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The analysis of 879 ROV dives carried out along the Italian coasts on hard substrata at mesophotic and upper bathyal depths (40-775 m) allowed us to evaluate the current basin-scale presence, relative abundance, bathymetric limits, and habitat preferences of one of the most charismatic Mediterranean habitat-former anthozoan species, Corallium rubrum (Linnaeus, 1758). The species is widespread, and its occurrence ranged from 13% of the explored sites in Ionian Calabria to a hotspot of approximately 80% in Sardinia. Population relative densities were generally low (< 10 colonies m-2), except along the Sardinian coasts and in some areas along the Apulian coast. Almost no red coral colonies were observed between 60 m and 590 m in the nine explored offshore seamounts in the Ligurian and Tyrrhenian Seas. A distinctive coastal distribution discontinuity was found in the Ionian Sea. The optimum bathymetric distribution was between 75 m and 125 m, and no colonies were found below 247 m. Red coral colonies showed a preference for biogenic habitats dominated by crustose coralline algae (CCA) and vertical substrata. The species was absent on iron wrecks. Corallium rubrum disappeared from 14% of the historical fishing banks, while it was confirmed in 86% of them, some of which have been deeply harvested in the past. In particular, the still flourishing Sardinian populations could be supported by the high reproductive potential and favourable hydrodynamic conditions in the area.

The present study investigated macrofauna associated with Paraleucilla magna, an alien and invasive calcareous sponge in the Mediterranean Sea, in a partially confined basin along the Apulian coast (Mar Grande of Taranto, NW Ionian Sea) comparing specimens sampled in Autumn and Spring. Richness and abundance of associated taxa were recorded, and values of frequency, density, diversity (H’) and evenness (J’) were calculated. On the whole, the phylum Arthropoda showed the highest values of species richness and abundance, in accordance with data referred to P. magna from Brazilian coasts. The phyla Cnidaria, Echinodermata and Mollusca were well represented as well. Surprisingly, no Polychaeta’s species were found, while the same taxon was the second most rich in the Brazilian specimens. Macrofauna associated with P. magna in the Mar Grande of Taranto showed a different taxa composition between Autumn and Spring. This result suggests the necessity for monthly, year-round sampling in order to better define how the macrofaunal assemblages change with changing environmental parameters.

Through the diversification of multitrophic communities it is possible to obtain in mariculture stable and sustainable systems useful for biomass production. This study on the synergistic interactions between the sponge Sarcotragus spinosulus (Porifera, Dictyoceratida), the macroalga Chaetomorpha linum (Chlorophyta, Cladophorales) and the European sea bass Dicentrarchus labrax (Chordata, Actinopterygii), provides the basis for the development and optimization of a lab-scale multi-trophic model for biomasses production and bioremediation.

On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3). To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January-March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January-March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January-March 2019 (37,822) and January-March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.

This is the first description of a Mediterranean mesophotic coral reef. The bioconstruction extended for 2.5 km along the Italian Adriatic coast in the bathymetric range −30/−55 m. It appeared as a framework of coral blocks mostly built by two scleractinians, Phyllangia americana mouchezii (Lacaze-Duthiers, 1897) and Polycyathus muellerae (Abel, 1959), which were able to edify a secondary substrate with high structural complexity. Scleractinian corallites were cemented by calcified polychaete tubes and organized into an interlocking meshwork that provided the reef stiffness. Aggregates of several individuals of the bivalve Neopycnodonte cochlear (Poli, 1795) contributed to the compactness of the structure. The species composition of the benthic community showed a marked similarity with those described for Mediterranean coralligenous communities and it appeared to be dominated by invertebrates, while calcareous algae, which are usually considered the main coralligenous reef-builders, were poorly represented. Overall, the studied reef can be considered a unique environment, to be included in the wide and diversified category of Mediterranean bioconstructions. The main reef-building scleractinians lacked algal symbionts, suggesting that heterotrophy had a major role in the metabolic processes that supported the production of calcium carbonate. The large amount of available suspended organic matter in the area could be the main nutritional source for these species, as already suggested in the literature referred to Mediterranean cold-water corals.

