Publications by authors named "David C Evans"

176 Publications

Response to "Low albumin levels should be interpreted, but not ignored".

Nutr Clin Pract 2021 Apr 12;36(2):504. Epub 2021 Feb 12.

American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.

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http://dx.doi.org/10.1002/ncp.10648DOI Listing
April 2021

Description and rediagnosis of the crested hadrosaurid (Ornithopoda) dinosaur on the basis of new cranial remains.

PeerJ 2021 25;9:e10669. Epub 2021 Jan 25.

Department of Earth Sciences, Denver Museum of Nature & Science, Denver, CO, USA.

For nearly 60 years, skulls of species have been differentiated primarily on the basis of crest shape rather than on unique morphologic characters of other cranial elements. Complicating matters is the fact that crests dramatically change shape throughout ontogeny. Without a complete growth series, it has become difficult to assess the taxonomic distinctness of each species through the lens of allometric growth. has proven to be especially troublesome to assess because of the poorly preserved nature of the type and only skull. A new, partial skull from the Fossil Forest Member of the Fruitland Formation-the same geologic unit as the type specimen-is the first opportunity to re-diagnose this species as well as redefine the genus with many new traits. An undescribed, short-crested subadult skull from the Kaiparowits Formation of Utah previously assigned to cf. allows detailed comparisons to be made between the unnamed Utah taxon and the material of this species from the type locality. We find that several characteristics of the squamosal, supraoccipital, and premaxilla shared between the referred skull and the type skull are unique to (senso stricto) within the genus, irrespective of the overall crest shape. A phylogenetic analysis that includes six new characters posits that and are sister taxa, and that the latter does not share a closest common ancestor with the long-crested as previously hypothesized. This result helps to explain why both taxa are found in northeastern New Mexico, USA and in sequential geologic units (Fruitland Formation and Kirtland Formation, respectively). Additionally, the exquisitely preserved new skull provides the first opportunity to unequivocally identify the osteological make-up of the cranial crest. Unlike in previous reconstructions, the crest composition in follows what is seen in other lambeosaurines such as , where the dorsal process of the premaxilla dominates the crest, with the nasal forming 80% of the ventral paired tubes, and the lateral premaxillary process acting a lateral cover between the dorsal and ventral tubes. The skull of is still incompletely known, so more complete material will likely reveal new features that further differentiate this species and aid in determining the pace of ornamental crest evolution.
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http://dx.doi.org/10.7717/peerj.10669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842145PMC
January 2021

siblings reveal life history in a saber-toothed cat.

iScience 2021 Jan 7;24(1):101916. Epub 2021 Jan 7.

Department of Natural History, Royal Ontario Museum, 100 Queen's Park, Toronto, ON M5S 1C6, Canada.

The saber-toothed cat is known predominantly from "predator trap" deposits, which has made many aspects of its life history difficult to infer. Here, we describe an association of at least two subadult and one adult from Pleistocene coastal deposits in Ecuador. The assemblage likely derived from a catastrophic mass mortality event, and thereby provides insights into the behavior of the species. The presence of a P in the subadult dentaries suggests inheritance, a rare instance of familial relatedness in the fossil record. The siblings were at least two years old and were associated with an adult that was likely their mother, indicating prolonged parental care in . Comparison with the growth of pantherine cats suggests that S had a unique growth strategy among big cats that combines a growth rate that is similar to a tiger and the extended growth period of a lion.
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http://dx.doi.org/10.1016/j.isci.2020.101916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835254PMC
January 2021

Description and etiology of paleopathological lesions in the type specimen of Parasaurolophus walkeri (Dinosauria: Hadrosauridae), with proposed reconstructions of the nuchal ligament.

J Anat 2020 Dec 1. Epub 2020 Dec 1.

School of Natural and Built Environment, Queen's University Belfast, Belfast, UK.

Paleopathology, or the study of ancient injuries and diseases, can enable the ecology and life history of extinct taxa to be deciphered. Large-bodied ornithopods are the dinosaurs with the highest frequencies of paleopathology reported to-date. Among these, the crested hadrosaurid Parasaurolophus walkeri is one of the most famous, largely due to its dramatic elongated and tubular nasal crest. The holotype of Parasaurolophus walkeri at the Royal Ontario Museum, Canada, displays several paleopathologies that have not been discussed in detail previously: a dental lesion in the left maxilla, perhaps related to periodontal disease; callus formation associated with fractures in three dorsal ribs; a discoidal overgrowth above dorsal neural spines six and seven; a cranially oriented spine in dorsal seven, that merges distally with spine six; a V-shaped gap between dorsal spines seven and eight; and a ventral projection of the pubic process of the ilium which covers, and is fused with, the lateral side of the iliac process of the pubis. These lesions suggest that the animal suffered from one or more traumatic events, with the main one causing a suite of injuries to the anterior aspect of the thorax. The presence of several lesions in a single individual is a rare observation and, in comparison with a substantial database of hadrosaur paleopathological lesions, has the potential to reveal new information about the biology and behavior of these ornithopods. The precise etiology of the iliac abnormality is still unclear, although it is thought to have been an indirect consequence of the anterior trauma. The discoidal overgrowth above the two neural spines also seems to be secondary to the severe trauma inflicted on the ribs and dorsal spines, and probably represents post-traumatic ossification of the base of the nuchal ligament. The existence of this structure has previously been considered in hadrosaurs and dinosaurs more generally through comparison of origin and insertion sites in modern diapsids (Rhea americana, Alligator mississippiensis, Iguana iguana), but its presence, structure, and origin-attachment sites are still debated. The V-shaped gap is hypothesized as representing the point between the stresses of the nuchal ligament, pulling the anterior neural spines forward, and the ossified tendons pulling the posterior neural spines backward. Different reconstructions of the morphology of the structure based on the pathological conditions affecting the neural spines of ROM 768 are proposed. Finally, we review the history of reconstructions for Parasaurolophus walkeri showing how erroneous misconceptions have been perpetuated over time or have led to the development of new hypotheses, including the wide neck model supported in the current research.
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http://dx.doi.org/10.1111/joa.13363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053592PMC
December 2020

Letter to the editor.

