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Abstract Coral reefs are declining due to anthropogenic warming. Nonetheless, some have recovered quickly from repeated bleaching events. Coral recovery depends on adaptation capabilities, fishing pressure, overall number of stressors, reef conditions before the event, and degree of connectivity. Coral reefs that are connected to many others can receive viable larvae and regain coverage faster. Around Moorea and Tahiti, within the Society Islands of French Polynesia, coral cover has regained its previous levels rapidly, despite several mass bleaching events over the past three decades. Here it is explored whether the connectivity with distant reefs may support such recovery by modeling the transport of coral larvae around the islands over 28 years. Ocean currents enable connectivity with the Tuamotu Islands, ~ 250 km to the northeast, that act as sources to Moorea and Tahiti for pelagic larval durations of three weeks or longer. The circulation around Moorea and Tahiti is very dynamic; mesoscale eddies can also halt the connectivity with the Tuamotu Islands and sporadically transport larvae from reefs to the west and southeast instead. With many undisturbed coral reefs within a 300 km radius and strong mesoscale variability, a dynamic, long-range connectivity may explain the recovery of reefs around Moorea and Tahiti.

The new mineral bonacinaite (IMA2018-056), Sc(AsO4) ⚫ 2H2O, was found on the dumps of the Varenche Mine (Saint-Barthélemy, Nus, Aosta Valley, Italy), an old manganese mine, where it occurs as a low-temperature hydrothermal mineral associated mainly with quartz, granular braunite, undefined manganese oxides, arseniopleite, manganberzeliite and thortveitite. Bonacinaite forms colourless (with faint to distinct violet tints), pseudohexagonal, thick tabular crystals, up to 0.25 mm in size, sometimes with annular internal zones showing violet tinges, or as small, faintly violet lath-shaped crystals. The crystals are transparent and brittle, with vitreous lustre. The calculated density of an almost pure bonacinaite crystal is 2.82 g cm−3. Optically, bonacinaite is biaxial negative, α=1.598(4), β=1.618(3), and γ=1.638(3) (measured with a Na light source, 589 nm); 2V (measured) is large, and 2V (calculated) = −88.9°. The empirical formula, based on six O atoms per formula unit is (Sc0.90Mn3+0.08Fe3+0.01Pb0.01)Σ1.00[(As0.95P0.06)Σ1.01O4] ⚫ 2H2O. Bonacinaite has monoclinic symmetry, with space group P21/n and unit-cell parameters (single-crystal data / powder diffraction data) a=5.533(1)/5.521(1), b=10.409(2)/10.336(3), c=9.036(2)/9.059(4) Å, β=91.94(3)/91.97(4), V=520.1(2)/516.7(3) Å3 and Z=4. The crystal structure was refined from single-crystal intensity data obtained from a distinctly Al- and P-bearing crystal to R1(F) = 3.7 % for 1178 reflections. Bonacinaite is isotypic with the other members of the metavariscite group: kolbeckite, metavariscite and phosphosiderite.

This study examines the linkages between the upper-ocean (0–200 m) oxygen (O2) content and stratification in the North Pacific Ocean using four Earth system models (ESMs), an ocean hindcast simulation, and an ocean reanalysis. The trends and variability in oceanic O2 content are driven by the imbalance between physical supply and biological demand. Physical supply is primarily controlled by ocean ventilation, which is responsible for the transport of O2-rich surface waters to the subsurface. Isopycnic potential vorticity (IPV), a quasi-conservative tracer proportional to density stratification that can be evaluated from temperature and salinity measurements, is used herein as a dynamical proxy for ocean ventilation. The predictability potential of the IPV field is evaluated through its information entropy. The results highlight a strong O2–IPV connection and somewhat higher (as compared to the rest of the basin) predictability potential for IPV across the tropical Pacific, where the El Niño–Southern Oscillation occurs. This pattern of higher predictability and strong anticorrelation between O2 and stratification is robust across multiple models and datasets. In contrast, IPV at mid-latitudes has low predictability potential and its center of action differs from that of O2. In addition, the locations of extreme events or hotspots may or may not differ between the two fields, with a strong model dependency, which persists in future projections. On the one hand, these results suggest that it may be possible to monitor ocean O2 in the tropical Pacific based on a few observational sites co-located with the more abundant IPV measurements; on the other, they lead us to question the robustness of the IPV–O2 relationship in the extratropics. The proposed framework helps to characterize and interpret O2 variability in relation to physical variability and may be especially useful in the analysis of new observation-based data products derived from the BGC-Argo float array in combination with the traditional but far more abundant Argo data.

