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Theory links dispersal and diversity, predicting the highest diversity at intermediate dispersal levels. However, the modulation of this relationship by macro-eco-evolutionary mechanisms and competition within a landscape is still elusive. We examine the interplay between dispersal, competition and landscape structure in shaping biodiversity over 5 million years in a dynamic archipelago landscape. We model allopatric speciation, temperature niche, dispersal, competition, trait evolution and trade-offs between competitive and dispersal traits. Depending on dispersal abilities and their interaction with landscape structure, our archipelago exhibits two 'connectivity regimes', that foster speciation events among the same group of islands. Peaks of diversity (i.e. alpha, gamma and phylogenetic), occurred at intermediate dispersal; while competition shifted diversity peaks towards higher dispersal values for each connectivity regime. This shift demonstrates how competition can boost allopatric speciation events through the evolution of thermal specialists, ultimately limiting geographical ranges. Even in a simple landscape, multiple intermediate dispersal diversity relationships emerged, all shaped similarly and according to dispersal and competition strength. Our findings remain valid as dispersal- and competitive-related traits evolve and trade-off; potentially leaving identifiable biodiversity signatures, particularly when trade-offs are imposed. Overall, we scrutinize the convoluted relationships between dispersal, species interactions and landscape structure on macro-eco-evolutionary processes, with lasting imprints on biodiversity. This article is part of the theme issue 'Diversity-dependence of dispersal: interspecific interactions determine spatial dynamics'. [ABSTRACT FROM AUTHOR]

Contemporary defaunation has profound ecological consequences ranging from local or even global co‐extinctions of interacting species to the loss of ecosystem functions and services critical for humanity. Other components of global change (climate change, introduced pests, land use changes) are also harming ecosystem functioning by augmenting tree mortality worldwide. Defaunation and increased tree mortality often coincide in many human‐altered ecosystems but whether they interact, leading to non‐additive effects on ecosystem functioning, remains largely unknown. However, under some ecological circumstances, the decline or extirpation of one species due to defaunation can be neutralized by increases in the abundance of some functionally similar species (i.e. 'density compensation'). We combined long‐term field data with individual‐based modelling to investigate the potential interactive effects of seed disperser loss, increased tree mortality and density compensation on seed dispersal in a heterogeneous landscape. Our simulation experiments showed that both stressors markedly limit not only the quantity of seed dispersal but also its quality since the impact on seed dispersal strongly varied among habitat types that differ strikingly in suitability for tree establishment. Density compensation had a marked positive effect on seed dispersal which, however, was largely limited under increased tree mortality. The combined negative effects of defaunation and increased tree mortality on seed dispersal were lower than the expected additive effect. This highlights the need to account for the joint operation of multiple stressors to accurately predict the impacts of global change on the link between biodiversity and ecosystem functioning. [ABSTRACT FROM AUTHOR]

Full medical registration in Germany requires passing three medical state examinations. The first state exam (M1) regarding pre-clinical subjects consists of a written exam and a viva voce exam. The second state exam (M2) is a written test and comprises the medical specialties. The third state exam (M3)is an oral/viva voce practical exam. The written test questions are published by the German Institute for Medical and Pharmaceutical Examination Questions (IMPP).Both written tests consist of 320 single choice questions with five possible answers each. Recently, artificial intelligence (AI) in the form of ChatGPT passed examinations of the US Medical License exam (USMLE) (1). ChatGPT is a large language model (LLM), which is based on the transformer network architecture "general pre-trained transformer" (GPT) with more than 170 billion parameters (2, 3). It recognizes speech patterns and responds in a context appropriate way to user queries/questions. We investigated whether Chat GPT could pass the first and second state examinations in Germany and thus is able to answer complex medical questions in the German language. [ABSTRACT FROM AUTHOR]

Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality. [ABSTRACT FROM AUTHOR]

Methadone maintenance therapy (MMT), a pharmacological treatment for opioid use disorder for the past 50 years, continues to remain controversial. Despite consistent and overwhelming evidence confirming the effectiveness and safety of MMT, misconceptions and myths persist regarding its legitimacy as a treatment for opioid addiction. This often results in the underutilization and limited availability of this treatment modality. Despite successful outcomes, the controversial nature of MMT, and the stigma experienced by the patients on methadone, has been a particularly difficult obstacle to overcome. We present the history of MMT, review the evidence for its efficacy in the treatment of opioid dependence, and explore the origins of the stigma and misconceptions related to MMT. [ABSTRACT FROM AUTHOR]

Context. Prescription opioid abuse is a major public health concern and an ongoing epidemic in the United States. Loperamide is a widely available and inexpensive over-the-counter antidiarrheal with peripheral mu-opioid receptor activity. Online resources discuss the use of loperamide for the amelioration of withdrawal symptoms or recreational abuse. We describe the clinical course of 5 patients abusing loperamide, 3 of whom had life-threatening cardiac arrhythmias. Methods. In this observational case series, patients with cardiac arrhythmias or history of loperamide abuse with cardiac arrhythmias were identified; 5 patients were identified and 4 of the 5 patients were seen directly at the bedside. Clinical profile and outcome of patients is reported. Results. We report 5 patients with history of loperamide abuse; 3 of the 5 patients had life-threatening cardiac arrhythmias. One of the patients experienced a second life-threatening arrhythmia after he resumed loperamide abuse. Loperamide levels were obtained in 4 of the 5 patients and were at least one order of magnitude greater than therapeutic concentrations. Discontinuation of loperamide resulted in complete resolution of cardiac conduction disturbances. Conclusion. This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch®. [ABSTRACT FROM AUTHOR]