Phys Sportsmed 2021 Feb 22:1-2. Epub 2021 Feb 22.

The American Society for Parenteral and Enteral Nutrition, Senior Director of Clinical Practice, Quality and Advocacy, Silver Spring, USA.

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http://dx.doi.org/10.1080/00913847.2020.1857668DOI Listing
February 2021

The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper.

Nutr Clin Pract 2021 Feb 30;36(1):22-28. Epub 2020 Oct 30.

American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.

Serum albumin and prealbumin, well-known visceral proteins, have traditionally been considered useful biochemical laboratory values in a nutrition assessment. However, recent literature disputes this contention. The aim of this document is to clarify that these proteins characterize inflammation rather than describe nutrition status or protein-energy malnutrition. Both critical illness and chronic illness are characterized by inflammation and, as such, hepatic reprioritization of protein synthesis occurs, resulting in lower serum concentrations of albumin and prealbumin. In addition, the redistribution of serum proteins occurs because of an increase in capillary permeability. There is an association between inflammation and malnutrition, however, not between malnutrition and visceral-protein levels. These proteins correlate well with patients' risk for adverse outcomes rather than with protein-energy malnutrition. Therefore, serum albumin and prealbumin should not serve as proxy measures of total body protein or total muscle mass and should not be used as nutrition markers. This paper has been approved by the American Society for Parenteral and Enteral Nutrition Board of Directors.
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http://dx.doi.org/10.1002/ncp.10588DOI Listing
February 2021

The accuracy and precision of body mass estimation in non-avian dinosaurs.

Biol Rev Camb Philos Soc 2020 12 1;95(6):1759-1797. Epub 2020 Sep 1.

Department of Ecology and Evolutionary Biology, University of Toronto, 25 Willcocks St, Toronto, Ontario, M5S 3B2, Canada.

Inferring the body mass of fossil taxa, such as non-avian dinosaurs, provides a powerful tool for interpreting physiological and ecological properties, as well as the ability to study these traits through deep time and within a macroevolutionary context. As a result, over the past 100 years a number of studies advanced methods for estimating mass in dinosaurs and other extinct taxa. These methods can be categorized into two major approaches: volumetric-density (VD) and extant-scaling (ES). The former receives the most attention in non-avian dinosaurs and advanced appreciably over the last century: from initial physical scale models to three-dimensional (3D) virtual techniques that utilize scanned data obtained from entire skeletons. The ES approach is most commonly applied to extinct members of crown clades but some equations are proposed and utilized in non-avian dinosaurs. Because both approaches share a common goal, they are often viewed in opposition to one another. However, current palaeobiological research problems are often approach specific and, therefore, the decision to utilize a VD or ES approach is largely question dependent. In general, biomechanical and physiological studies benefit from the full-body reconstruction provided through a VD approach, whereas large-scale evolutionary and ecological studies require the extensive data sets afforded by an ES approach. This study summarizes both approaches to body mass estimation in stem-group taxa, specifically non-avian dinosaurs, and provides a comparative quantitative framework to reciprocally illuminate and corroborate VD and ES approaches. The results indicate that mass estimates are largely consistent between approaches: 73% of VD reconstructions occur within the expected 95% prediction intervals of the ES relationship. However, almost three quarters of outliers occur below the lower 95% prediction interval, indicating that VD mass estimates are, on average, lower than would be expected given their stylopodial circumferences. Inconsistencies (high residual and per cent prediction deviation values) are recovered to a varying degree among all major dinosaurian clades along with an overall tendency for larger deviations between approaches among small-bodied taxa. Nonetheless, our results indicate a strong corroboration between recent iterations of the VD approach based on 3D specimen scans suggesting that our current understanding of size in dinosaurs, and hence its biological correlates, has improved over time. We advance that VD and ES approaches have fundamentally (metrically) different advantages and, hence, the comparative framework used and advocated here combines the accuracy afforded by ES with the precision provided by VD and permits the rapid identification of discrepancies with the potential to open new areas of discussion.
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http://dx.doi.org/10.1111/brv.12638DOI Listing
December 2020

A Novel Immune Modulator for Patients With Necrotizing Soft Tissue Infections (NSTI): Results of a Multicenter, Phase 3 Randomized Controlled Trial of Reltecimod (AB 103).

Ann Surg 2020 09;272(3):469-478

University of Kentucky, Lexington, Kentucky.

Background And Objective: Reltecimod, a CD 28 T-lymphocyte receptor mimetic, inhibits T-cell stimulation by an array of bacterial pathogens. A previous phase 2 trial demonstrated improved resolution of organ dysfunction after NSTI. We hypothesized that early administration of reltecimod would improve outcome in severe NSTI.

Methods: Randomized, double-blind, placebo-controlled trial of single dose reltecimod (0.5 mg/kg) administered within 6 hours of NSTI diagnosis at 65 of 93 study sites. Inclusion: surgical confirmation of NSTI and organ dysfunction [modified Sequential Organ Failure Assessment Score (mSOFA) score ≥3]. Primary analysis was modified Intent-to-Treat (mITT), responder analysis using a previously validated composite endpoint, necrotizing infection clinical composite endpoint, defined as: alive at day 28, ≤3 debridements, no amputation beyond first operation, and day 14 mSOFA ≤1 with ≥3 point reduction (organ dysfunction resolution). A prespecified, per protocol (PP) analysis excluded 17 patients with major protocol violations before unblinding.