Abstract The Island Mass Effect (IME) around the Maldives is responsible for intense blooms with distinct seasonal patterns. These blooms sustain the fishing industry of the archipelagic nation, a vital source of income that occupies about 30% of the population. Through high resolution ocean simulations, we explore the physical processes responsible for the increased productivity and its observed variability, and their sensitivity to changes in land distribution. Year-round the frictional break of the currents in the presence of shallow bathymetry produces a strong vertical shear in the flow that favors vertical mixing, independently of the currents direction. The impact of this mixing is visible at the ocean surface during March and April, when the mixed-layer is shallow and the ocean currents are generally weak. A different mechanism than observed in spring modulates the IME during the monsoon seasons, in both winter and summer, when the zonal currents forced by the strong winds cross the archipelago: the flow accelerates while squeezing between the atolls, giving rise to intense wakes, and strong upwelling originates in the lees in response to the kilometer-scale flow divergence. This upwelling creates an asymmetric cooling signal in the lee of the islands and obfuscates the effects of the enhanced vertical mixing. The land reclamation efforts being planned on some of the islands may undercut the upwelling that drives the blooms during the monsoon seasons.

Abstract The probability of survival in avalanche accidents is time-dependent. Critically buried victims who undergo a long burial duration (over 60 min) face a possible mortality rate of over 80%. Understanding the physiological response during critical avalanche burial is crucial for improving rescue strategies and outcomes. We present the case of a 55-year-old male skier buried under an avalanche for 4 h and 51 min in the Italian Alps. Continuous heart rate monitoring revealed distinct phases of cardiac activity during burial. Despite severe hypothermia, the victim survived without extracorporeal rewarming. This case highlights the importance of continuous monitoring and appropriate on-site management in avalanche accidents. Factors such as the presence of an air pocket may positively influence survival. This case underscores the importance of comprehensive resuscitative measures and guidelines for managing avalanche victims with prolonged burial durations.

ABSTRACT Objective: To establish the epidemiological profile of shoulder injuries suffered by surfers, through the injury proportion rate, type, mechanism and/or severity, caused by surfing. Methods: This systematic review was conducted and written in accordance with the guidelines for systematic reviews– PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The bibliographic research was carried out between January 2020 and January 2022 in journals indexed in the Web of Science, SPORTDiscus, PubMed, Scopus, Cochrane and Embase databases. Data were analyzed in RStudio, and the methodological quality of the studies was assessed. Results: Ten studies were included, all of which were retrospective in cross-sectional design and had an average methodological quality of 75%. The meta-analysis showed an injury incidence rate of 14.88%. Odds ratio analysis showed that injuries of joint origin are 7.26 times significantly higher in individuals with shoulder injuries, and injuries of bone origin and skin injuries had reduced odds of 70% and 89%, respectively. The most common mechanism of injury was the movement of paddling (57,68%), with the average prevalence of acute injuries being 31.53% and chronic injuries being 68.47%. Conclusion: There was a scarcity and/or variation in the categorization of data regarding injuries in the shoulder region resulting from surfing, with injuries of joint and musculotendinous origin being frequent; and rowing, the most overloading factor. Level of evidence II, Systematic Review.

