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Introduction Suicide is one of the leading causes of unnatural death worldwide. There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. Objectives We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. Methods We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Results Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Conclusions Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario. Disclosure of Interest None Declared

Abstract Antarctic minke whales, Balaenoptera bonaerensis, breed in tropical and temperate waters of the Southern Hemisphere in winter and feed in Antarctic grounds in the austral summer. These seasonal migrations could be less defined than those of other whale species, but the evidence is scanty. We quantitatively describe the epibiotic fauna of Antarctic minke whales and explore its potential to trace migrations. Seven species were found on 125 out of 333 examined Antarctic minke whales captured during the last Antarctic NEWREP-A expedition in the Southern Ocean: the amphipod Balaenocyamus balaenopterae (prevalence = 22.2%), the copepod Pennella balaenoptera (0.6%); three coronulid, obligate barnacles, Xenobalanus globicipitis (11.1%), Coronula reginae (8.7%), C. diadema (0.9%); and two lepadid, facultative barnacles, Conchoderma auritum (9.0%) and C. virgatum (0.3%). Species with prevalence > 8% exhibited a modest increase in their probability of occurrence with whale body length. Data indicated positive associations between coronulid barnacles and no apparent recruitment in Antarctic waters. All specimens of X. globicipitis were dead, showing progressive degradation throughout the sampling period, and a geographic analysis indicated a marked drop of occurrence where the minimum sea surface temperature is

Abstract In vehicular communications, the increase of the channel load caused by excessive periodical messages (beacons) is an important aspect which must be controlled to ensure the appropriate operation of safety applications and driver-assistance systems. To date, the majority of congestion control solutions involve including additional information in the payload of the messages transmitted, which may jeopardize the appropriate operation of these control solutions when channel conditions are unfavorable, provoking packet losses. This study exploits the advantages of non-cooperative, distributed beaconing allocation, in which vehicles operate independently without requiring any costly road infrastructure. In particular, we formulate the beaconing rate control problem as a Markov Decision Process and solve it using approximate reinforcement learning to carry out optimal actions. Results obtained were compared with other traditional solutions, revealing that our approach, called SSFA, is able to keep a certain fraction of the channel capacity available, which guarantees the delivery of emergency-related notifications with faster convergence than other proposals. Moreover, good performance was obtained in terms of packet delivery and collision ratios.

Abstract Aggressive behavior of bottlenose dolphins (Tursiops truncatus) towards conspecifics is widely described, but they have also often been reported attacking and killing harbour porpoises (Phocoena phocoena) around the world. However, very few reports exist of aggressive interactions between bottlenose dolphins and other cetacean species. Here, we provide the first evidence that bottlenose dolphins in the western Mediterranean exhibit aggressive behavior towards both striped dolphins (Stenella coeruleoalba) and Risso’s dolphins (Grampus griseus). Necropsies and visual examination of stranded striped (14) and Risso’s (2) dolphins showed numerous lesions (external rake marks and different bone fractures or internal organ damage by blunt trauma). Indicatively, these lessons matched the inter-tooth distance and features of bottlenose dolphins. In all instances, these traumatic interactions were presumed to be the leading cause of the death. We discuss how habitat changes, dietary shifts, and/or human colonization of marine areas may be promoting these interactions.

Methotrexate (MTX) is a commonly used drug for the treatment of rheumatoid arthritis (RA), but its effectiveness can vary greatly among patients. Pharmacogenetics, the study of how genetic variations can affect drug response, has the potential to improve the personalized treatment of RA by identifying genetic markers that can predict a patient’s response to MTX. However, the field of MTX pharmacogenetics is still in its early stages and there is a lack of consistency among studies. This study aimed to identify genetic markers associated with MTX efficacy and toxicity in a large sample of RA patients, and to investigate the role of clinical covariates and sex-specific effects. Our results have identified an association of ITPA rs1127354 and ABCB1 rs1045642 with response to MTX, polymorphisms of FPGS rs1544105, GGH rs1800909, and MTHFR genes with disease remission, GGH rs1800909 and MTHFR rs1801131 polymorphisms with all adverse events, and ADA rs244076 and MTHFR rs1801131 and rs1801133, However, clinical covariates were more important factors to consider when building predictive models. These findings highlight the potential of pharmacogenetics to improve personalized treatment of RA, but also emphasize the need for further research to fully understand the complex mechanisms involved.