Results: Two hundred ninety patients were enrolled, mITT (Reltecimod 142, Placebo 148): mean age 55 ± 15 years, 60% male, 42.4% diabetic, 28.6% perineal infection, screening mSOFA mean 5.5 ± 2.4. Twenty-eight-day mortality was 15% in both groups. mITT necrotizing infection clinical composite endpoint success was 48.6% reltecimod versus 39.9% placebo, P = 0.135 and PP was 54.3% reltecimod versus 40.3% placebo, P = 0.021. Resolution of organ dysfunction was 65.1% reltecimod versus 52.6% placebo, P = 0.041, mITT and 70.9% versus 53.4%, P = 0.005, PP.

Conclusion: Early administration of reltecimod in severe NSTI resulted in a significant improvement in the primary composite endpoint in the PP population but not in the mITT population. Reltecimod was associated with improved resolution of organ dysfunction and hospital discharge status.
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http://dx.doi.org/10.1097/SLA.0000000000004102DOI Listing
September 2020

A new, transitional centrosaurine ceratopsid from the Upper Cretaceous Two Medicine Formation of Montana and the evolution of the '-line' dinosaurs.

R Soc Open Sci 2020 Apr 29;7(4):200284. Epub 2020 Apr 29.

Department of Natural History, Royal Ontario Museum, 100 Queen's Park, Toronto, Ontario, Canada M5S 2C6.

Ceratopsids are among the most ubiquitous dinosaur taxa from the Late Cretaceous terrestrial formations of the Western Interior of North America, comprising two subfamilies, Chasmosaurinae and Centrosaurinae. The Two Medicine Formation of northwestern Montana has produced numerous remains of centrosaurine dinosaurs, which represent three taxa previously considered valid: , and . Here, we reassess the previous referral of specimens to and demonstrate that this taxon is represented solely by its holotype specimen, which was first diagnosed as . One of the specimens previously referred to '' instead represents a new eucentrosauran centrosaurine taxon diagnosed here, gen. et sp. nov. expresses a unique combination of eucentrosauran centrosaurine characters, including an elongate nasal horncore, diminutive supraorbital horncores, and a parietal bearing straight, elongate P3 processes, semi-elongate P4 processes and non-elongate P5, P6 and P7 processes. Within the stratigraphic succession of Eucentrosaura, occurs intermediate to and , and likewise reflects intermediate morphology. Assessed within the stratigraphic, geographical, taphonomic, ontogenetic and phylogenetic framework of Unified Frames of Reference, we fail to reject the hypothesis that represents a transitional taxon within an anagenetic lineage of eucentrosauran centrosaurines.
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http://dx.doi.org/10.1098/rsos.200284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211873PMC
April 2020

The internal cranial anatomy of Champsosaurus (Choristodera: Champsosauridae): Implications for neurosensory function.

Sci Rep 2020 04 28;10(1):7122. Epub 2020 Apr 28.

Department of Earth Sciences, Carleton University, Ottawa, Canada.

Although isolated Champsosaurus remains are common in Upper Cretaceous sediments of North America, the braincase of these animals is enigmatic due to the fragility of their skulls. Here, two well-preserved specimens of Champsosaurus (CMN 8920 and CMN 8919) are CT scanned to describe their neurosensory structures and infer sensory capability. The anterior portion of the braincase was poorly ossified and thus does not permit visualization of a complete endocast; however, impressions of the olfactory stalks indicate that they were elongate and likely facilitated good olfaction. The posterior portion of the braincase is ossified and morphologically similar to that of other extinct diapsids. The absence of an otic notch and an expansion of the pars inferior of the inner ear suggests Champsosaurus was limited to detecting low frequency sounds. Comparison of the shapes of semicircular canals with lepidosaurs and archosauromorphs demonstrates that the semicircular canals of Champsosaurus are most similar to those of aquatic reptiles, suggesting that Champsosaurus was well adapted for sensing movement in an aquatic environment. This analysis also demonstrates that birds, non-avian archosauromorphs, and lepidosaurs possess significantly different canal morphologies, and represents the first morphometric analysis of semicircular canals across Diapsida.
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http://dx.doi.org/10.1038/s41598-020-63956-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188685PMC
April 2020

Characteristics of scene trauma patients discharged within 24-hours of air medical transport.

Int J Crit Illn Inj Sci 2020 Jan-Mar;10(1):25-31. Epub 2020 Mar 6.

Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA.

Introduction: Helicopters play an important role in trauma; however, this service comes with safety risks, high transport costs, and downstream care charges.

Objective: Our objective was to determine the characteristics of early discharged trauma patients (<24 h length of stay) in order to reduce overtriage.

Methodology: Data were obtained from the trauma registries at one of two Level 1 trauma centers. Eligible patients included all scene trauma patients transported by helicopter to the Level 1 trauma centers from January 1, 2016, to December 31, 2017, who had a length of stay of 24 h or less. Patient factors such as age, gender, scene location, loaded miles, and transportation costs were collected. Trauma type, mechanism of injury, Abbreviated Injury Scale (AIS), Injury Severity Score, Revised Trauma Score, and prehospital vital signs were documented. Driving distances between the accident scene to local hospital, home of record to local hospital, and home of record to the Level I trauma center were also calculated for patients transported to Level 1 trauma center.