Objectives To evaluate a postpartum telephone-based lifestyle intervention to prevent diabetes in high-risk women with recent gestational diabetes mellitus (GDM).Design Multicentre parallel randomised clinical trial.Setting Specialised antenatal clinics in the Brazilian National System.Methods Lifestyle Intervention for Diabetes Prevention After Pregnancy compared (1:1) postpartum telephone support for lifestyle changes with conventional care in women with recent GDM at substantial risk for diabetes. Randomisation started on 28 March 2015 and ended on 13 March 2020, with the onset of the COVID-19 pandemic. We used Cox regression to estimate HRs for diabetes and analysis of covariance adjusted for follow-up time to assess weight change.Outcomes The primary outcome was incident diabetes ascertained with blinded measurements of oral glucose tolerance tests. The secondary outcome was a change in measured weight.Results We enrolled 5323 women with GDM, 2735 (51%) being at high risk. After invitations, baseline assessment and exclusions, we assigned 466 women to intervention (231) or control (235) groups. Attendance was satisfactory (≥7/20 phone sessions) in 75%. Over an average follow-up of 29.7 (15.6) months, 142 (30.5%) women progressed to diabetes, 75 (32%) in the control and 67 (29%) in the intervention group. There was no reduction in the incidence of diabetes (HR=0.84; 0.60–1.19) and only a non-significant 0.97 kg less weight gain (p=0.09). Among the 305 women randomised more than 1 year before the COVID-19 pandemic, the intervention did not reduce the incidence of diabetes (HR=0.71; 0.48–1.04) despite a 2.09 kg (p=0.002) lesser weight gain.Conclusion The strategy to identify women with GDM at high risk proved valid, as women often gained weight and frequently developed diabetes. Over a 30-month follow-up, telephone support for lifestyle changes at postpartum did not reduce weight gain or diabetes incidence, although only 75% attended the minimum number of telephone sessions. The COVID-19 pandemic negatively impacted trial conduction.Trial registration number NCT02327286.

Sicily ranks as the third-largest region in Italy for olive growing and olive oil production, holding the second position nationally regarding the number of active olive oil mills. This pioneering study integrates spatial and economic analyses to examine the geographical distribution of olive oil mills in Sicily and their relationship with the localization of olive groves. Using Local Indicators of Spatial Association (LISA), we conducted an advanced analysis of spatial patterns of olive oil mills, considering travel time on the road network. The adopted methodology addresses issues related to overestimation based on straight-line assumptions and the neglect of travel speed. Unlike traditional Euclidean distance approaches, our methodology provides a detailed understanding of the spatial relationships between olive oil mills and olive groves, revealing distinct patterns linked to elevation and proximity to olive groves. By linking profitability indicators with spatial clusters, we identify different thresholds of economic sustainability. Consequently, these findings contribute to a more comprehensive understanding of the olive oil industry, suggesting more environmentally sustainable practices. Policymakers, researchers, and industry stakeholders can leverage this knowledge to make informed decisions that foster the long-term sustainability of the olive oil sector.

Abstract Aiming to study the performance, carcass characteristics, nutrient digestibility, blood parameters, salivary cortisol levels, and economic viability of pigs administered aspartic protease, a total of 135 pigs were housed in pens in a randomized block design, divided into five treatments with nine replications. The experimental diets were positive control (PC), basic diet with a 5.0% reduction in protein and amino acid requirements; negative control (NC) with a 7.5% reduction in protein and amino acid requirements; NC + 100 g/mT of aspartic protease (NC100); NC + 150 g/mT of aspartic protease (NC150); and NC + 200 g/mT of neutral serine protease (NC200). The inclusion of protease, independently of the source and amount, increased the average daily weight gain (P 0.05) in the blood parameters or salivary cortisol levels were found. Regarding economic viability, proteases increased the profitability, with NC150 leading to the best results. Thus, the use of aspartic proteases is recommended to improve performance and further facilitate pork production.