Each individual cetacean is an ecosystem itself, potentially harboring a great variety of animals that travel with it. Despite being often despised or overlooked, many of these epizoites have been proven to be suitable bio-indicators of their cetacean hosts, informing on health status, social interactions, migration patterns, population structure or phylogeography. Moreover, epizoites are advantageous over internal parasites in that many of them can be detected by direct observation (e.g., boat surveys), thus no capture or dissection of cetaceans are necessary. Previous reviews of epizoites of cetaceans have focused on specific geographical areas, cetacean species or epibiotic taxa, but fall short to include the increasing number of records and scientific findings about these animals. Here we present an updated review of all records of associations between cetaceans and their epibiotic fauna (i.e., commensals, ecto- or mesoparasites, and mutualists). We gathered nearly 500 publications and found a total of 58 facultative or obligate epibiotic taxa from 11 orders of arthropods, vertebrates, cnidarians, and a nematode that are associated to the external surface of 66 cetacean species around the globe. We also provide information on the use as an indicator species in the literature, if any, and about other relevant traits, such as geographic range, host specificity, genetic data, and life-cycle. We encourage researchers, not only to provide quantitative data (i.e., prevalence, abundance) on the epizoites they find on cetaceans, but also to inform on their absence. The inferences drawn from epizoites can greatly benefit conservation plans of both cetaceans and their epizoites.

Abstract Background Acinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs). The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact. Methods Design: Quasi-experimental intervention study based on open cohorts. Setting: Public tertiary referral centre. Period: January 2009–August 2017. Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings. Analysis: joinpoint regression and interrupted time-series analysis. Results The intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = − 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs. Conclusion The multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.

The three-dimensional (3D) documentation and surveying of cultural heritage can be carried out following several geomatics techniques such as laser scanning and thermography in order to detect the original 3D shape after applying reverse engineering solutions. In almost all cases, the integration of data collected by different instruments is needed to achieve a successful and comprehensive 3D model of the as-built architectural shape of the historical building. This paper describes the operations carried out by the authors to determine the as-built 3D model of the Escuelas Pias Church, related namely to the dome and circular nave. After the description of the church and historical notes, attention will be driven to the indirect registration results obtained with three different laser scanning software packages, highlighting similarities and differences, and the consequences while generating meshes. The 3D model carried out will then be described and the results of some investigations with regard to the hypotheses about the design of the dome and the origin of the alterations will be presented.

Abstract Background Diseases associated to external parasitosis are scarcely reported in sea turtles. During the last decades several organism have been documented as a part of normal epibiont community connected to sea turtles. The copepod Balaenophilus manatorum has been cited as a part of epibiont fauna with some concern about its parasitic capacity. This study serves three purposes, i.e. (i) it sheds light on the type of life style that B. manatorum has developed with its hosts, particularly turtles; (ii) it makes a cautionary note of the potential health risks associated with B. manatorum in sea turtles under captivity conditions and in the wild, and (iii) it provides data on effective treatments against B. manatorum. Results We report for the first time a massive infestation of the copepod B. manatorum and subsequent acute mortality in a group of loggerhead sea turtle hatchlings. Four-month-old turtles from a head-starting program started exhibiting excitatory and fin rubbing behavior preceding an acute onset of lethargy, skin ulceration and death in some animals. All the individuals (n = 57) were affected by severe copepod load and presented different degrees of external macroscopic skin lesions. The ventral area of front flippers, axillar and pericloacal skin were mostly affected, and were the main parasite distribution regions. Copepods were also detected on plastron and carapace sutures. The gut contents of B. manatorum reacted positively for cytokeratin, indicating consumption of turtle skin. Severe ulcerative necrotic dermatitis and large amount of bacteria presence were the major histopathological findings. Conclusions Individual fresh water immersion for 10 min and lufenuron administration (0.1 ppm) to the water system every 2 weeks proved effective for removing turtle parasites and to control re-infestation, respectively. The results from our study clearly indicated that B. manatorum individuals consume turtle skin. The pathological effects of this agent and the potential implications in sea turtle conservation and management are discussed.

