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Large randomised studies of new long-acting medications for the prevention and treatment of HIV have shown high effectiveness and acceptability. Although modelling studies indicate these agents could be fundamental in HIV elimination, coordination of their entry into health-care markets is crucial, especially in low-income and middle-income countries with high HIV prevalence, where coordination is low despite UNAIDS flagging that global HIV targets will not be met. Research and implementation projects are tightly controlled by originator pharmaceutical companies, with only a small percentage of eligible people living with or affected by HIV benefiting from these projects. WHO, financial donors, manufacturers, and governments need to consider urgent coordinated action from stakeholders worldwide, akin to the successful introduction of dolutegravir into treatment programmes across low-income and middle-income countries. Without this immediate coordination, large-scale access to long-acting agents for HIV will be delayed, potentially extending into the 2030s. This delay is unacceptable considering the established global HIV targets.

Die COVID-19-Pandemie und die damit einhergehenden Maßnahmen sorgten für große Alltagsveränderungen, die Auswirkungen auf die psychische Gesundheit und das psychische Belastungserleben hatten.

Established as a sub-discipline of Chemical Engineering in the 1960s by the late Professor R.W.H. Sargent at Imperial College London, Process Systems Engineering (PSE) has played a significant role in advancing the field, positioning it as a leading engineering discipline in the contemporary technological landscape. Rooted in Applied Mathematics and Computing, PSE aligns with the key components driving advancements in our modern, information-centric era. Sargent’s visionary foresight anticipated the evolution of early computational tools into fundamental elements for future technological and scientific breakthroughs, all while maintaining a central focus on Chemical Engineering. This paper aims to present concise and concrete ideas for propelling PSE into a new era of progress. The objective is twofold: to preserve PSE’s extensive and diverse knowledge base and to reposition it more prominently within modern Chemical Engineering, while also establishing robust connections with other data-driven engineering and applied science domains that play important roles in industrial and technological advancements. Rather than merely reacting to contemporary challenges, this article seeks to proactively create opportunities to lead the future of Chemical Engineering across its vital contributions in education, research, technology transfer, and business creation, fully leveraging its inherent multidisciplinarity and versatile character.

The use of carbon fibre-reinforced polymers in high-performance electric motors enables higher levels of efficiency and system rigidity. The demands on the surface quality of the individual components are so high that they can only be achieved by grinding processes. This paper investigates the influence of fibre orientation and abrasive grain size on the surface roughness during side-face grinding of CFRP.

IMPORTANCE: Patients with atrial fibrillation (AF) can have an ischemic stroke (IS) despite oral anticoagulant (OAC) treatment. Knowledge regarding the association between OAC discontinuation and the subsequent risk of recurrent IS in patients with AF is limited. OBJECTIVES: To determine the risk of recurrent IS in patients with AF receiving OAC and to evaluate the association between OAC discontinuation and the risk of recurrent IS. DESIGN, SETTING, AND PARTICIPANTS: This is a nationwide cohort study of patients aged 50 years or older in Denmark who had AF and an IS (entry IS) and were initiating or restarting subsequent OAC treatment after being discharged between January 2014 and December 2021. Patients were followed up for recurrent IS until June 2022. Within this study cohort, a nested case-control analysis was performed in which patients with recurrent IS were matched to patients receiving OAC who had not yet experienced a stroke. Data were analyzed from May 25, 2023, to April 18, 2024. EXPOSURE: Use of OAC at the time of recurrent IS or the equivalent date in matched controls based on redeemed prescriptions. MAIN OUTCOMES AND MEASURES: The primary outcome was recurrent IS. Crude and adjusted cumulative incidences of recurrent IS and all-cause mortality were calculated in cohort analyses, and adjusted odds ratios (aORs) were determined for recurrent IS associated with OAC discontinuation in nested case-control analyses. RESULTS: The study cohort included 8119 patients (4392 [54.1%] male; mean [SD] age, 78.4 [9.6] years; median (IQR) CHA2DS2-VASc score, 4.0 [3.0-5.0]). Over a mean (SD) follow-up of 2.9 (2.2) years, 663 patients had a recurrent IS, of whom 533 (80.4%) were receiving OAC at the time of their recurrent IS. The crude cumulative incidence of recurrent IS at 1 year was 4.3% (95% CI, 5.9%-7.1%), and the crude cumulative incidence of all-cause mortality was 15.4% (95% CI, 14.7%-16.2%). Adjusted analysis showed similar results. Patients who discontinued OACs had a higher risk of recurrent IS (89 cases [13.4%], 180 controls [6.8%]; aOR, 2.13; 95% CI, 1.57-2.89) compared with patients still receiving OAC. CONCLUSIONS AND RELEVANCE: The risks of recurrent IS and mortality were high in patients with AF despite secondary prevention with OAC, and OAC discontinuation doubled the risk of recurrent IS compared with patients who continued OAC. This finding highlights the importance of OAC continuation and the need for improved secondary stroke prevention in patients with AF.