Spatial and temporal variations in the level of dust activity can provide valuable information for policymaking and climate research. Recently, Moderate Resolution Imaging Spectroradiometer (MODIS) aerosol products have been successfully used for retrieving dust aerosol optical depth (DAOD), especially over bright dust source areas, and Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2) aerosol reanalysis provides DAOD and additionally other dust-aerosol-related parameters. In this study, spatial and temporal variations in dust activity in Australia were analyzed using MODIS and MERRA-2 combined (M&M) DAOD and MERRA-2 near-surface dust concentrations and estimated PM10 for the period 1980–2020. Validation results show that M&M DAOD has an expected error of ±(0.016+0.15τ) compared to the ground observations at the AErosol RObotic NETwork (AERONET) dust storms on populated areas sites. MERRA-2 near-surface dust concentrations show a power-law relationship with visibility data collected at meteorological stations with an r2 value from 0.18 to 0.44, and the estimated MERRA-2 PM10 shows similar temporal variations and correlates with ground-based PM10 data with an r2 value from 0.14 to 0.44 at six selected stations in Australia. Moreover, MERRA-2 horizontal dust flux shows the same major dust pathways as those in previous studies and similar dust emissions and deposition areas identified using ground-based observations. Dust events based on DAOD over eastern Australia are concentrated in the north in December, are concentrated in the south in February, and can occur anywhere in January. Near-surface dust concentration was found to be the highest (over 200 µg m−3) over the center of Lake Eyre basin in central Australia and radially decreased toward the coast to below 20 µg m−3 via the two main pathways in the southwest and northeast. The ratio of near-surface dust concentration to PM10 shows a similar spatial pattern. Total dust emission was estimated to be 40 Mt (megatonnes) per year over the period 1980–2020, of which nearly 50 % was deposited on land and the rest exported away from the Australian continent.

In the last few decades, the traditional paradigm of teleonomy, in which the amino acid sequence of a protein is tightly associated with its structure and, in turn, with its function, has been partially undermined. The idea of a protein as a two-state object has been superseded by that of understanding it as a multistate object. Indeed, some proteins, or portions of a protein, display intrinsically disordered regions (IDRs), which means that they lack stable secondary or tertiary structures. While we are aware that IDRs are present in almost half of the total human proteins, we are still quite far away from understanding their contextual-specific functions and figuring out how they mechanistically work. In the present perspective article, we will attempt to summarize the role/s of IDRs in ubiquitin–proteasome system (UPS)-mediated protein quality control (PQC) at different levels, ranging from ubiquitination to protein degradation through the proteasome machinery up to their role in decoding the complex ubiquitin code. Ultimately, we will critically discuss the future challenges we are facing to gain insights into the role of IDRs in regulating UPS-mediated PQC.

Due to global shifts in demographics and advances in chronic illness management over the past few decades, domiciliary care has become the primary setting for caring for older people. In this regard, nurses play a crucial role, promoting quality care and minimizing hospital admissions and the need for institutionalization. However, historical and geographic variation in nursing titles and the multitude of labels for different roles have been obstacles to the creation of a clear map outlining specific nursing roles in home care for older people. The aim of this scoping review is to map the evidence on the different nurses’ roles in caring for older people in domiciliary settings. This review will include primary, secondary, and gray literature on nurses’ roles in domiciliary settings for older people, sourced through comprehensive searches of various databases (MEDLINE, Embase, CINAHL) and reference scanning. No language restrictions will be applied. Two independent reviewers will conduct screening and data extraction. The tabulated results will be informed by descriptive frequencies and content analysis, presenting comprehensive findings. The review protocol was retrospectively registered within OSF database on the 23 November 2023.

The γ decay of the elusive narrow, near-threshold proton resonance in 11B was investigated at Laboratori Nazionali di Legnaro (INFN) in a particle-γ coincidence experiment, using the 6Li(6Li,pγ) fusion-evaporation reaction and the GALILEO-GALTRACE setup. No clear signature was found for a possible E1 decay to the 1/21−, first-excited state of 11B, predicted by the Shell Model Embedded in the Continuum (SMEC) with a branching of 0.98−69+167×10−3 with respect to the dominant particle-decaying modes. The statistical analysis of the γ-ray spectrum provided an average upper limit of 2.37×10−3 for this γ-ray branching, with a global significance of 5σ. On the other hand, by imposing a global confidence level of 3σ, a significant excess of counts was observed for E=γ9300(20) keV, corresponding to a resonance energy of 11429(20) keV (namely 200(20) keV above the proton separation energy of 11B) and a γ-ray branching of 1.12(35)×10−3. This result is compatible with the SMEC calculations, potentially supporting the existence of a near-threshold proton resonance in 11B.

