Northern Ireland within the study period. Results Cases of CP represented 0.3% of the Northern Ireland population aged 0 to 24 years but accounted for 1.6% of hospital admissions and 1.6% of outpatient appointments. They had higher rates of elective admissions and multi‐day hospital stays than the general population. Respiratory conditions were the most common reason for emergency admissions. Those with most severe CP were 10 times more likely to be admitted, and four times more likely to attend outpatients, than those with mild CP. Interpretation Linkage between a register and routinely collected healthcare data provided a confirmed cohort of cases of CP that was sufficiently detailed to analyse healthcare use by disease severity

Burns and Scalds Assessment Template:Standardising clinical assessment of childhood burns in the Emergency Department

Objectives The Burns and Scalds Assessment Template (BaSAT) is an evidence-based proforma coproduced by researchers and ED staff with the aim of (1) standardising the assessment of children attending ED with a burn, (2) improving documentation and (3) screening for child maltreatment. This study aimed to test whether the BaSAT improved documentation of clinical, contributory and causal factors of children’s burns. Methods A retrospective before-and-after study compared the extent to which information was recorded for 37 data fields after the BaSAT was introduced in one paediatric ED. Pre-BaSAT, a convenience sample of 50 patient records of children who had a burn was obtained from the hospital electronic database of 2007. The post-BaSAT sample included 50 randomly selected case notes from 2016/2017 that were part of another research project. Fisher's exact test and Mann-Whitney U tests were conducted to test for statistical significance. Results Pre-BaSAT, documentation of key data fields was poor. Post-BaSAT, this varied less between patients, and median completeness significantly (p<0.001) increased from 44% (IQR 4%–94%) to 96% (IQR 94%–100%). Information on ‘screening for maltreatment, referrals to social care and outcome’ was poorly recorded pre-BaSAT (median of 4% completed fields) and showed the greatest overall improvement (to 95%, p<0.001). Documentation of domestic violence at home and child’s ethnicity improved significantly (p<0.001) post-BaSAT; however, these were still not recorded in 36% and 56% of cases, respectively. Conclusion Introduction of the BaSAT significantly improved and standardised the key clinical data routinely recorded for children attending ED with a burn

Step into My Mind Palace:Exploration of a Collaborative Paragogy Tool in VR

Virtual Reality (VR) can mediate remote collaborative learning and can support pedagogical processes like paragogy. Within education, methods such as spaced repetition and memory palaces exist to support the cognitive process of remembering. We identify an opportunity to enhance learner-led collaborative paragogy involving these methods through immersive VR experiences. We present CleVR, a VR-mediated collaboration-based system that supports the memory palace and spaced repetition techniques. As an exploratory study, we aim to identify the applicability, viability and user perception for such a system combining these two techniques in VR. CleVR is a novel implementation which provides a location-driven metaphor to populate and present multiple resources related to a topic for peer-led exploration. We discuss the design and provide a prototype implementation of CleVR. We conducted two studies, a targeted expert user review and a broader proof of concept survey. The results of the studies show interesting outcomes, with the system described as ‘engaging’, ‘useful’ and ‘fun’. Our findings provide insights to the potential of using Virtual Reality Learning Environments (VRLE) geared towards collaborative learner-led activities

Teacher and student views on the feasibility of peer to peer education as a model to educate 16–18 year olds on prudent antibiotic use—a qualitative study

Peer education (PE) has been used successfully to improve young peoples’ health-related behaviour. This paper describes a qualitative evaluation of the feasibility of university healthcare students delivering PE, covering self-care and antibiotic use for infections, to biology students in three UK schools (16–18 years), who then educated their peers. Twenty peer educators (PEds) participated in focus groups and two teachers took part in interviews to discuss PE feasibility. Data were analysed inductively. All participants reported that teaching students about antibiotic resistance was important. PE was used by PEds to gain communication skills and experience for their CV. PEds confidence increased with practice and group delivery. Interactive activities and real-life illness scenarios facilitated enjoyment. Barriers to PE were competing school priorities, no antibiotic content in the non-biology curriculum, controlling disruptive behaviour, and evaluation consent and questionnaire completion. Participation increased PEds’ awareness of appropriate antibiotic use. This qualitative study supports the feasibility of delivering PE in schools. Maximising interactive and illness scenario content, greater training and support for PEds, and inclusion of infection self-care and antibiotics in the national curriculum for all 16–18-year olds could help facilitate greater antibiotic education in schools. Simplifying consent and data collection procedures would facilitate future evaluations