The aim of this study was to provide further knowledge of the ecological, spatial, and temporal distribution and life‐cycle traits of the sympatric seahorse species Hippocampus hippocampus and Hippocampus guttulatus. From 2011 to 2014, data were collected from 20 sites along the Apulian coast (Southern Italy) in order to cover a wide range of coastal marine, open water, and lagoon sites, from the surface to a depth of 48 metres. Seahorses were found at seven of the 20 sites investigated. Both species displayed temporal persistence, patchy distribution, and a high spatial demographic heterogeneity. This study revealed a smaller maximum size and size at maturity of H. guttulatus than has been reported elsewhere. Although it is possible that environmental factors are influencing the size of these animals, there may be genetic explanations, especially for lagoon populations. Despite the fragmented distribution and often low abundance found along the Apulian coast, some seahorse populations appear to be locally persistent and stable over time, suggesting that there is a need for appropriate location‐specific conservation strategies. Not just maintaining but increasing the area of artificial substrates, which enhance habitat complexity and provide holdfasts, could represent a possible approach to help conserve marine littoral biodiversity and to protect endangered species in lagoons.

Sponge assemblages associated with coralligenous outcrops were studied with the aim of describing and comparing their composition, morphological features and distribution at different depths (shallow vs. deep) along the Apulian coasts. In addition, image analysis enabled the description of the main features of coralligenous outcrops and the detection of structuring species. The paper provides a significant contribution in terms of supplying new taxa of sponges associated to coralligenous assemblages and emphasising the importance of invertebrates in realising calcareous constructions. Most of the new finding came from deep sites, thus underlining the need to improve taxonomic studies on coralligenous communities at greater depths. A total of 153 taxa of sponges were recorded: 4 Calcarea, 6 Homoscleromorpha and 143 Demospongiae. Two species, Clathria (Microciona) macrochela and Thoosa armata, are new records for the Italian sponge fauna, with C. (M.) macrochela representing a new record for the whole Mediterranean. New findings for the Ionian and Adriatic Seas totalled 25 and 8 species, respectively. Thirty-nine species are endemic for the Mediterranean. Data analyses clustered sites into two groups, separated according to the depth. Deep sites, characterised by animal dominance, exhibit a heterogeneous substrate texture richer in cavities than the shallow and homogeneous algal ones. Differences in sponge species composition also correspond to differences in the distribution of sponge growth forms, with the insinuating cryptic species more abundant in deeper communities. Ten of 15 sponge species included in national and international wildlife protection laws and policy have been detected in the present study.

Objectives To develop key messages for methadone and buprenorphine safety education material based on an analysis of calls to the NYC Poison Control Center (NYC PCC) and designed for distribution to caregivers of young children. Methods Retrospective review of all calls for children 5 years of age and younger involving methadone or buprenorphine from January 1, 2000, to June 15, 2014. A data abstraction form was completed for each case to capture patient demographics, exposure and caller sites, caller relation to patient, qualitative information regarding the exposure scenario, the product information, if naloxone was given, and the medical outcome of the case. Results A total of 123 cases were identified. The ages of the children ranged from 4 days to 5 years; 55% were boys. All exposures occurred in a home environment. The majority of the calls were made to the NYC PCC by the doctor (74%) or nurse (2%) at a health care facility. Approximately one-fourth of the calls came from the home and were made by the parent (22%) or grandparent (2%). More than one-half of the exposures involved methadone (64%). Naloxone was administered in 28% of cases. Approximately one-fourth of the children did not experience any effect after the reported exposure, one-half (51%) experienced some effect (minor, moderate, or major), and there was 1 death (1%). More than one-half of the children were admitted to the hospital, with 40% admitted to critical care and 13% to noncritical care. Approximately 23% were treated and released from the hospital, and 20% were lost to follow-up or never arrived to the hospital. The remaining 4% were managed on site without a visit to the hospital. Conclusion Exposures to methadone and buprenorphine are dangerous with some leading to serious health effects. Safe storage and disposal instructions are needed for homes where children may be present.