Abstract Background Adults and larvae of generalist parasites are exposed to diverse hosts and local environmental conditions throughout their life cycles, thus local adaptation is expected to occur through phenotypic plasticity and/or natural selection. We investigated how the combined effect of cryptic host specificity and local selective pressures could shape reproductive traits of a putative generalist parasite in the oceanic realm. Methods The LSU rDNA, ITS2 and the mt-COI of individuals of the digenean Pholeter gastrophilus (Kossack, 1910) Odhner, 1914 (Heterophyidae Leiper, 1909) from oceanic striped dolphins, Stenella coeruleoalba Meyen, and coastal bottlenose dolphins, Tursiops truncatus Montagu, in the western Mediterranean were used to elucidate whether worms were conspecific. Infection parameters were compared between both dolphin species. General Linear Mixed Models were used to analyse the influence of host species on four reproductive traits of P. gastrophilus: body size, maturity stage (non-gravid/gravid), egg size, and number of eggs in utero. AIC values were used to rank competing models, and p-values to assess the effect of specific predictors. Results Evidence indicated that worms collected from both dolphin species were conspecific. All worms collected were gravid and infection parameters did not differ between dolphin species. However, body size and egg size of individuals of P. gastrophilus were significantly larger in striped dolphins. The number of eggs in utero did not significantly differ between dolphin species but, for a given body size, worms in bottlenose dolphins harboured more eggs. A trade-off between egg size and egg number was found in worms from both dolphin species, with a higher slope in striped dolphins. Conclusions Apparently, striped dolphin is a more suitable host for P. gastrophilus, but reproductive investment seems to be adapted to the habitat where the life-cycle develops. Worms from striped dolphins likely face the problem of finding intermediate hosts in the oceanic realm and apparently invest into offspring size to enhance the early survival of larvae and the potential to multiply asexually within the first intermediate host. The small-sized worms from bottlenose dolphins would be adapted to reproduce early because of higher adult mortality, generating smaller and numerous eggs in a coastal habitat where chances of transmission are presumably higher.

Presentamos un método reproducible y sencillo para valorar la calidad de las cicatrices desde un punto de vista estético. El empleo de fotografías digitales procesadas mediante programas informáticos, permite realizar mediciones colorimétricas en la cicatriz y en la piel sana adyacente. Los resultados pueden expresarse con fórmulas matemáticas capaces de cuantificar las diferencias cromáticas entre ambas superficies. Hemos comparado con este sistema los resultados obtenidos en 20 pacientes con cicatrices patológicas divididos en 2 series terapéuticas durante 9 meses. Diez pacientes recibieron tratamiento con gel de silicona frente a otros 10 que recibieron tratamiento fotoprotector. El análisis colorimétrico en el estudio independiente reveló que las diferencias estadísticamente significativas halladas entre la cicatriz y la piel sana circundante antes del tratamiento se mantenían en el grupo tratado con fotoprotector, mientras que no aparecían tras el tratamiento con gel de silicona. El estudio colorimétrico relativizado Scar-score (Puntuación de cicatriz), mostró una significativa recesión en ambos grupos, pero que era de mayor entidad en la serie tratada con gel de silicona. Tanto el análisis bivariante como el multivariante revelaron un beneficio terapéutico significativamente mayor en el grupo tratado con gel de silicona frente al grupo con tratamiento fotoprotector.The authors present a reproducible and simple method to evaluate scars from a cosmetic point of view. The use of digital photographs processed by means of computer programs enables us to carry out colorimetric measurements on the scar and adjacent healthy skin. Results can be expressed with mathematical formulae that make it possible to quantify the chromatic differences between both surfaces. The results obtained in 20 patients with pathological scars divided into 2 therapeutic series for 9 months were compared with this system. Ten patients received treatment with silicone gel and another 10 received photoprotector treatment. Colorimetry revealed in the independent study that statistically significant differences found between healthy and scar skin before treatment were maintained in the group treated with the photoprotector gel while they did not appear after administration of the silicone gel. The relativised colorimetric study (Scar-score) showed a significant recession in both groups but this was greater in the group treated with silicone gel. Both the bivariant and multivariant analysis revealed a significantly higher therapeutic benefit in the group treated with silicone gel compared to the photoprotector treatment.