Results: Two hundred and twenty-six of 1042 total patients (21.7%) were discharged within 24 h of helicopter transport from the accident scene to trauma center. Less than 2% of patients were in the age group of 70 years or older. Only 2 (0.88%) patients discharged within 24 h had a prehospital systolic blood pressure <90 mmHg. For patients transported to Level 1 trauma center, the average loaded miles were 50.51 ± 14.99, with average transport charges being $27,921.19± $3536.61. Twenty-one percent of Level 1 trauma center patients were self-pay, and families typically drove 71.7 ± 123.23 miles to Level 1 trauma center versus 28.74 ± 40.62 to their local emergency department.

Conclusions: A significant number of patients transported from the scene are discharged within 24 h of admission to a trauma center. These patients rarely have prehospital hypotension, do not receive significant volumes of crystalloid resuscitation, and are infrequently over 70 years of age. One in five patients has no third-party coverage and assumes $27,921.19 in average transport charges.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_75_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170344PMC
March 2020

ASPEN Consensus Recommendations for Refeeding Syndrome.

Nutr Clin Pract 2020 Apr 2;35(2):178-195. Epub 2020 Mar 2.

Clinical Pharmacy Services, Mississippi Baptist Medical Center, Jackson, Mississippi, USA.

Introduction: In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations.

Methods: Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee.

Findings/recommendations: This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%-20% (mild), 20%-30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories.

Conclusions: These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.
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http://dx.doi.org/10.1002/ncp.10474DOI Listing
April 2020

Lipid Use in Hospitalized Adults Requiring Parenteral Nutrition.

JPEN J Parenter Enteral Nutr 2020 02;44 Suppl 1:S28-S38

Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.

In hospitalized patients, lipid emulsions are an integral part of balanced parenteral nutrition. Traditionally, a single lipid source, soybean oil, has been given to patients and was usually regarded as just a source of energy and to prevent essential fatty-acid deficiency. However, mixtures of different lipid emulsions have now become widely available, including mixtures of soybean oil, medium-chain triglycerides, olive oil, and fish oil. Fish oil is high in the ω-3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). There is a growing body of evidence that these ω-3 fatty acids can exert beneficial immunomodulatory, anti-inflammatory, and inflammation-resolution effects across a wide range of patient groups including surgical, cancer, and critically ill patients. At least in part, these effects are realized via potent specialized pro-resolution mediators (SPMs). Moreover, parenteral nutrition including ω-3 fatty acids can result in additional clinical benefits over the use of standard lipid emulsions, such as reductions in infection rates and length of hospital and intensive care unit stay. Clinical and experimental evidence is reviewed regarding lipid emulsion use in a variety of hospitalized patient groups, including surgical, critically ill, sepsis, trauma, and acute pancreatitis patients. Practical aspects of lipid emulsion use in critically ill patients are also considered, such as how to determine and fulfill energy expenditure, how and when to consider parenteral nutrition, duration of infusion, and safety monitoring.
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http://dx.doi.org/10.1002/jpen.1733DOI Listing
February 2020

Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States.

JPEN J Parenter Enteral Nutr 2020 03 29;44(3):395-406. Epub 2020 Jan 29.

University of Maryland Medical Center, Baltimore, Maryland, USA.

Objective: Healthcare leaders seek guidance on prudent investment in programs that improve patient outcomes and reduce costs, which includes the value of nutrition therapy. The purpose of this project was to conduct an evidence review and evaluate claims analyses to understand the financial and quality impact of nutrition support therapy on high-priority therapeutic conditions.

Methods: Task 1 included a review of existing literature from 2013 to 2018 to identify evidence that demonstrated the clinical and economic impact of nutrition intervention on patient outcomes across 13 therapeutic areas (TAs). In Task 2, analytic claims modeling was performed using the Medicare Parts A and B claims 5% sample dataset. Beneficiaries diagnosed in 5 selected TAs (sepsis, gastrointestinal [GI] cancer, hospital-acquired infections, surgical complications, and pancreatitis) were identified in the studies from Task 1, and their care costs were modeled based on nutrition intervention.

Results: Beginning with 1099 identified articles, 43 articles met the criteria, with a final 8 articles used for the Medicare claims modeling. As examples of the modeling demonstrated, the use of advanced enteral nutrition formula could save at least $52 million annually in a sepsis population. The total projected annual cost savings from the 5 TAs was $580 million.

Conclusion: Overall, optimization of nutrition support therapy for specific patient populations is estimated to reduce Medicare spending by millions of dollars per year across key TAs. These findings demonstrate the evidence-based value proposition of timely nutrition support to improve clinical outcomes and yield substantial cost savings.
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http://dx.doi.org/10.1002/jpen.1768DOI Listing
March 2020

Computed tomography analysis of the cranium of Champsosaurus lindoei and implications for the choristoderan neomorphic ossification.

J Anat 2020 04 6;236(4):630-659. Epub 2020 Jan 6.

Department of Earth Sciences, Carleton University, Ottawa, Canada.