The present paper provides a multidisciplinary fine-scale description of a Mediterranean mesophotic new habitat dominated by the bivalve Neopycnodonte cochlear (Poli, 1795), building large and thick pinnacles on vertical cliffs at two study areas along the southern Italian coast. The pinnacles, constituted by a multilayered aggregation of living and dead specimens of N. cochlear, were interconnected with each other to form a framework of high structural complexity, never observed before for this species. The bioconstruction, considerably extended, resulted very complex and diversified in the associated community of structuring organisms. This latter included 165 taxa attributable to different ecological groups occurring in different microhabitats of the bioconstruction. Among the secondary structuring taxa there were scleractinians, serpulids and bryozoans, all contributing to the deposition of calcium carbonate, and poriferans, helping to bind shells together or eroding carbonate by boring species. In comparison with coralligenous sensu stricto and the recently described Mediterranean mesophotic coral reef, the Neopycnodonte bioconstruction showed peculiar features, since it lacked the major contribution of encrusting coralline algae and scleractinians as reef builders, respectively.

Spread of alien species (AS) is a serious threat to marine habitats and analysis of principal descriptors of their occurrence is pivotal to set reliable conservation strategies. 2. In order to assess the susceptibility of marine habitats to biological invasions, a dataset was gathered of the occurrence of 3899 species from 29 phyla, taken from 93 marine sites located along the Italian coast in the period 2000-2012.

Loperamide is an over-the-counter antidiarrheal with opioid-receptor agonist properties. Recommended over-the-counter doses (range = 2-8 mg daily) do not produce opioid effects in the central nervous system because of poor oral bioavailability and P-glycoprotein efflux* of the medication (1); recent reports suggest that large doses (50-300 mg) of loperamide produce euphoria, central nervous system depression, and cardiotoxicity (2-4). Abuse of loperamide for its euphoric effect or for self-treatment of opioid withdrawal is increasing (5). Cases of loperamide abuse reported to the Upstate New York Poison Center and New York City Poison Control Center were analyzed for demographic, exposure, clinical, and laboratory characteristics. Cases of intentional loperamide abuse reported to the National Poison Database System (NPDS) also were analyzed for demographic, dose, formulation, and outcome information.

Objectives: Oximes such as pralidoxime (2-PAM) are essential antidotes for life-threatening organophosphate poisoning. Unfortunately, oximes are expensive, have limited use, and have short shelf lives. As such, maintaining large stockpiles in preparation for terrorist activity is not always possible. We have demonstrated that atropine is stable well beyond its labeled shelf life and that recently expired 2-PAM was clinically efficacious in a series of poisoned patients. Because 2-PAM is often dosed empirically, clinical improvement does not guarantee pharmacological stability. We therefore chose to analyze the chemical stability of expired 2-PAM.Methods: Samples of lyophylized 2-PAM were maintained according to the manufacturer's recommendations for 20 years beyond the published shelf life. We studied 2-PAM contained in a MARK I autoinjector that was stored properly for 3 years beyond its expiration date. An Agilent LC/MSD 1100 with diode-array detector and an Agilent Sorbax SB-C-18, 4.6 × 150-mm, 5-μm column were used with the following solvent systems: water with 0.01% trifluoroacetic acid and methanol with 0.01% trifluoroacetic acid. Fresh reagent grade 2-PAM was used as a standard. Results were repeated for consistency.Results: Lyophylized 2-PAM was a white powder that was clear and colorless in solution. Liquid chromatography was identical to the standard and resulted in 2 isolated peaks with identical mass spectra, suggesting that they are stereoisomers. The autoinjector discharged a clear, yellowish solution. In addition to the 2 peaks identified for lyophylized 2-PAM, a small third peak was identified with a mass spectra corresponding to the reported N -methyl pyridinium carboxaldehyde degradation product.Conclusions: When properly stored, lyophylized 2-PAM appears to be chemically stable well beyond its expiration date. Although the relative amount of degradation product found in solubilized (autoinjector) 2-PAM was small, it is unclear whether this may be toxic and therefore is of concern. Further studies performed with lots of drug stored under varied conditions would be required to fully determine the stability of expired 2-PAM.(Disaster Med Public Health Preparedness. 2012;6:20–25)