The highly specialized coronulid barnacle Xenobalanus globicipitis attaches exclusively on cetaceans worldwide, but little is known about the factors that drive the microhabitat patterns on its hosts. We investigate this issue based on data on occurrence, abundance, distribution, orientation, and size of X. globicipitis collected from 242 striped dolphins (Stenella coeruleoalba) that were stranded along the Mediterranean coast of Spain. Barnacles exclusively infested the fins, particularly along the trailing edge. Occurrence, abundance, and density of X. globicipitis were significantly higher, and barnacles were significantly larger, on the caudal fin than on the flippers and dorsal fin. Barnacles were found more frequently and in greater numbers on the dorsal rather than ventral side of the caudal fin and on the central third of dorsal and ventral fluke surfaces. Nearly all examined individuals attached with their cirral fan oriented opposite to the fluke edge. We suggest that X. globicipitis may chemically recognize dolphins as a substratum, but fins, particularly the flukes, are passively selected because of creation of vortices that increase contact of cyprids with skin and early survival of these larvae at the corresponding sites. Cyprids could actively select the trailing edge and orient with the cirri facing the main direction of flow. Attachment on the dorsal side of the flukes is likely associated with asymmetrical oscillation of the caudal fin, and the main presence on the central segment of the flukes could be related to suitable water flow conditions generated by fluke performance for both settlement and nutrient filtration.

Diversos y fundados análisis científicos demuestran que una de las derivadas del denominado “cambio climático” es el calentamiento global del planeta y, con él, la posible elevación significativa de los niveles de mares y océanos en el planeta. Ello podría suponer, en determinados casos, la desaparición bajo las aguas de amplias porciones del territorio de diversos Estados, muy particularmente de ciertos Estados archipelágicos del Pacífico que podrían ver, incluso, la total desaparición de sus espacios terrestres. Con ello desaparecería uno de los elementos constitutivos del Estado, cuestionándose entonces sus efectos en la soberanía e, incluso, en la propia existencia de dicho Estado. Quedaría igualmente afectado otro elemento de la estatalidad: la población, que podría verse desplazada conformando una nueva tipología de “desplazados climáticos”. El Derecho internacional actual ofrece diversas soluciones a dichos problemas, si bien parte de la adopción de esas soluciones implicarían la asunción de opciones políticas de cierta envergadura con efectos jurídicos reseñables. Este trabajo analiza parte de estas cuestiones, proponiendo algunas de las mismas como posibles soluciones a la posible alteración territorial o la desaparición de ciertos Estados debida al cambio climático.

Objetivo: Describir las actuaciones farmacéuticas realizadas en un servicio de farmacia hospitalaria, evaluando su grado de aceptación por parte del personal médico y valorando su significación clínica. Método: Estudio descriptivo y retrospectivo de las actuaciones farmacéuticas realizadas mediante un impreso oficial desde el sistema de distribución de medicamentos en dosis unitarias del servicio de farmacia de un hospital universitario. Variables recogidas: datos sociodemográficos del paciente y datos farmacoterapéuticos de la actuación farmacéutica. La información se registró en una base de datos Microsoft Office Excel®. Para tipificar las actuaciones y valorar su significación o impacto clínico (idoneidad de la actuación farmacéutica) se empleó el método Iaser® modificado y adaptado. Para evaluar el grado de aceptación se utilizó el sistema informático de gestión del servicio de farmacia. El procesamiento estadístico se realizó mediante el programa SPSS®. Resultados: Se registraron 484 actuaciones farmacéuticas durante los 6 meses de duración del estudio. Los grupos ATC mayoritarios de los fármacos implicados fueron: J-antiinfecciosos (37%), C-cardiovascular (23%) y A-digestivo (19%). El grado de aceptación fue casi del 50%. Los motivos más frecuentes de actuación farmacéutica fueron la modificación de la dosis/pauta/vía de administración por una posología inadecuada (39,5%) y plantear alguna alternativa terapéutica debido a un medicamento no incluido en la Guía Farmacoterapéutica (33,1%). En cuanto a la idoneidad de las citadas actuaciones, el 75% se consideraron significativas. Conclusiones: La validación de las prescripciones médicas por parte del farmacéutico permite detectar problemas relacionados con los medicamentos y prevenir y/o resolver resultados negativos asociados a la medicación. Los resultados obtenidos nos indican que sería necesario establecer medidas de mejora para incrementar el grado de aceptación por el personal médico facultativo, como la implantación de un sistema de comunicación más eficaz. La colaboración dentro de un equipo clínico multidisciplinario es necesaria para mejorar la calidad asistencial y garantizar la seguridad de los pacientes.