Choristoderes are extinct neodiapsid reptiles that are well known for their unusual cranial anatomy, possessing an elongated snout and expanded temporal arches. Although choristodere skulls are well described externally, their internal anatomy remains unknown. An internal description was needed to shed light on peculiarities of the choristodere skull, such as paired gaps on the ventral surface of the skull that may pertain to the fenestra ovalis, and a putative neomorphic ossification in the lateral wall of the braincase. Our goals were: (i) to describe the cranial elements of Champsosaurus lindoei in three dimensions; (ii) to describe paired gaps on the ventral surface of the skull to determine if these are indeed the fenestrae ovales; (iii) to illustrate the morphology of the putative neomorphic bone; and (iv) to consider the possible developmental and functional origins of the neomorph. We examined the cranial anatomy of the choristodere Champsosaurus lindoei (CMN 8920) using high-resolution micro-computed tomography scanning. We found that the paired gaps on the ventral surface of the skull do pertain to the fenestrae ovales, an unusual arrangement that may be convergent with some plesiosaurs, some aistopods, and some urodeles. The implications of this morphology in Champsosaurus are unknown and will be the subject of future work. We found that the neomorphic bone is a distinct ossification, but is not part of the wall of the brain cavity or the auditory capsule. Variation in the developmental pathways of cranial bones in living amniotes was surveyed to determine how the neomorphic bone may have developed. We found that the chondrocranium and splanchnocranium show little to no variation across amniotes, and the neomorphic bone is therefore most likely to have developed from the dermatocranium; however, the stapes is a pre-existing cranial element that is undescribed in choristoderes and may be homologous with the neomorphic bone. If the neomorphic bone is not homologous with the stapes, the neomorph likely developed from the dermatocranium through incomplete fusion of ossification centres from a pre-existing bone, most likely the parietal. Based on the apparent morphology of the neomorph in Coeruleodraco, the neomorph was probably too small to play a significant structural role in the skull of early choristoderes and it may have arisen through non-adaptive means. In neochoristoderes, such as Champsosaurus, the neomorph was likely recruited to support the expanded temporal arches.
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http://dx.doi.org/10.1111/joa.13134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083570PMC
April 2020

A new leptoceratopsid dinosaur from Maastrichtian-aged deposits of the Sustut Basin, northern British Columbia, Canada.

PeerJ 2019 7;7:e7926. Epub 2019 Nov 7.

Department of Natural History, Royal Ontario Museum, Toronto, ON, Canada.

A partial dinosaur skeleton from the Sustut Basin of northern British Columbia, Canada, previously described as an indeterminate neornithischian, is here reinterpreted as a leptoceratopsid ceratopsian, , gen. et. sp. nov. The skeleton includes parts of the pectoral girdles, left forelimb, left hindlimb, and right pes. It can be distinguished from other named leptoceratopsids based on the proportions of the ulna and pedal phalanges. This is the first unique dinosaur species reported from British Columbia, and can be placed within a reasonably resolved phylogenetic context, with recovered as more closely related to than . At 68.2-67.2 Ma in age, falls between, and slightly overlaps with, both and , and represents a western range extension for Laramidian leptoceratopsids.
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http://dx.doi.org/10.7717/peerj.7926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842559PMC
November 2019

Are there Field Triage Criteria that Can Predict Low-Yield Air Medical Transports?

Prehosp Disaster Med 2019 Dec 10;34(6):596-603. Epub 2019 Oct 10.

Department of Emergency Medicine, The Ohio State University, Columbus, Ohio USA.

Introduction: Air medical transport of trauma patients from the scene of injury plays a critical role in the delivery of severely injured patients to trauma centers. Over-triage of patients to trauma centers reduces the system efficiency and jeopardizes safety of air medical crews.

Hypothesis: The objective of this study was to determine which triage factors utilized by Emergency Medical Services (EMS) providers are strong predictors of early discharge for trauma patients transported by helicopter to a trauma center.

Methods: A retrospective chart review over a two-year period was performed for trauma patients flown from the injury site into a Level I trauma center by an air medical transport program. Demographic and clinical data were collected on each patient. Prehospital factors such as Glasgow Coma Score (GCS), Revised Trauma Score (RTS), intubation status, mechanism of injury, anatomic injuries, physiologic parameters, and any combinations of these factors were investigated to determine which triage criteria accurately predicted early discharge. Hospital factors such as Injury Severity Score (ISS), length-of-stay (LOS), survival, and emergency department disposition were also collected. Early discharge was defined as a hospital stay of less than 24 hours in a patient who survives their injuries. A more stringent definition of appropriate triage was defined as a patient with in-hospital death, an ISS >15, those taken to the operating room (OR) or intensive care unit (ICU), or those receiving blood products. Those patients who failed to meet these criteria were also used to determine over-triage rates.

Results: An overall early discharge rate of 35% was found among the study population. Furthermore, when the more stringent definition was applied, over-triage rates were as high as 85%. Positive predictive values indicated that patients who met at least one anatomic and physiologic criteria were appropriately transported by helicopter as 94% of these patients had stays longer than 24 hours. No other criteria or combination of criteria had a high predictive value for early discharge.

Conclusions: No individual triage criteria or combination of criteria examined demonstrated the ability to uniformly predict an early discharge. Although helicopter transport and subsequent hospital care is costly and resource consuming, it appears that a significant number of patients will be discharged within 24 hours of their transport to a trauma center. Future studies must determine the impact of eliminating "low-yield" triage criteria on under-triage of scene trauma patients.
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http://dx.doi.org/10.1017/S1049023X19004904DOI Listing
December 2019

Cranial Anatomy of New Specimens of Saurornitholestes langstoni (Dinosauria, Theropoda, Dromaeosauridae) from the Dinosaur Park Formation (Campanian) of Alberta.

Anat Rec (Hoboken) 2020 04 9;303(4):691-715. Epub 2019 Sep 9.

Department of Natural History (Palaeobiology), Royal Ontario Museum, Toronto, Ontario, Canada.