Reduced transition probabilities have been extracted between excited, yrast states in the N=Z+2 nucleus 94Pd. The transitions of interest were observed following decays of the Iπ=14+, Ex=2129-keV isomeric state, which was populated following the projectile fragmentation of a 124Xe primary beam at the GSI Helmholtzzentrum für Schwerionenforschung accelerator facility as part of FAIR Phase-0. Experimental information regarding the reduced E2 transition strengths for the decays of the yrast 8+ and 6+ states was determined following isomer-delayed Eγ1−Eγ2−△T2,1 coincidence method, using the LaBr3(Ce)-based FATIMA fast-timing coincidence gamma-ray array, which allowed direct determination of lifetimes of states in 94Pd using the Generalized Centroid Difference (GCD) method. The experimental value for the half-life of the yrast 8+ state of 755(106) ps results in a reduced transition probability of B(E2:8→+6+) = 205−25+34 e2fm4, which enables a precise verification of shell-model calculations for this unique system, lying directly between the N=Z line and the N=50 neutron shell closure. The determined B(E2) value provides an insight into the purity of (g9/2)n configurations in competition with admixtures from excitations between the (lower) N=3pf and (higher) N=4gds orbitals for the first time. The results indicate weak collectivity expected for near-zero quadrupole deformation and an increasing importance of the T=0 proton-neutron interaction at N=48.

In recent years, efforts have been made to increase the proportion of electricity demand met by Renewable Energy Sources (RESs). Distributed Energy Resources (DERs) play a crucial role in this frame, particularly in Microgrids (MGs) where DERs and clusters of loads are interconnected. This paper presents an Energy Management System (EMS) developed for a low-voltage MG installed in Italy, connecting Photovoltaic (PV) units, a Wind Turbine (WT), a Battery Energy Storage System (BESS), a Combined Heat and Power (CHP) unit and loads: the EMS aims to optimize the day-ahead scheduling of the MG, considering both economic and power quality criteria. The mathematical model incorporates the capability curves of the inverters connected to DERs and allows for curtailment of PV and WT units, with curtailment costs assessed using the Levelized Cost of Electricity (LCOE). Penalties for the absorption of reactive power from the external network are considered and evaluated in accordance with the current regulatory framework. Optimal Power Flow (OPF) equations are integrated into the EMS model, too. A preliminary analysis, carried out on a simplified MG, evaluates the impact of linearizing the DERs capability curves and OPF equations on the EMS’s outcomes. Finally, a sensitivity analysis evaluates the impact of different operational constraints and of different objective function formulations on the operation of the MG, discussing key energy and economic results.

Barakat syndrome, also called HDR syndrome, is a rare genetic disorder encompassing hypoparathyroidism (H), sensorineural deafness (D) and renal disease (R). A 64-year-old woman was referred to our endocrinology clinic for a switch in treatment (from dihydrotachysterol to calcitriol). She had progressive sensorineural deafness since the age of 18 and idiopathic hypoparathyroidism diagnosed at age of 36. Her medical history included osteoporosis with hip/spine fractures, nephrolithiasis and a family history of hearing loss, osteoporosis and kidney disease. The patient’s clinical presentation indicated Barakat syndrome. Genetic analysis found a GATA3:c.916C>T nonsense variant. Further tests such as audiometry, labs and renal imaging supported the diagnosis. Due to rarity and manifold symptoms, diagnosis can be challenging. Optional GATA3 testing was suggested in 2018, except in cases of isolated sensorineural deafness or renal disease with pertinent family history. In isolated ‘H’ cases without ‘D’ and ‘R’, GATA3 studies are not required, as no haploinsufficiency cases were reported. Given the rise in genetic disorders, physicians should consistently consider rare genetic disorders in patients with suggestive symptoms, even decades after onset. Although diagnosis might not always impact management directly, it aids patients in accepting their condition and has broader family implications.

