Self-poisoning with paracetamol is the most frequently used overdose method in the UK. Psychosocial assessments were conducted by mental health clinicians with 127 consecutive individuals who presented with pure paracetamol overdoses to a large general hospital over 8 months, including asking about the source of the tablets and scoring the patients’ acts on the Beck Suicide Intent scale (BSI). Patients were predominantly female (86%) and young (79% aged 12–24 years). Most had used paracetamol which was available in the home (77%). Those who purchased paracetamol for the act took double the number of tablets compared with those who used paracetamol available in the home (37 v. 18), had higher suicidal intent (mean BSI: 11 v. 7) and more often required treatment with N-acetyl cysteine (71% v. 43%). These results highlight the need for safer home storage of paracetamol and consideration of reducing pack size limits on paracetamol that can be purchased.

As usage of military artificial intelligence (AI) expands, so will anti-AI countermeasures, known as adversarials. International humanitarian law offers many protections through its obligations in attack, but the nature of adversarials generates ambiguity regarding which party (system user or opponent) should incur attacker responsibilities. This article offers a cognitive framework for legally analyzing adversarials. It explores the technical, tactical and legal dimensions of adversarials, and proposes a model based on foreseeable harm to determine when legal responsibility should transfer to the countermeasure's author. The article provides illumination to the future combatant who ponders, before putting on their adversarial sunglasses: “Am I conducting an attack?”

As part of a study into the effects of human activities on the welfare of free-living wildlife, the relative scale and severity of welfare problems in wild mammals and birds in Europe were investigated. Major cases were described and compared in terms of the nature and level of harm (pain, stress and fear) they cause, the duration of these effects and the number of individuals affected. The use of anticoagulant rodenticides, myxomatosis in rabbits, the poisoning of wildfowl by ingested lead shot, the contamination of seabirds with fuel oil, the effects of shooting, injuries due to collisions with road traffic and prédation by domestic cats all severely compromise the welfare of large numbers of animals. Practical approaches to the alleviation and prevention of some of these welfare problems are discussed. We suggest that in assessing the environmental impact of new developments and technologies prior to their implementation, possible consequences to wildlife welfare should always be considered.

The United Nations Sustainable Development Goals aim to improve livelihoods and maintain functioning ecosystems, and include the provision of electricity and the prevention of desertification. We show that the pursuit of those two goals can lead to developments that put critical ecosystem functions at risk. Vultures are scavengers that provide sanitary ecosystem services, but their populations across Africa are declining due to poisoning, electrocution, and collision with power infrastructure. The extent to which the pursuit of sustainable development threatens vultures in Africa is unclear. We surveyed 227 km of powerlines in Ethiopia, which revealed bird mortality (0.15 vulture carcasses / km) at power infrastructure constructed under a National Electrification Programme to provide universal electricity access by 2025. We also interviewed 190 local pastoralists in 10 areas about livelihood challenges, which revealed that the bush Prosopis juliflora, which was originally introduced to prevent desertification but then invaded north-eastern Ethiopia, increased livestock predation and motivated the use of poison to control predators. Actions to increase universal access to electricity and to reduce desertification therefore have undesired side-effects that increase vulture mortality through electrocution and poisoning. To avoid negatively affecting local vulture populations and the services they provide, we urge governments to use infrastructure designs that minimise the risk of electrocution and assist pastoralists to protect their livestock and reduce the risk of poisoning to vultures and other wildlife.

Vitamin and mineral supplements (VMS) are widely available and commonly used. Little is known about patterns of poisoning exposures to VMS in the Australian population. We performed a retrospective study of calls to the New South Wales Poisons Information Centre (NSWPIC), July 2014–June 2019. NSWPIC is Australia’s largest PIC, taking approximately 100 000 calls/year (50 % of Australian poisoning calls) from healthcare professionals and members of the public. We conducted additional analyses on Fe exposures due to their high risk of acute toxicity. There were 10 944 VMS exposures reported to NSWPIC during the study period, increasing 9·6 % per annum over a 5-year period (95 % CI, 7·2, 12·1 %). Toddlers (1–4 years) accounted for 41·5 % (4546) of cases. Agents most commonly involved were multivitamins (n 3610), vitamin D (n 2080), Fe (n 1533) and Mg (n 804). In 17·7 % (1934) of cases, the call originated from hospital or the patient was referred to hospital by NSWPIC. Fe exposures increased by 14·0 % per year (95 % CI, 9·5, 18·5 %), and most were associated with high-strength products (> 45 mg elemental Fe per unit dose, n 1036). Fe exposures were hospitalised in 38 % of cases (n 583). We conclude that VMS exposures are increasing in Australia. Although most exposures can be managed at home, many required hospitalisation. Fe exposures are increasing and had higher rates of hospitalisation than other agents. VMS are often considered safe and without the potential for adverse effects, highlighting the importance of public education into the potential risks of misuse of these products.

African White-backed Vultures were recently uplisted to ‘Critically Endangered’ by IUCN due to declines across their range. Poisoning is widely accepted as the major reason for these declines. Botswana supports a high number of this species (breeding pairs > c.1,200), but as yet no published information exists on their breeding success in the country. However, mass poisonings within Botswana and neighbouring countries have killed thousands of White-backed Vultures in recent years. We therefore expected that nesting numbers may have declined in this region if these poisoning events killed local breeding birds. We used information from aerial surveys conducted between 2006 and 2017 in Khwai and Linyanti, two important breeding areas for this species in north-central Botswana, to determine if there was any change in nesting numbers and breeding success of White-backed Vultures. Results showed an overall 53.5% decline in nesting numbers, with a greater decline in Linyanti than in Khwai. In both areas, breeding success was significantly lower in 2017 than it was 10 ten years earlier. We recommend that similar repeat surveys are continued to provide greater confidence in the trends of both nesting numbers and breeding performance. Population viability analysis suggested that if the productivity levels detected in 2017 were a true indication of current productivity levels for this population, and if recent high poisoning rates continue, this population could be extirpated from the area in the next 13 years.

We examined the change in Swiss suicide rates since 1969, breaking down the rates according to the method used. The descriptive analyses of the main suicide methods are presented. The suicide rates reached a peak in the late 1970s/early 1980s and declined in more recent years. Firearm suicides and suicides by falls were the exception and sustained their upwards trend until the 1990s. Suicide by vehicle exhaust asphyxiation showed a rapid decline following the introduction of catalytic converters in motor vehicles. No substantial method substitution was observed. Suicide by poisoning declined in the 1990s but rose again following an increase in assisted suicide in somatically incurable patients. Suicide is too often regarded as a homogeneous phenomenon. With regard to the method they choose, suicide victims are a heterogeneous population and it is evident that different suicide methods are chosen by different people. A better understanding of the varying patterns of change over time in the different suicide methods used may lead to differentiated preventive strategies.

Carbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient’s left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.