The holotype of the dromaeosaurid Saurornitholestes langstoni was described in 1978 on the basis of fewer than 30 associated cranial and postcranial bones of a single individual from Dinosaur Provincial Park. Four additional partial skeletons of Saurornitholestes were recovered from Campanian (Upper Cretaceous) beds of Alberta and Montana over the next 25 years, although reasonably complete skeletons remained elusive, and virtually nothing was known about the skull. The lack of truly diagnostic material has been problematic, and the relationships of Saurornitholestes to other dromaeosaurids have been difficult to resolve because of the incomplete knowledge of its anatomy. In 2014, an almost complete skeleton, including the skull, was collected less than a kilometer from where the holotype had been found. Although similar in body size to Velociraptor, the facial region of the skull is relatively shorter, taller, and wider. The nasals are pneumatic. The premaxillary teeth are distinctive, and teeth previously identified in the Dinosaur Park Formation as Zapsalis abradens can now be identified as the second premaxillary tooth of S. langstoni. Morphology and wear patterns suggest that these may have been specialized for preening feathers. Many traits define a Campanian North American clade, Saurornitholestinae, that is distinct from an Asian clade that includes Velociraptor (Velociraptorinae). This new information on the skull allows a more complete evaluation of its systematic position within the Dromaeosauridae and supports the suggestion of at least two major faunal interchanges between Asia and North America during the Cretaceous. Anat Rec, 303:691-715, 2020. © 2019 American Association for Anatomy.
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http://dx.doi.org/10.1002/ar.24241DOI Listing
April 2020

Modeling Human Cancer-induced Cachexia.

Cell Rep 2019 08;28(6):1612-1622.e4

Arthur G. James Comprehensive Cancer Center Cancer Cachexia Program, The Ohio State University, Columbus, OH 43210, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA. Electronic address:

Cachexia is a wasting syndrome characterized by pronounced skeletal muscle loss. In cancer, cachexia is associated with increased morbidity and mortality and decreased treatment tolerance. Although advances have been made in understanding the mechanisms of cachexia, translating these advances to the clinic has been challenging. One reason for this shortcoming may be the current animal models, which fail to fully recapitulate the etiology of human cancer-induced tissue wasting. Because pancreatic ductal adenocarcinoma (PDA) presents with a high incidence of cachexia, we engineered a mouse model of PDA that we named KPP. KPP mice, similar to PDA patients, progressively lose skeletal and adipose mass as a consequence of their tumors. In addition, KPP muscles exhibit a similar gene ontology as cachectic patients. We envision that the KPP model will be a useful resource for advancing our mechanistic understanding and ability to treat cancer cachexia.
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http://dx.doi.org/10.1016/j.celrep.2019.07.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733019PMC
August 2019

Intrapleural Tissue Plasminogen Activator for Traumatic Retained Hemothorax.

Ann Pharmacother 2019 10 21;53(10):1060-1066. Epub 2019 Apr 21.

1 The Ohio State University Wexner Medical Center, Columbus, OH, USA.

To describe the efficacy, safety, dosing regimen, and administration technique of intrapleural alteplase for the treatment of retained hemothorax. A PubMed, EMBASE, and Google Scholar search (January 2000 to February 2019) was conducted with the search terms , and . Articles were included if they described the use of intrapleural alteplase in adult patients with a retained hemothorax; single patient case reports and abstracts were excluded. A total of 6 retrospective reviews and 1 meta-analysis were identified for inclusion. A variety of dosing strategies have been defined for the administration of intrapleural alteplase ranging from 6 to 100 mg, volume of fluid from 50 to 120 mL of normal saline, and the number of total doses has ranged from 1 to 8 over the treatment course. A majority of studies showed a greater than 80% success rate and less than 7% bleeding rate. Because of the paucity of data for use of alteplase in retained hemothorax and administration of a high-risk medication, this review provides dosing and administration recommendations based on reported safety and efficacy. Administration of intrapleural alteplase should be considered in patients with retained hemothorax as an alternative to surgical intervention. In contrast to intrapleural alteplase administration for other indications such as empyema, higher doses and volumes of alteplase are recommended for retained hemothorax.
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http://dx.doi.org/10.1177/1060028019846122DOI Listing
October 2019

Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study.

Injury 2019 Jun 28;50(6):1192-1201. Epub 2019 Mar 28.

Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada; Department of Surgery, Université Laval, Québec, QC, Canada.

Background: Variations in adjusted costs have been observed among trauma centres in the United States but patient outcomes were not better in centres with higher costs. Attempts to improve injury care efficiency are hampered by insufficient patient-level information on resource use and on the drivers of resource use intensity.

Objectives: To estimate patient-level resource use for injury admissions, identify determinants of resource use intensity, and evaluate inter-hospital variations in resource use.

Methods: We conducted a retrospective cohort study including ≥16-year-olds admitted to adult trauma centres in a mature, inclusive Canadian trauma system between 2014 and 2016. We extracted data from the trauma registry and hospital financial reports. We estimated resource use with activity-based costs, identified determinants of resource use intensity using a multilevel linear model and assessed the relative importance of each determinant with Cohen's f. We evaluated inter-provider variations with intraclass correlation coefficients (ICC) and 95% confidence intervals.

Results: We included 32,411 patients. Median costs per admission were $4857 (Quartiles 1 and 3 2961-8448). The most important contributors to total resource use were the medical ward (57%), followed by the operating room (OR; 23%) and the intensive care unit (13%). The strongest determinant of resource use intensity was discharge destination (Cohen's f = 7%). The most resource intense patient group was spinal cord injuries with $11,193 (7115-17,606) per admission. While resource use increased with increasing age for the medical ward, it decreased with increasing age for the OR. Resource use was 18% higher in level I centres compared to level IV centres and we observed significant variations in resource use across centres (ICC = 5% [4-6]), particularly for the OR (28% [20-40]).

Conclusions: Resource use for acute injury care in Quebec is not solely due to the clinical status of patients. We identified determinants of resource use that can be used to establish evidence-based resource allocations and improve injury care efficiency. The method we developed for estimating patient-level, in-hospital resource use for injury admissions and identifying related determinants could be reproduced using local trauma registry data and our unit costs or unit costs specific to each setting.
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http://dx.doi.org/10.1016/j.injury.2019.03.038DOI Listing
June 2019

A new hadrosauroid (Dinosauria: Ornithopoda) from the Late Cretaceous Baynshire Formation of the Gobi Desert (Mongolia).