Abstract Background Focal brain lesions following a stroke of the middle cerebral artery induce large-scale network disarray with a potential to impact multiple cognitive and behavioral domains. Over the last 20 years, non-invasive brain neuromodulation via electrical (tCS) stimulation has shown promise to modulate motor deficits and contribute to recovery. However, weak, inconsistent, or at times heterogeneous outcomes using these techniques have also highlighted the need for novel strategies and the assessment of their efficacy in ad hoc controlled clinical trials. Methods We here present a double-blind, sham-controlled, single-center, randomized pilot clinical trial involving participants having suffered a unilateral middle cerebral artery (MCA) stroke resulting in motor paralysis of the contralateral upper limb. Patients will undergo a 10-day regime (5 days a week for 2 consecutive weeks) of a newly designed high-definition transcranial direct current stimulation (HD-tDCS) protocol. Clinical evaluations (e.g., Fugl Meyer, NIHSS), computer-based cognitive assessments (visuo-motor adaptation and AX-CPT attention tasks), and electroencephalography (resting-state and task-evoked EEG) will be carried out at 3 time points: (I) Baseline, (II) Post-tDCS, and (III) Follow-up. The study consists of a four-arm trial comparing the impact on motor recovery of three active anodal tDCS conditions: ipsilesional DLPFC tDCS, contralesional cerebellar tDCS or combined DLPFC + contralesional cerebellar tDCS, and a sham tDCS intervention. The Fugl-Meyer Assessment for the upper extremity (FMA-UE) is selected as the primary outcome measure to quantify motor recovery. In every stimulation session, participants will receive 20 min of high-density tDCS stimulation (HD-tDCS) (up to 0.63 mA/ $${\mathrm{cm}}^{2}$$ cm 2 ) with $${\mathrm{\pi cm}}^{2}$$ π cm 2 electrodes. Electrode scalp positioning relative to the cortical surface (anodes and cathodes) and intensities are based on a biophysical optimization model of current distribution ensuring a 0.25 V/m impact at each of the chosen targets. Discussion Our trial will gauge the therapeutic potential of accumulative sessions of HD-tDCS to improve upper limb motor and cognitive dysfunctions presented by middle cerebral artery stroke patients. In parallel, we aim at characterizing changes in electroencephalographic (EEG) activity as biomarkers of clinical effects and at identifying potential interactions between tDCS impact and motor performance outcomes. Our work will enrich our mechanistic understanding on prefrontal and cerebellar contributions to motor function and its rehabilitation following brain damage. Trial registration ClinicalTrials.gov NCT05329818. April 15, 2022.

Introduction Predicting acute affective episodes in individuals with Bipolar Disorder (BD) remains a clinical challenge. Specific environmental stressors, including air pollution, noise, and temperature variations might worsen affective symptoms or sleep in the general population, but their role in BD relapses is often overlooked. Indeed, they might exacerbate BD by perturbing circadian rhythms – fundamental aspects of BD. Objectives We thereby present the protocol of this pilot study and future preliminary data. We aim to longitudinally assess sleep alterations, mood fluctuations, and environmental exposure to several factors (air pollutants, climate, noise, artificial light-at-night, green space access) in patients with BD and to check the association of these variables with BD relapses. Methods In this pilot study, we will recruit 40 patients with BD in a 6-month prospective study. Patients were assessed during baseline, at 3 and 6 months. Data recollected will consist of a subjective (questionnaires) and objective (through meteorological stations) evaluation of physical environmental factors around the home residence; clinical assessment of mood and circadian rhythms, and continuous tracking of sleep-wake patterns, energy, and movement using actigraphy. Results Expected results will show that exposure to a worse environment (higher pollution, noise, light exposure, climate) will be associated with worse BD outcomes (i.e., relapse, mood symptoms, sleep alterations). Conclusions We will be sharing preliminary data from our ongoing study, offering insights into early patterns and findings that shed light on our objectives. Disclosure of Interest None Declared