We report an in-depth study of the thermodynamic and magnetocaloric properties of a strongly frustrated magnet, Cs2Fe2(MoO4)3. The underlying structure belongs to the double trillium lattice, which consists of two FeII(S= 2) sites with easy-axis and easy-plane single-ion anisotropy. Detailed 57Fe Mössbauer spectroscopic investigations along with ligand-field calculations support the existence of disparate ground states. The antiferromagnetic ordered structure is presented by the propagation vector k= (0,0,0) with noncollinear magnetic moments of 2.97 μB(Fe1) and 0.17 μB(Fe2), respectively. Strong and disordered magnetic correlations exist in the temperature regime between TN≈ 1.0 K and |θCW| ≈ 22 K. The large degeneracy of the ground state is investigated in terms of its magnetocaloric response. Magnetization and specific heat measurements indicate a significant magnetocaloric cooling efficiency, making this rare-earth-free compound a promising candidate for cryogenic magnetic refrigeration applications, with refrigeration capacity of 79 J kg–1for Δ(μ0H) = 8 T.

Vitamin A plays a key role in lung development, but there is no consensus regarding the optimal vitamin A dose and administration route in extremely low birthweight (ELBW) infants. We aimed to assess whether early postnatal additional high-dose fat-soluble enteral vitamin A supplementation versus placebo would lower the rate of moderate or severe bronchopulmonary dysplasia or death in ELBW infants receiving recommended basic enteral vitamin A supplementation.

Während herkömmliche Studienkredite und die staatliche Förderung nach dem BAföG als studentische Geldquellen in der letzten Zeit immer weiter an Bedeutung verloren haben, verzeichnen sog. Bildungsfonds aktuell auch in Deutschland eine wachsende Zahl an Vertragsabschlüssen. Das Geschäftsmodell der Bildungsfonds besteht darin, dass ausgewählte Studierende aus dem Fonds regelmäßige Zahlungen erhalten, um ihr Studium zu finanzieren. Nach dessen Abschluss leisten sie Rückzahlungen an den Bildungsfonds, deren Höhe von ihrer individuellen Einkommenssituation während einer bestimmten Zeitspanne nach dem Berufseinstieg abhängt. Niedrige Rückzahlungen der Geförderten mit geringem Einkommen werden kompensiert durch wesentlich höhere Zahlungen der nach dem Studium gut Verdienenden. Das individuelle Einkommensrisiko des einzelnen Geförderten wird entsprechend dem Versicherungsprinzip vom Bildungsfonds, letztendlich aber von der Solidargemeinschaft der Geförderten getragen. Die zivilrechtliche Einordnung entsprechender Studienfinanzierungsverträge wird in der Rechtsprechung und im – bislang hierzu spärlichen – Schrifttum nicht einheitlich vorgenommen. Sie ist aber wesentlich mit Blick auf die anwendbaren Vorschriften, etwa des Verbraucherdarlehensrechts. Hiermit sowie mit der bankaufsichtsrechtlichen Relevanz von Studienfinanzierungsverträgen befasst sich der nachstehende Beitrag.

Making sustainable biopolymers available as replacements for fossil-based additives requires fitting of physical and chemical properties. As β-1,4-linked hemicelluloses are soluble in water only to a certain extent, introduction of a functional group (ternary amines) is required to overcome this issue. The study showed that the reaction conditions for the etherification of glycans from depectinized apple pomace can be varied significantly while still obtaining the desired degree of substitution with high yields. Keeping the reaction temperature at 60 °C, the time can be lowered to 0.5–1 h, which saves up to 4 h in total, and the input equivalents of diethylaminoethyl can significantly be reduced up to 63% regarding numerical optimization. An important result was the strong increase in the water solubility by 200%, which is excellent for future applications in water-based coating systems.