The present study focuses on the reproductive success of transplants of the bath sponge Spongia officinalis Linnaeus, 1759, with the aim of investigating the possibility of restocking this species, one of the most endangered organisms of the Mediterranean sessile zoobenthos. Transplants of S. officinalis, collected from a wild population along the Apulian coasts (Ionian Sea, Italy), have been moved into an area where the species was present in the past. The transplants consisted both of specimens in toto and of fragments of different sizes, obtained after having cut the mother sponge into pieces. All transplanted sponges showed complete cicatrisation of the cut surfaces within a month of the initial manipulation and had a survival rate of 100% throughout the 12 months of the study. From the present investigation, it has emerged that the reproductive effort and the larval release by the transplants do not differ significantly from those shown by the source population. This successful technical approach supports its application as a strategy for restocking the population of this endangered species.

The buds of the sponge Tethya seychellensis, collected in May 2006 from South Male Atoll (Maldives), have been processed for histological and ultrastructural investigations. Buds show three stages, different in morphology and size, reflecting different steps of their differentiation: round-shaped buds (stage I), cylindrical-shaped buds (II) and thin-stalked spearshaped buds (III). Cells with inclusions, belonging to the category of spherulous cells, are the main components of these buds. At stage I, some irregularly shaped cells, probably precursors of the choanocytes, are able to engulf and remove portions of the collagen matrix, a feature which could be interpreted as an initial step in choanocyte differentiation. Tethya seychellensis stands out among the other congeneric species owing to the occurrence of choanocyte chambers in the unreleased buds, as observed at stages II and III. The precocious differentiation of the choanocyte chambers allows the detached bud to act as a young functional sponge, thus enhancing the survival chances of these filter-feeding organisms. The structure of the buds of T. seychellensis stresses once more that in the genus Tethya the organisation of the buds represents a species-specific process, which varies according to the plasticity and the morphogenetic potentiality expressed by a single species.

Spermatogenesis of the marine sponge Halichondria semitubulosa (formerly Pellina semitubulosa) has been investigated at the ultrastructural level. This process can be observed in March when, among the choanocyte chambers of the aquiferous system, spermatic cysts are visible. They are delimited by pinacocyte‐like cells and include elements in progressive development: spermatocytes of the first and second order, spermatids and spermatozoa. The early phase of spermatogenesis was not detected. Spermatocytes of the first order show an elongated shape, several small mitochondria and patched chromatin; spermatocytes of the second order, frequently connected by bridges, show denser chromatin, a single large mitochondrion with numerous tightly adherent cristae, glycogen, and round‐shaped inclusions with a central electron‐dense core. In the spermatids the chromatin tends to be packed in the central region. Spermatozoa have a uniformly dense nucleus in close association with the large mitochondrion. Sperm maturatio...

The spatial distribution and temporal changes of demosponges and bryozoans in the northern basin of the Venice Lagoon were studied from samples collected from wooden piles and artificial rocks in June and October 2001. Twenty species of demosponges and 18 species of bryozoans were recorded. Sponges were found at 10 out of 11 sampling stations, while bryozoans were found at all 11 sampling stations. The studied taxocoenoses showed a high percentage cover of the lagoon hard bottoms. Eleven out of the 20 detected species of sponges were reported in a previous study on this taxocoenosis carried out on material collected in 1954–1955. Moreover, the most abundant species were also recorded during a study in 1989. These observations suggest a remarkable degree of persistence of the sponge community. Among bryozoans, the comparison with literature data showed a wider variation in species composition, with the occurrence of five new species in the studied area. The Indo‐Pacific invasive Tricellaria inopinata repla...