Introduction Bipolar disorder (BD) is a multifaceted illness encompassing mood, energy, cognitive and biorhythms alterations. Sleep disturbances are common in prodromic, acute and inter-episodic phases of BD. Suicidality presents a known association with sleep disturbances. However, their interplay in BD remains intricate and not fully elucidated. Objectives The aim of the present systematic review (SR) and meta-analysis (MA) is to summarise the available evidence and to provide an estimate of the association between sleep disturbances and suicidality, defined as presence of suicide ideation, behaviour and suicide attempts, in patients with BD. Methods We conducted a comprehensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, PsycINFO, and SCOPUS databases. We included all studies reporting an association between sleep problems and suicidal behaviour in BD patients. No language restriction was imposed. Effect sizes were calculated as odds ratio (OR) for dichotomic variables, standard mean difference (SMD) for continuous outcomes, and Spearman’s coefficient (r) for correlations. Heterogeneity was assessed using the I2 statistic. Global inconsistency was evaluated using the Q statistics with the corresponding p-value. Results The initial search yielded 911 unique abstracts, of which 62 underwent full-text screening. Fourteen publications were included, comprising twelve cross-sectional and two longitudinal studies. The total sample consisted of 19,601 subjects diagnosed with BD, of which 51.76% were females and 69.52% had a diagnosis of BD type 1. We found that people with BD and sleep disturbances tend to have higher suicidality, both current (SMD=0.79, 95%CI=0.53, 1.05) and lifetime (OR=1.8; 95%CI=1.41, 2.55), when compared with people with BD and no sleep disturbances. Additionally, patients with BD and a history of suicide attempts tend to have more sleep problems (OR=1.37, 95%CI=1.21, 1.55). Moreover, a positive correlation exists between suicidality and poor sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) (r= 0.24, 95%CI=0.10, 0.36). No heterogeneity was found, except in the subanalysis of correlation (I2=66.67%, Q p-value=0.01). Conclusions Our SRMA outlines a positive relation between sleep disturbances and suicidality in patients with BD. The small number of included studies and the scarcity of longitudinal studies, preventing the inference of a causal relationship, represent the major limitations of this study. Also, studies with objective measures of sleep alterations are currently lacking. The prompt recognition, objective measurement, and treatment of sleep alterations could be crucial in averting or reducing suicidal attempts in BD. Disclosure of Interest C. Possidente: None Declared, M. Bort: None Declared, M. De Prisco: None Declared, V. Oliva: None Declared, G. Fico Grant / Research support from: Fellowship from “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), L. Bracco: None Declared, C. Sommerhoff: None Declared, L. Montejo: None Declared, A. Murru Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00672, PI22/00840) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdireccion General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER), E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/ 00805, PI21/00787) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdireccio ́n General de Evaluacio ́n and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357; the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151).

Introduction With the rapid changes of attitude, investigation and legislation around cannabis and its subproducts in the Western world, there is a need to profoundly examine the consequences of its use in the general population and, specifically, in people affected by mental disorders. There is a clear relationship between cannabis use and psychosis, but there is also growing evidence of its relationship with manic episodes (Sideli et al, 2019). A systematic review published by the CANMAT Task Force in 2022 examined again the relationship between cannabis use and bipolar disorder (BD), establishing association with worsened course and functioning of BD in frequent users (Tourjman et al., 2023). On the other hand, some recent papers have highlighted the role of the endocannabinoid system (ECS) in BD, suggesting even possible beneficial effects, mainly through the CB2 receptor (Arjmand et al, 2019). Objectives To describe the impact of cannabis in the psychiatric readmission in BD and to approach the differences in course in cannabis users with regards to non-users. Methods We conducted a prospective cohort study including the patients admitted to our acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019 (including patients with one of both final diagnosis: BD or schizoaffective disorder). We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined. Results The study, which included 309 patients, concluded that cannabis users were admitted and had the first episode at a younger age (p=0.005), a higher percentage of them did not have a previous diagnosis (p=0.026) nor a previous history of mental health issues (p=0.019) and it was more likely to be their first admission (p=0.011) and to suffer psychotic symptoms (p=0.002). As of treatment, the results were statistically significant regarding the fact that a lower proportion of patients had received previous psychiatric treatment (p=0.004) and previous electroconvulsive therapy (p=0.003). There was a higher chance of them being non-adherent with medication (p