The safety and feasibility of human milk fortification with bovine colostrum (BC) were investigated in very preterm infants (FortiColos trial, NCT03537365). The BC product contained lower calcium, phosphate, and iron levels compared to the conventional fortifier (CF). We tested whether fortification with BC plus extra phosphate was sufficient to support the infants' mineral status assessed by blood biochemistry. In a randomised controlled trial (FortiColos, NCT03537365), mineral status was compared after fortification with BC versus CF. Blood calcium, phosphate, and haemoglobin were determined before and up to 3 weeks after the start of fortification (at the mean age of 8–9 days). The maximum supplemental doses of calcium, phosphate, and iron given were retrieved from patient medical records. Results were adjusted for gestational age, birth weight, and enteral nutrition with the mother's own milk and/or donor human milk. Blood values of calcium, phosphate, and haemoglobin were similar between groups. Infants in both groups required supplementation with calcium and phosphate, but infants fed BC required higher maximum doses of phosphate and calcium (p< 0.05) to maintain acceptable blood values. Regardless of fortification groups, the most immature (<29 weeks of gestation) and small for gestational age infants showed a higher risk for requiring additional phosphate (odds ratio [OR]: 3.9, p< 0.001; OR: 2.14, p= 0.07, respectively). The use of BC as a fortifier for human milk requires additional phosphate and calcium relative to a CF. Regardless of the fortification product, the most immature and small infants require additional mineral supplementation. Bovine colostrum contains less phosphate, calcium, and iron compared to a conventional fortifier.It is unknown what the recommended amount of minerals and iron in fortification products should be. Bovine colostrum contains less phosphate, calcium, and iron compared to a conventional fortifier. It is unknown what the recommended amount of minerals and iron in fortification products should be. Infants fed with bovine colostrum required additional phosphate and calcium compared to a conventional fortifier.Regardless of the fortification product, the most preterm and growth‐restricted infants required additional mineral supplementation. Infants fed with bovine colostrum required additional phosphate and calcium compared to a conventional fortifier. Regardless of the fortification product, the most preterm and growth‐restricted infants required additional mineral supplementation.

The toxin‐producing dinoflagellate Alexandrium pseudogonyaulaxhas become increasingly abundant in northern European waters, replacing other Alexandriumspecies. A. pseudogonyaulaxproduces goniodomins and lytic substances, which can be cytotoxic toward other organisms, including fish, but we still know little about the environmental conditions influencing its growth and toxicity. Here, we investigated the impacts of different nitrogen sources and light intensities, common bottom‐up drivers of bloom formation, on the growth and toxin content of three A. pseudogonyaulaxstrains isolated from the Danish Limfjord. While the growth rates were significantly influenced by nitrogen source and light intensity, the intracellular toxin contents only showed strong differences between the exponential and stationary growth phases. Moreover, the photophysiological response of A. pseudogonyaulaxshowed little variation across varying light intensities, while light‐harvesting pigments were significantly more abundant under low light conditions. This study additionally highlights considerable physiological variability between strains, emphasizing the importance of conducting laboratory experiments with several algal strains. A high physiological plasticity toward changing abiotic parameters points to a long‐term establishment of A. pseudogonyaulaxin northern European waters.

Mit ihren gesundheitsfördernden und präventiven Maßnahmen in den Kitas und Schulen leistet die Gruppenprophylaxe einen wichtigen Beitrag zur Zahn- und Mundgesundheit der Kinder und Jugendlichen und damit auch für deren Allgemeingesundheit. Durch die nahezu vollständige Flächendeckung ist die Gruppenprophylaxe das reichweitenstärkste Präventionsangebot, mit dem auch benachteiligte Kinder und Jugendliche erreicht werden, die selten eine Zahnarztpraxis aufsuchen. Im Zusammenspiel mit den weiteren in den zahnmedizinischen Praxen durchgeführten präventiven Maßnahmen, beispielsweise den Früherkennungsuntersuchungen oder der Individualprophylaxe für Kinder und Jugendliche, eröffnet die Gruppenprophylaxe den Kindern und Jugendlichen die Chance auf eine lebenslange Mundgesundheit. Die Verhütung von Karies gelingt umso besser, je früher mit präventiven Maßnahmen begonnen wird. Daher kommt der Einbeziehung der unter 3-Jährigen in die Maßnahmen der Gruppenprophylaxe eine besondere Bedeutung zu. Darüber hinaus ist die enge Zusammenarbeit zwischen Zahnmedizin, Kinder- und Jugendmedizin, Gynäkologie und Geburtshilfe sowie den Hebammen notwendig.

Efficiency Adjusted Deferred Acceptance Rule (EDA)is a promising candidate mechanism for a public school assignment. A potential drawback of EDA is that it could encourage students to game the system since it is not strategy‐proof. However, to successfully strategize, students typically need information that is unlikely to be available to them in practice. We model school choice under incomplete information and show that EDA is regret‐free truth‐telling, which is a weaker incentive property than strategy‐proofness and was introduced by Fernandez (2020). We also show that there is no efficient matching rule that weakly Pareto dominates a stable matching rule and is regret‐free truth‐telling. Note that the original version of EDA by Kesten (2010) weakly Pareto dominates a stable matching rule, but it is not efficient.