Introduction: Poisoning from organophosphates and carbamates is a significant cause of morbidity and mortality worldwide. Concerns have been expressed over the safety and efficacy of the use of oximes such as pralidoxime (2-PAM) in patients with carbamate poisoning in general, and more so with carbaryl poisoning specifically. The goal of the present study was to evaluate the role of 2-PAM in a mouse model of lethal carbaryl poisoning. Methods: Female ICR Swiss Albino miceweighing 25-30 g were acclimated to the laboratory andhoused in standard conditions. One hundred and ten mice received an LD50dose of carbaryl subcutaneously. Ten minutes later, they were randomized by block randomization to one of eight treatment groups: normal saline control, atropine alone, 100 mg/kg 2-PAM with and without atropine, 50 mg/kg 2-PAM with and without atropine, and 25 mg/kg 2-PAM with and without atropine. All medications were given intraperitoneally and the atropine dose was constant at 4 mg/kg. The single objective endpoint was defined as survival to 24 hours. Fatalities were compared using a Chi squared or Fisher's exact test. Results: Following an LD50of carbaryl, 60% of the animals died. Atropine alone statistically improved survival (15% lethality). High dose 2-PAM with and without atropine was numerically worse, but not statistically different from control. While the middle dose of 2-PAM was no different than control, the addition of atropine improved survival (10% fatality). Low-dose 2-PAM statistically improved survival (25% lethality). Atropine further reduced lethality to 10%. Conclusion: When appropriately dosed, 2-PAM alone protects against carbaryl poisoning in mice. Failure to demonstrate this benefit in other models may be the result of oxime overdose. Human & Experimental Toxicology (2007) 26, 125-129

The reproductive cycle of Geodia cydonium in a semi-enclosed Mediterranean bay (Porto Cesareo, SW Apulia) was studied with monthly frequency over a 3-year period. The investigation was carried out by uti- lizing a technique consisting of tagging ten individuals with a PVC stick and cutting oV, by means of a metal cork borer, small samples (cylinders about 5 cm 3 in vol- ume) from each of them for histological analysis. Sex- ual reproductive elements were detected in all individuals, but in the third year some specimens showed reduced reproductive activity or complete infertility. Spermatogenesis occurred in a short period (from June to August) whereas oogenesis lasted longer (from spring to late summer). Spermatic cysts occurred when the frequency of specimens with oocytes reached its maximum values. A relationship between water temperature and the onset of gamete diVerentiation was observed. G. cydonium is here conWrmed ovipa- rous and gonochoric with a sex ratio in favour of the females. However, in contrast with current literature on Porifera—which suggests that only a limited num- ber of sponges, all belonging to the same species are sexually active—the sexual reproduction of this species involves all the examined individuals. This Wnding can be explained by the methodological approach used in this research, which diVers from the traditional way of assessing the sponge reproductive cycle by analysing randomly collected specimens within a population. The study of a series of individuals over time represents a better "model technique" for investigating sponge sex- ual reproduction and the eVect of environmental parameters on gamete diVerentiation.

The availability of bath sponges has been recently reduced due to the depletion of natural banks due to the high fishing pressure together with some local epidemic events. At present, the commercial supply is far below the demand. The main purpose of this work was to estimate the rearing performance of Spongia officinalis var. adriatica, one of the most common Mediterranean commercial sponges, testing two different variants of culture on suspended ropes: a horizontal system placed close to the seabed, and a vertical system extended along the water column. The trials were carried out in Southern Italy (Ionian coast of Apulia, Central Mediterranean) from April 1997 to April 2000. Wild specimens of sponge were cut into pieces of different weight to test possible differences in growth and survival. During the study period, both systems resisted deterioration due to water movement and other ecological factors. In general, the growth performance (average weight, specific growth rate) did not significantly vary between the cultivation systems, nor were statistical differences in growth detected between the cuttings of different initial size. The mean growth observed was rather variable among sponge cuttings, even considering the same rearing condition and size range. The measured variations of hydrological parameters did not seem to affect survival, growth performance, or reproductive activity, which was detected almost all year round. Larger explants (about 50 g in wet weight) reached the commercial size after three years of rearing, thus identifying this initial size as the most suitable for cultivation

Unintentional Ingestions (UIs) in NYC were investigated for children under 5 years using syndromic surveillance data. Emergency Department visits for UIs have remained stable in this population from 2010 through July 2014, with foreign bodies such as coins and medications comprising the bulk of these visits. Among medications, analgesics were the most common known source of poisoning. Our results corroborate findings from the Poison Control Center and will be used to identify all UIs in near real-time. Our results also suggest a link between accidental medicinal UIs and poverty level and living with grandparents, which we will further explore in future studies.