Objetivo: Describir las actuaciones farmacéuticas realizadas en un servicio de farmacia hospitalaria, evaluando su grado de aceptación por parte del personal médico y valorando su significación clínica. Método: Estudio descriptivo y retrospectivo de las actuaciones farmacéuticas realizadas mediante un impreso oficial desde el sistema de distribución de medicamentos en dosis unitarias del servicio de farmacia de un hospital universitario. Variables recogidas: datos sociodemográficos del paciente y datos farmacoterapéuticos de la actuación farmacéutica. La información se registró en una base de datos Microsoft Office Excel®. Para tipificar las actuaciones y valorar su significación o impacto clínico (idoneidad de la actuación farmacéutica) se empleó el método Iaser® modificado y adaptado. Para evaluar el grado de aceptación se utilizó el sistema informático de gestión del servicio de farmacia. El procesamiento estadístico se realizó mediante el programa SPSS®. Resultados: Se registraron 484 actuaciones farmacéuticas durante los 6 meses de duración del estudio. Los grupos ATC mayoritarios de los fármacos implicados fueron: J-antiinfecciosos (37%), C-cardiovascular (23%) y A-digestivo (19%). El grado de aceptación fue casi del 50%. Los motivos más frecuentes de actuación farmacéutica fueron la modificación de la dosis/pauta/vía de administración por una posología inadecuada (39,5%) y plantear alguna alternativa terapéutica debido a un medicamento no incluido en la Guía Farmacoterapéutica (33,1%). En cuanto a la idoneidad de las citadas actuaciones, el 75% se consideraron significativas. Conclusiones: La validación de las prescripciones médicas por parte del farmacéutico permite detectar problemas relacionados con los medicamentos y prevenir y/o resolver resultados negativos asociados a la medicación. Los resultados obtenidos nos indican que sería necesario establecer medidas de mejora para incrementar el grado de aceptación por el personal médico facultativo, como la implantación de un sistema de comunicación más eficaz. La colaboración dentro de un equipo clínico multidisciplinario es necesaria para mejorar la calidad asistencial y garantizar la seguridad de los pacientes.

We compared the helminth communities of 5 owl species from Calabria (Italy) and evaluated the effect of phylogenetic and ecological factors on community structure. Two host taxonomic scales were considered, i.e., owl species, and owls vs. birds of prey. The latter scale was dealt with by comparing the data here obtained with that of birds of prey from the same locality and with those published previously on owls and birds of prey from Galicia (Spain). A total of 19 helminth taxa were found in owls from Calabria. Statistical comparison showed only marginal differences between scops owls (Otus scops) and little owls (Athene noctua) and tawny owls (Strix aluco). It would indicate that all owl species are exposed to a common pool of 'owl generalist' helminth taxa, with quantitative differences being determined by differences in diet within a range of prey relatively narrow. In contrast, birds of prey from the same region exhibited strong differences because they feed on different and wider spectra of prey. In Calabria, owls can be separated as a whole from birds of prey with regard to the structure of their helminth communities while in Galicia helminths of owls represent a subset of those of birds of prey. This difference is related to the occurrence in Calabria, but not Galicia, of a pool of 'owl specialist' species. The wide geographical occurrence of these taxa suggest that local conditions may determine fundamental differences in the composition of local communities. Finally, in both Calabria and Galicia, helminth communities from owls were species-poor compared to those from sympatric birds of prey. However, birds of prey appear to share a greater pool of specific helmith taxa derived from cospeciation processes, and a greater potential exchange of parasites between them than with owls because of phylogenetic closeness.