PLoS One 2019 17;14(4):e0208480. Epub 2019 Apr 17.

Department of Geosciences, Faculty of Science, Osaka City University, Osaka Prefecture, Osaka, Japan.

A new genus and species of non-hadrosaurid hadrosauroid, Gobihadros mongoliensis, is described from a virtually complete and undeformed skull and postcranial skeleton, as well as extensive referred material, collected from the Baynshire Formation (Cenomanian-Santonian) of the central and eastern Gobi Desert, Mongolia. Gobihadros mongoliensis is the first non-hadrosaurid hadrosauroid from the Late Cretaceous of central Asia known from a complete, articulated skull and skeleton. The material reveals the skeletal anatomy of a proximate sister taxon to Hadrosauridae in remarkable detail. Gobihadros is similar to Bactrosaurus johnsoni and Gilmoreosaurus mongoliensis, but can be distinguished from them in several autapomorphic traits, including the maximum number (three) of functional dentary teeth per tooth position, a premaxillary oral margin with a 'double-layer morphology', and a sigmoidal dorsal outline of the ilium with a well-developed, fan-shaped posterior process. All of these characters in Gobihadros are inferred to be convergent in Hadrosauridae. Phylogenetic analysis positions Gobihadros mongoliensis as a Bactrosaurus-grade hadrosauromorph hadrosauroid. Its relationship with Maastrichtian hadrosaurids from Asia (e.g., Saurolophus angustirostris, Kerberosaurus manakini, Wulagasaurus dongi, Kundurosaurus nagornyi) are sufficiently distant to indicate that these latter taxa owe their distribution to migration from North America across Beringia, rather than having a common Asian origin with Go. mongoliensis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208480PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469754PMC
January 2020

Evaluation of Rectal Vancomycin Irrigation for Treatment of Infection in Patients Post-Colectomy for Toxic Colitis.

Surg Infect (Larchmt) 2019 Jul 22;20(5):411-415. Epub 2019 Mar 22.

2 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio.

infection (CDI) accounts for as many as 25% of episodes of antibiotic-associated diarrhea and is the most common cause of healthcare-associated diarrhea. Rectal vancomycin irrigation is a therapy option; however, evidence is limited for its value post-colectomy. The objective of this study was to describe outcomes of patients who underwent total colectomy for fulminant colitis and received rectal vancomycin post-operatively. This was a single-center retrospective chart review of adult patients who underwent total colectomy for fulminant CDI. Efficacy outcomes were all-cause in-hospital death, intensive care unit (ICU) and hospital length of stay, ventilator-free days at day 28 post-procedure, development of proctitis or pseudomembranes, need for re-initiation of CDI therapy, and normalization of infectious signs and symptoms at completion of CDI therapy. The primary safety outcome was the incidence of rectal stump blowout. Of the 50 patients included, 38 (76%) received treatment with rectal vancomycin at the discretion of the surgeon. The Sequential Organ Failure Assessment score on the day of the procedure was higher in the rectal vancomycin group; however, this difference did not reach statistical significance. No difference was observed between the groups in the primary outcome of all-cause death. There was no significant difference between the groups for hospital length of stay, but there was a trend toward longer ICU length of stay for patients who received rectal vancomycin (9.5 days vs. 2.5 days; p = 0.05). No differences in the remaining secondary efficacy outcomes were observed. No episodes of rectal stump blowout were observed in either group. This study aimed to add to the limited data on the use of rectal vancomycin irrigation post-colectomy for toxic colitis. Although our results do not support routine use of rectal vancomycin irrigation, they suggest that this therapy is not harmful if providers are considering its use for severe infections refractory to alternative treatment.
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http://dx.doi.org/10.1089/sur.2018.265DOI Listing
July 2019

Sweet and Sour: Impact of Early Glycemic Control on Outcomes in Necrotizing Soft-Tissue Infections.

Surg Infect (Larchmt) 2019 May/Jun;20(4):305-310. Epub 2019 Feb 4.

1 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Necrotizing soft-tissue infection (NSTI) is a devastating disease associated with high rates of morbidity and mortality. Hyperglycemia is associated with poor wound healing; however, there are no studies evaluating glycemic control outcomes in patients with NSTI. The objective of this study was to examine disease progression and death in patients with NSTI who achieved early glycemic control (EGC) compared with patients that did not. A retrospective chart review of patients with NSTI was conducted between November 2011 and August 2017. Early glycemic control was defined as a daily average blood glucose concentration ≤150 mg/dL for a minimum of two consecutive days from admission to hospital day three. The primary outcome of this study was a composite of ≤3 debridement procedures by hospital day 14 and survival to discharge. Secondary outcomes were the total number of debridement procedures, amputation, hospital length of stay (LOS), intensive care unit (ICU) LOS, number of hypoglycemic events throughout hospitalization, and discharge disposition. One-hundred five patients were included in the analysis. There were 62% male patients, mean age of 55.3 years, mean weight of 106.9 kg, and 57.1% with diabetes mellitus (DM). The 54 (51.4%) patients with EGC were less likely to have DM (29.6% versus 86.3%; p < 0.001), had a lower median admission glucose concentration (120.5 [97-144] versus 198 [153-295.5] mg/dL; p < 0.001), and had lower median daily glucose values during the first 96 hours after admission (p < 0.001). There was no significant difference in the primary outcome (83.3%% versus 84.3%; p > 0.99) or incidence of hypoglycemia (14.8% versus 23.5%; p = 0.32). Patients with EGC were more likely to return home after discharge (44.4% versus 23.5%; p = 0.039). Overall, there was no difference in composite clinical outcomes between patients with EGC and those without, although more patients who achieved EGC were discharged home. Patients with DM were less likely to achieve EGC.
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http://dx.doi.org/10.1089/sur.2018.182DOI Listing
August 2019

Changes in exhaled 13CO2/12CO2 breath delta value as an early indicator of infection in intensive care unit patients.