The present work focused on the taxonomic composition, spatial distributions, and temporal distributions of the sponge fauna from the main lagoon systems of southern Italy: Lesina, Varano, Taranto, Alimini, Faro, Ganzirri, Tindari and Marsala. Overall, 62 sponge species were recorded, belonging to the classes Demospongiae (52 species), Calcarea (8) and Homoscleromorpha (2). All the lagoon systems studied hosted sponges, even if with marked differences. Species richness varied from one (Lesina) to 45 (Marsala). A large number of the species recorded during this study (52%) was found only at a single site, whereas a species only (Halichondria (H.) panicea) was present in all the environments studied. Sponges colonised all available substrates. Salinity was the ecological factort hat best explained the spatial distribution of sponges, even though the wide heterogeneity of sponge assemblages, strongly suggests an important role of stochastic factors acting on pre- and post-settlement phases. Comparison of the present data with lists available from the literature shows that sponge assemblages from most of the studied lagoons were quite persistent. However, in some of the lagoons remarkable extinction processes, probably related to massive and prolonged anthropogenic pressures, have contributed to large changes in the sponge patterns.

Objective: Warfarin is a high-risk medication whose safe use may be greatly improved by patient education. This study evaluate evaluated patients’ understanding of warfarin instructions, medication management, the Food and Drug Administration’s (FDA) warfarin medication guide content, and patient information recommendations. Methods: Interviews conducted at 2 hospital-based outpatient primary care sites with patients initiated on warfarin therapy within the last year. Results: Interviews were conducted with 49 patients. Seventy percent were between 36 and 64 years old and reported taking between 1 and 18 different medications daily. Many (76%) received information about warfarin when first prescribed to them, 65% written and 60% verbal (answers reflect more than one response). Patients found content in the medication guide difficult to understand; 18% were unable to identify information about diet and 21% were unable to locate information about when to call their provider. Analysis showed that 19% had trouble with numeracy issues related to warfarin. Patients’ suggestions of ways to convey warfarin information included more graphics, in-person counseling, and multilingual translations. Conclusion: This study demonstrates gaps in patients’ understanding of warfarin therapy. Relying solely on the information in the FDA medication guide is insufficient to guarantee adequate understanding. Utilizing the suggestions from patients’ feedback on other ways to deliver information should help future patients with different learning abilities and styles.

DPP-4 inhibitors (sitagliptin, saxagliptin, and linagliptin) are approved for the treatment of diabetes. They are considered safe due to their hyperglycemia dependent mechanism of action. We examined all isolated exposures to DPP-4 inhibitors reported to the National Poison Database System since 2006 to determine if significant toxicity occurs after exposure with attention to pediatric and intentional overdoses. NPDS data regarding DPP-4 ingestions in all age groups between January 2006 and March 2013 was collected. Cases were reviewed, and the following inclusion criteria applied: (1) reported ingestion of a DPP-4 inhibitor and (2) known clinical outcome. Exclusion criteria included the following: (1) exposure to more than a single substance, (2) no known outcome, and (3) clinical outcome judged to be unrelated to the exposure. One thousand four hundred seventy-six cases were reviewed while 826 were excluded. Of 650 included cases, 562 developed no clinical effects. Mild effects were noted in 77. There were no deaths. Moderate/major effect cases were investigated: two medication-naive nondiabetic individuals with accidental exposures developed clinically significant hypoglycemia requiring treatment. One diabetic patient on a DPP-4 inhibitor developed prolonged hypoglycemia requiring admission and continuous exogenous dextrose. Of 650 included exposures to DPP-4 inhibitors, 639 (98.3%) had either no or minor clinical effects. Three resulted in clinically significant hypoglycemia requiring intervention. None of the moderate or major clinical outcomes were the result of intentional overdoses for the purpose of self-injury. No exploratory ingestions resulted in moderate or major effects. Based on this data, exposure to DPP-4 inhibitors may rarely result in clinically significant hypoglycemia.