Introduction Bipolar disorder (BD) is a chronic and recurrent disease characterized by acute mood episodes alternated with periods of euthymia. The available literature postulates that a biphasic dysregulation of mitochondrial bioenergetics might be observed in BD. Objectives We aimed to explore differences in in vivo mitochondrial respiration (1) intra-individually: longitudinally within patients during an acute mood episode of BD and after clinical remission, and (2) inter-individually: between patients with BD on depressive or manic episodes and healthy controls (HC). Methods Patients admitted to our acute psychiatric ward with a manic episode or bipolar depression were recruited. Different mitochondrial oxygen consumption rates (OCRs) were assessed during the acute episode (T0) and after clinical remission (T1) in one million of peripheral blood mononuclear cells (PBMC): Routine, Leak, ETC and Rox. They were measured as picomoles of oxygen per million cells (pmol O2/million). This experiment was also conducted in HC. High-resolution respirometry was performed at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system. Manic and depressive symptoms were assessed using standardized psychometric scales. Oxygen consumption capacity was compared (1) intra-individually, during acute episodes and after clinical remission, and (2) inter-individually, during acute manic and depressive episodes, and in HC. Statistical analyses were performed with SPSS, GraphPad and R Statistics. Results 20 patients with BD (15 manic, 5 depressed) and 10 HC were included. A significant increase in the maximal oxygen consumption capacity (ETC) was observed in clinical remission (27.4 ± 17.4) compared to the acute episodes (21.1 ± 11.7, p = 0.001), which remained significant after subtracting Rox from the other rates (p = 0.001). At T1, patients admitted with a manic episode tended to show higher mean ETC (31.2 ± 18.7) compared with T0 (24.1 ± 12.0, p = 0.074); the tendency persisted after Rox subtraction (p = 0.076). Patients admitted with a depressive episode also showed higher ETC means in T1 (16.3 ± 3.8) compared to T0 (12.1 ± 3.4), but there were not significant differences (p = 0.231). When HC, manic and depressive patients at T0 were compared between them, significant differences were observed in ETC (H =8.5; p =0.014) and Rox (H =13.8; p = 0.001). After Rox deduction, differences in ETC remained (H =11.7; p = 0.003). Individuals with bipolar depression showed lower ETC rates (12.1 ± 3.4) than those with a manic episode (24.1 ± 12.0; t = -3.5, p = 0.003), which was also found after Rox deduction (p = 0.001). Conclusions In both manic and depressive episodes in BD, mitochondrial respiration might be reduced and increase after clinical remission. Further studies with larger samples will allow to confirm these results and also to identify potential mitochondrial state-dependent biomarkers. Disclosure of Interest A. Giménez-Palomo Grant / Research support from: AGP is supported by a Rio Hortega 2021 grant (CM21/00094) from the Spanish Ministry of Health financed by ISCIII and cofinanced by Fondo Social Europeo Plus (FSE+)., M. Guitart-Mampel: None Declared, A. Meseguer: None Declared, M. Valentí: None Declared, L. Bracco: None Declared, H. Andreu: None Declared, E. Vieta: None Declared, G. Garrabou: None Declared, I. Pacchiarotti: None Declared

The slowdown of the Atlantic Meridional Overturning Circulation (AMOC) and associated consequences on ocean carbon uptake could have large implications for the Earth's climate system and its global carbon cycle. This study analyzes ten Earth System Models from the Coupled Model Intercomparison Project Phase 6 (CMIP6) and reveals that the regional carbon uptake in the subpolar North Atlantic under a high CO2 emission scenario moderately correlates with the decline in AMOC at 40°N. AMOC transports warm and salty subtropical waters to the subpolar regions. Models with stronger AMOC slowdown generally exhibit weaker surface warming and larger decline of surface salinity and alkalinity. We consider two plausible mechanisms linking the AMOC slowdown to the decline of regional CO2 uptake: the reduction in surface alkalinity and diminished subduction. The decline of surface salinity and alkalinity reduces the ocean's capacity to buffer acids leading to a reduced CO2 uptake. This important contribution is unique to the North Atlantic. Diminished convective mixing and subduction of surface water can further decrease the downward transport of anthropogenic carbon, as also shown in previous research. The centennial trends of pCO2 are decomposed into four components driven by temperature, salinity, alkalinity and dissolved inorganic carbon, revealing that alkalinity and dissolved inorganic carbon are both significant contributors. The alkalinity-driven pCO2 essentially follows surface salinity, establishing the linkage between AMOC slowdown and alkalinity decline. Our results indicate that alkalinity changes are important for the interplay between AMOC and the regional carbon sequestration ability across the late 20th and the entirety of the 21st century in the subpolar North Atlantic.