J Trauma Acute Care Surg 2019 01;86(1):71-78

From the Department of Animal Science, University of Wisconsin-Madison, Madison, Wisconsin (D.E.B.); Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin (A.P.O.); Department of Surgery, Section of Acute and Critical Care Surgery, Washington University, St. Louis, Missouri (S.A.B.); Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University, Columbia, Ohio (D.C.E.); Department of Surgery, Division of Acute Care Surgery, University of Florida, Jacksonville, Florida (A.J.K.); Isomark, LLC, Madison, Wisconsin (E.A.B., D.E.B.).

Background: We have developed a new, noninvasive predictive marker for onset of infection in surgical intensive care unit (ICU) patients. The exhaled CO2/CO2 ratio, or breath delta value (BDV), has been shown to be an early marker for infection in a proof of concept human study and in animal models of bacterial peritonitis. In these studies, the BDV changes during onset and progression of infection, and these changes precede physiological changes associated with infection. Earlier diagnosis and treatment will significantly reduce morbidity, mortality, hospitalization costs, and length of stay. The objective of this prospective, observational, multicenter study was to determine the predictive value of the BDV as an early diagnostic marker of infection.

Methods: Critically ill adults after trauma or acute care surgery with an expected length of stay longer than 5 days were enrolled. The BDV was obtained every 4 hours for 7 days and correlated to clinical infection diagnosis, serum C-reactive protein, and procalcitonin levels. Clinical infection diagnosis was made by an independent endpoint committee. This trial was registered at the US National Institutes of Health (ClinicalTrials.gov) NCT02327130.

Results: Groups were demographically similar (n = 20). Clinical infection diagnosis was confirmed on day 3.9 ± 0.63. Clinical suspicion of infection (defined by SIRS criteria and/or new antibiotic therapy) was on day 2.1 ± 0.5 in all infected patients. However, 5 (56%) of 9 noninfected subjects also met clinical suspicion criteria. The BDV significantly increased by 1‰ to 1.7‰ on day 2.1 after enrollment (p < 0.05) in subjects who developed infections, while it remained at baseline (± 0.5‰) for subjects without infections.

Conclusion: A BDV greater than 1.4‰ accurately differentiates subjects who develop infections from those who do not and predicts the presence of infection up to 48 hours before clinical confirmation. The BDV may predict the onset of infection and aid in distinguishing SIRS from infection, which could prompt earlier diagnosis, earlier appropriate treatment, and improve outcomes.

Level Of Evidence: Diagnostic test, level III.
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http://dx.doi.org/10.1097/TA.0000000000002097DOI Listing
January 2019

GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community.

JPEN J Parenter Enteral Nutr 2019 01 2;43(1):32-40. Epub 2018 Sep 2.

Department of Medicine, Siriaj Hospital, Bangkok, Thailand.

Background: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

Methods: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.

Results: A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories.

Conclusions: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
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http://dx.doi.org/10.1002/jpen.1440DOI Listing
January 2019

New insights into chasmosaurine (Dinosauria: Ceratopsidae) skulls from the Upper Cretaceous (Campanian) of Alberta, and an update on the distribution of accessory frill fenestrae in Chasmosaurinae.

PeerJ 2018 3;6:e5194. Epub 2018 Jul 3.

Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada.

Chasmosaurine ceratopsids are well documented from the Upper Cretaceous (Campanian) Dinosaur Park Formation (DPF) of southern Alberta and Saskatchewan, and include , , , , and material possibly referable to In this study, we describe three recently prepared chasmosaurine skulls (CMN 8802, CMN 34829, and TMP 2011.053.0046) from the DPF, and age-equivalent sediments, of Alberta. CMN 8802 and CMN 34829 are both referred to sp. based on the size and shape of the preserved parietal fenestrae. TMP 2011.053.0046 is referred to sp. based on the position and orientation of its preserved epiparietals. Each skull is characterized by the presence of an accessory fenestra in either the squamosal (CMN 8802 and TMP 2011.053.0046) or parietal (CMN 34829). Such fenestrae are common occurrences in chasmosaurine squamosals, but are rare in the parietal portion of the frill. The origin of the fenestrae in these three specimens is unknown, but they do not appear to exhibit evidence of pathology, as has been previously interpreted for the accessory fenestrae in most other chasmosaurine frills. These three skulls contribute to a better understanding of the morphological variation, and geographic and stratigraphic distribution, of chasmosaurines within the DPF and age-equivalent sediments in Western Canada.
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http://dx.doi.org/10.7717/peerj.5194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034596PMC
July 2018

Research Agenda 2018: The American Society for Parenteral and Enteral Nutrition.

JPEN J Parenter Enteral Nutr 2018 Jul;42(5):838-844

Faculty in Critical Care, Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1002/jpen.1312DOI Listing
July 2018

Four-Oil Lipid Emulsion (Smoflipid) as a Tool in Managing Parenteral Nutrition Shortages.

Nutr Clin Pract 2018 08 25;33(4):584. Epub 2018 Jun 25.

Department of Surgery, The Ohio State University, Columbus, Ohio, USA.

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http://dx.doi.org/10.1002/ncp.10106DOI Listing
August 2018