Sperm ultrastructure and some steps of spermatogenesis of the serpulids Hydroides dianthus, Serpula vermicularis and Vermiliopsis infundibulum are reported. In all the species examined the germinal cells originated from a germinative epithelium associated to blood vessels in the intersegmental septa. The spermatocytes were irregular in shape with a large nucleus and a thin cytoplasmic layer. In early spermatids in which the nucleus gradually condensed, a developed endoplasmic reticulum and some electron-dense bodies were observed. The nucleus was dehydrated in the late spermatids and assumed a cylindrical shape. In all the examined species, the morphology of the ripe spermatozoa can be ascribed to the ect-aquasperm type. The acrosome had a simple cup shape in V. infundibulum, whilst it was more developed extending laterally to the nucleus in H. dianthus, and cup-shaped with a swelling towards the nucleus in S. vermicularis. When the morphology of the serpulid spermatozoa was superimposed on a phylogenetic scheme, some trends could be highlighted. Although the paucity of data on serpulid spermatozoa ultrastructure at present prevents any phylogenetic inference, the comparison of acrosome ultrastructure within a group having similar reproductive strategies showed an increase in the internal complexity of the acrosome.

Study objectives: To determine the availability and use of premixed activated charcoal in sorbitol preparations during multiple-dose activated charcoal therapy in the emergency department. Design and setting: A prospective telephone survey of all 911 receiving hospitals within the catchment area of one poison center. Type of participants: Hospital pharmacy supervisors and ED charge nurses. Intervention: Hospital pharmacy supervisors were surveyed about the available preparations of activated charcoal on their hospital's formulary, and ED charge nurses in these same hospitals were surveyed about the prevalence of sorbitol use in multiple-dose activated charcoal regimens. Measurements and main results: Eleven hospitals (16%) stocked only activated charcoal in sorbitol preparations. Twenty-one hospitals (31%) had both activated charcoal in sorbitol preparations and activated charcoal without sorbitol preparations, and 35 hospitals (52%) had only activated charcoal without sorbitol preparations. Repeat dosing of sorbitol during multiple-dose activated charcoal therapy occurred in 33 of 67 (49%) of the EDs surveyed. Conclusion: Sorbitol dosing is often repeated with activated charcoal during multiple-dose activated charcoal therapy in the ED because of the ready availability (and sometimes exclusive availability) of premixed activated charcoal in sorbitol preparations.

Phylogeny of Syllidae is under debate due to new studies based on molecular and morphological data. The noticeable taxonomic diversity of syllids (about 700 listed species) is also mirrored in the array of reproductive strategies as well as in sperm morphology, counting a display of forms already supposed to reflect phylogenetic relationships between the species. The sperm ultrastructure of Syllis gerlachi, S. prolifera and S. vittata is herein presented and compared to the Syllinae species studied previously. Moreover, the egg structure and the gamete allocation within stolons of S. vittata are particularly investigated. Both male germinal cells at different level of maturation and oocytes were found in the same individual of S. vittata, suggesting simultaneous hermaphroditism. The ultrastructural analysis revealed that the observed spermatozoa belong to the ect-aquasperm type resembling those of the similar studied species (Syllis sp., S. pigmentata and S. krohni). Differences in the acrosome structure and nucleus shape are in accordance with a recent phylogenetic reconstruction and suggest a trend in the evolution of spermatozoa in Syllinae toward the development of the apical part. However, further molecular and ultrastructural analyses are needed to support this hypothesis. This is the first record of simultaneous hermaphroditism within Syllinae.

Evidence-based guidelines do not exist for the treatment of patients with chronic mild—moderate digoxin toxicity. We sought to evaluate differences among specialists in the use of digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic digoxin toxicity created by consensus among authors. All cases had the same digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic digoxin toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research.

Carbon monoxide (CO) is the leading cause of poisoning death in the United States. Research has shown that proper use of a CO detector in the home can reduce morbidity and mortality related to unintentional CO exposure. The authors evaluated three CO education workshops that included distribution of free CO detectors for home use, and their intervention reached 133 participants. Pretest surveys and follow-up calls evaluated change in knowledge and behavior factors. Results showed that statistically significant increases were found on three out of five knowledge-based items and 91% of respondents (N = 80) reported installing CO detectors in their home. Follow-up calls provided an opportunity to clarify information and provide tailored information to participants.