Die Einführung eines Unit Dose Systems ist Teil eines Konzepts zur Erhöhung der Arzneimitteltherapiesicherheit im Herz- und Diabeteszentrum NRW (HDZ NRW), Bad Oeynhausen. Es ist ein Krankenhausprojekt mit weitreichenden Änderungen im gesamten Medikationsprozess, welches einer sorgfältigen Vorbereitung, einer regen Kommunikation zwischen allen Projektbeteiligten (Ärzteschaft, Pflegekräfte, Apotheker*innen) und eines eng miteinander abgestimmten Implementierungsplanes bedurfte. Vier Universitätskliniken mit insgesamt elf Stationen waren am Projekt beteiligt. Im Beitrag werden die Planung und Entstehung der neuen Versorgungsform beschrieben und erste Erfahrungen nach einem Jahr geschildert.

We present the self-consistent Pauli equation, a semi-relativistic model for charged spin-1/21/2particles with self-interaction with the electromagnetic field. The Pauli equation arises as the O⁢(1/c)O(1/c)approximation of the relativistic Dirac equation. The fully relativistic self-consistent model is the Dirac–Maxwell equation where the description of spin and the magnetic field arises naturally. In the non-relativistic setting, the correct self-consistent equation is the Schrödinger–Poisson equation which does not describe spin and the magnetic field and where the self-interaction is with the electric field only. The Schrödinger–Poisson equation also arises as the mean field limit of the 𝑁-body Schrödinger equation with Coulomb interaction. We propose that the Pauli–Poisson equation arises as the mean field limit N→∞N\to\inftyof the linear 𝑁-body Pauli equation with Coulomb interaction where one has to pay extra attention to the fermionic nature of the Pauli equation. We present the semiclassical limit of the Pauli–Poisson equation by the Wigner method to the Vlasov equation with Lorentz force coupled to the Poisson equation which is also consistent with the hierarchy in 1/c1/cof the self-consistent Vlasov equation. This is a non-trivial extension of the groundbreaking works by Lions & Paul and Markowich & Mauser, where we need methods like magnetic Lieb–Thirring estimates.

Background Melanoma causes most skin cancer–related deaths, and disparities in mortality persist. Rural communities, compared to urban, face higher levels of poverty and more barriers to care, leading to higher stage at presentation and shorter survival in melanoma. To further evaluate these disparities, we sought to assess the association between rurality and melanoma cause-specific mortality and receipt of recommended surgery in a national cohort.Methods Patients with primary non-ocular, cutaneous melanoma from the SEER database, 2000-2017, were included. Outcomes included melanoma-specific survival and receipt of recommended surgery. Rurality was based on Rural-Urban Continuum Codes. Variables included age, sex, race, ethnicity, income, and stage. Multivariate regression models assessed the effect of rurality on survival and receipt of recommended surgery.Results 103,606 patients diagnosed with non-ocular cutaneous primary melanoma met criteria during this period. 93.3% (n= 96620) were in urban areas and 6.7% (n= 6986) were in rural areas. On multivariate regression controlling for age, sex, race, ethnicity, and stage patients living in a rural area were less likely to receive recommended surgery (aOR .52, 95% CI: .29-.90, P= .02) and had increased hazard of melanoma-specific mortality (aHR 1.19, 95% CI: 1.02-1.40, P= .03) even after additionally controlling for surgery receipt.Conclusion Using a large national cohort, our study found that rural patients were less likely to receive recommended surgery and had shorter melanoma cause-specific survival. Our findings highlight the importance of access to cancer care in rural areas and how this ultimately effects survival for these patients.

Adaptation is central to address climate impacts. At present, we have a limited understanding of the effectiveness of adaptation to reduce risks in a warming world, because adaptation remains insufficiently addressed in climate impact projections. Where projections exist, these are assessed mostly in case study settings. The importance of water is apparent within the field of climate adaptation, with the majority of documented and projected adaptation related to water. Based on a meta-review of projections of adaptation, we assess the ability of different modeled water-related adaptation options to reduce climate risk at 1.5°C, 2°C, 3°C, and 4°C of warming and show that the effectiveness of the assessed options decreases with increasing warming across all world regions and options. Although adaptation benefits can be achieved for many regions, increasing maladaptive outcomes are projected at higher levels of warming. Our analysis highlights the urgent need to limit global warming by drastically reducing emissions to avoid catastrophic impacts.

Breast cancer is a leading cause of death in women, and its management highly depends on early disease diagnosis and monitoring. This remains challenging due to breast cancer’s heterogeneity and a scarcity of specific biomarkers that could predict responses to therapy and enable personalized treatment. This Perspective describes the diagnostic landscape for breast cancer management, molecular strategies targeting receptors overexpressed in tumors, the theranostic potential of the oxytocin receptor (OTR) as an emerging breast cancer target, and the development of OTR-specific optical and nuclear tracers to study, visualize, and treat tumors. A special focus is on the chemistry and pharmacology underpinning OTR tracer development, preclinical in vitroand in vivostudies, challenges, and future directions. The use of peptide-based tracers targeting upregulated receptors in cancer is a highly promising strategy complementing current diagnostics and therapies and providing new opportunities to improve cancer management and patient survival.