This study was carried out to evaluate the microbiological accumulation capability of the demosponge Spongia officinalis var. adriatica. Six microbiological parameters were researched in two sampling periods in the water and in reared sponge samples coming from sites with different degrees of microbial contamination: an off-shore fish farm displaced off the Apulian coast (Southern Adriatic Sea) and a no-impacted area displaced into the Marine Protected Area of Porto Cesareo (Apulian coast-Ionian Sea). We detected the density of culturable heterotrophic bacteria by spread plate on marine agar, total culturable bacteria at 37 degrees C on Plate Count Agar and vibrios on thiosulphate-citrate-bile-sucrose-salt (TCBS) agar. Total and fecal coliforms as well as fecal streptococci concentrations were detected by the MPN method. Bacterial densities were always higher in the sponge homogenates compared with the corresponding seawater in the sampling points and in both sampling periods. As regard vibrios, total culturable bacteria at 37 degrees C and fecal streptococci concentrations, the highest values were observed in the sponge samples coming from the off-shore fish farm during the summer period. The ability of Spongia officinalis var. adriatica to accumulate the microbial pollution indicators suggests that this species can be employed as a bioindicator for monitoring water quality.

Objectives/Hypothesis: Human cocaine research is predicated on data from the clinical practice of otolaryngology that are more than 25 years old and predate both the cocaine epidemic and the first reported association between cocaine use and myocardial infarction. The authors' objective was to reassess the epidemiology and toxicity of medicinal cocaine use among otolaryngologists and to compare current trends in usage and safety data with previously reported data. Study Design: An anonymous closed-question survey replicating the methodology of a previous study was used. Methods: The survey was mailed to active members of the American Academy of Otolaryngology—Head and Neck Surgery. The survey used a closed-question format asking about the use of cocaine, safety measures taken, and adverse outcomes and included information about practice type and location. Results were compared with previously published data using a χ2 test with P < .05 considered significant. Results: In all, 7815 surveys were mailed. Four thousand seventeen otolaryngologists returned the survey, representing a 54% response rate. Of the respondents, only 50% had used cocaine in their practice during the previous year. Physicians who had been in practice for less than 10 years were less likely to have used cocaine than those who had been in practice for more than 10 years (78% vs. 93% [P < .001]). Compared with the data reported in 1977, fewer physicians reported ever using cocaine in their practice (88% vs. 92% [P < .001]), fewer physicians had used cocaine in their practice at any time in the previous 10 years (68% vs. 92% [P < .001]), and a greater number of adverse reactions were reported by current respondents (26% vs. 22% [P < .001]). Tachycardia and hypertension were the most commonly reported adverse effects. Other important adverse events included 14 deaths, survivable cardiac arrest, ventricular tachycardia, and seizures. Conclusion: The clinical use of cocaine in otolaryngology has decreased significantly in the past 25 years as a result of discontinuation of use by physicians who had previously used cocaine and an increasing number of otolaryngologists who have never used it. This decline may reflect a better understanding of its potential toxicities, problems associated with storing and dispensing of a tightly controlled substance, increased availability of safer alternative medications, or a combination of these.

Children younger than 5 are at greatest risk for unintentional poisonings. Children in low-income situations are particularly vulnerable for exposures to potential poisons. Focus groups were conducted at a Women, Infants, and Children (WIC) program located in a large urban public hospital in New York City to gain information from low-income parents of young children about real and perceived barriers to calling the local poison control center, resources for poison prevention messages, and ideas about public awareness campaigns. All focus group members were low-income parents of young children. Most participants reported that they would call 911 in the event of a poisoning due to child welfare and self-efficacy issues. Health education theory using the social-cognitive theory provides a framework for developing future poison prevention programs to address identified issues with parents of young children.

The variations in both silica content and spicular size were studied in two populations of the demosponge Pellina semitubulosa (Lieberkuhn). Samples were collected over a period of 1 year (June 1994 to May 1995) in two Mediterranean coastal basins: Porto Cesareo (southwestern Apulia) and Marsala (northwestern Sicily). The values of spicule size (length and width) and sponge silica content were significantly higher in the population of Porto Cesareo, where the highest water silica concentration was recorded. In both Porto Cesareo and Marsala the sponge silica content showed a seasonal trend, positively correlated with water temperature values. In both populations, the smallest spicules were found in specimens collected from summer to late autumn, after sexual reproduction. Secretion of new spicules may be connected with the process of remodelling occurring in sponges after gamete and larval release.