Federal Ministry Of Education Research Articles

Patients’ experiences of racism in German inpatient healthcare

Abstract Background Racism is recognised as a social determinant of health. An evolving concern in research and policymaking has been the impact of racism in the healthcare system, particularly regarding the quality of healthcare and barriers for healthcare. Little is known about patients’ experiences of racism in hospitals and rehabilitation facilities in Germany and their coping strategies in dealing with racism. Methods As part of a joint project on racism in healthcare (RiGeV) funded by the Federal Ministry of Education and Research, twenty qualitative interviews and two group discussions with patients and their next of kin about their experiences in hospitals and rehabilitation facilities were conducted and analysed using the documentary method. Ethical approval for this study was obtained from the Ethics Committee of Fulda University of Applied Sciences. Results Interviews with patients and their next of kin revealed that the most significant experiences of racism in hospitals are attributions of dramatisation and exaggeration of pain, embedded in a general perception of not being taken seriously and/or being ignored. Patients try to avoid such experiences that compromise their trust and sense of security, as well as the quality of treatment they receive. Healthcare for refugees is impacted by structural barriers (AsylBLg) which jeopardise the healing process and represent a considerable psychosocial burden. Conclusions Recommendations for policies and practice include a mission statement for non-discriminatory treatment and the sanctioning of racism within healthcare institutions. A complaints office should manage implementation and offer support for affected patients. The topic of racism must be addressed in the training and further education of doctors and healthcare professionals. Patient trust in a safe and high-quality form of healthcare should be strengthened by addressing their complaints. Health care for refugees has to be improved. Key messages • Racism in German inpatient healthcare represents a considerable psychosocial burden for patients and impairs the quality of treatment they receive. • Policies for reducing racism inpatient healthcare have to be implemented.

Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial

Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure. EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany. Eligible patients (aged 18years or older) had heart failure, with New York Heart Association class IIor more and NT-proBNP concentrations greater than or equal to 400pg/mL. Patients were randomly assigned (1:1) to receive EIPC with standard cardiac care or standard cardiac care alone. Randomisation was computer-generated with allocation concealment, variable block sizes, and stratification by investigational site. The primary endpoints were health status and mood, measured every 3months over 12months using the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-PAL) and the Kansas City Cardiomyopathy Questionnaire (KCCQ), analysed by intention to treat. This trial is registered with DRKS.de, DRKS00013922. Between May 21, 2019, and Nov 15, 2021, 843patients were assessed for eligibility, 205of whom were enrolled (100 assigned to EIPC and 105assigned to standard cardiac care). 143 (70%) patients were male and 62 (30%) were female. Over 12months, both groups significantly improved in FACIT-PAL and KCCQ Overall Summary Score(OSS) with no significant differences between the groups (FACIT-PAL adjusted mean difference 0·98points [95% CI -1·28to 3·23]; p=0·40; KCCQ-OSS adjusted mean difference -2·06points [-7·89to 3·78]; p=0·49). Nine (9%) patients in the EIPC group and seven (7%) patients in the standard cardiac care group died from any cause, with no significant differences in time to death between the two groups (hazard ratio [HR] 1·32 [95% CI 0·49 to 3·54]; p=0·58). 22 (22%) patients in the EIPC group and 21 (21%) patients in the standard cardiac care group were hospitalised at least once due to heart failure, with no significant differences in time to heart-failure-related hospitalisation between the two groups (HR 1·09 [0·61 to 1·98]; p=0·77). 70 (70%) patients in the EIPC group and 62 (59%) in the standard cardiac care group had any adverse events (p=0·10). In this open-label, randomised clinical trial, standard cardiac care, featuring guideline-directed optimisation of medical therapy and regular 3-monthly follow-ups was found to be as effective as when combined with EIPC in improving health status and mood in patients with non-terminal heart failure. Future clinical practices should consider EIPC based on individual patient needs. Federal Ministry of Education and Research.

Elucidating the Effect of Pre-Lithiation of Silicon Dominant Anodes on the Full Cell Performance

Over the last few years, there has been a high interest in increasing the energy density of lithium-ion batteries in order to increase the driving range of battery electric vehicles. On a material level, silicon is a promising anode active material candidate due to its high theoretical capacity of 3579 mAh g-1, which is approximately ten-fold higher than that of the currently used graphite anodes with a theoretical capacity of 372 mAh g-1.[1] However, the main drawbacks of silicon are its intrinsic volume expansion of +300 % upon lithiation.[2] This leads to rupturing of the passivating solid electrolyte interphase (SEI), particle cracking, and loss of electronic contact, limiting the lifetime of batteries with silicon based anodes, thus hindering their transition into application.As a possible solution, Jantke et al. proposed the concept of partial utilization of µm-sized crystalline silicon, where only one-third of the theoretical capacity is used for (de)lithiation. Thereby, a crystalline core remains, and the volume expansion on the particle-level is reduced to approximately + 100%.[3] In addition, it was shown that irreversible losses during the formation and upon cycling can be compensated by pre-lithiation of the anode, which increases the lifetime significantly.[4,5] In this study, we investigated a promising cell chemistry for high-energy applications, containing a Si-dominant anode and a cathode based on a Co-free lithium- and manganese-rich NMC. The here used anode consists of 70 wt% silicon, 20 wt% graphite, 2 wt% conductive C65, and 8 wt% LiPAA-binder. Note that graphite mainly acts as a conductive additive within the operating voltage window, with a negligible contribution to the overall anode capacity. The electrochemical testing was conducted at 25 °C in Swagelok® T-cells containing two glass fiber separators, a 1M LiPF6 in FEC:DEC (2:8, v:v) electrolyte and a lithium metal reference.Without pre-lithiation, these full-cells suffered from rapid capacity fading, reaching the 80 % state-of-health (SOH) criterion after ~100 cycles. As will be discussed, our analysis shows that the primary mode of failure in these cells is the loss of cyclable lithium, evidenced by an increase in the end-of-discharge potential at the anode. It was found that with increasing end-of-discharge potential at the anode, the anode resistance at low state-of-charge rises significantly.Therefore, silicon anodes were lithiated in coin half-cells to 25, 50, and 75 % of the reversible cathode capacity (corresponding to 300, 600, and 900 mAh gSi -1). Then, the anodes were harvested in the lithiated state and assembled in a Swagelok® T-cell with the same cathode, separator, and electrolyte as the non-pre-lithiated reference cells. Pre-lithiation leads to similar reversible charge/discharge capacities, but generates a cyclable lithium reservoir in the anode.Successively increasing the pre-lithiation of the anode increases the lifetime from 100 to 550 cycles. The onset of the above-described aging phenomena is delayed by 150 cycles for every additional 25 % pre-lithiation. Further, the influence of aging and lithium inventory on anode and cathode resistance will be discussed, showing that the increase in anode resistance is mainly a function of (de)lithiation rather than cycle number.Acknowledgments:The authors gratefully acknowledge the funding from the BMBF (Federal Ministry of Education and Research, Germany) in the ExZellTUM III project (grant number 03XP0255). We also kindly thank Wacker Chemie AG and BASF SE for providing the anode and cathode active materials.

Effect of Mechanical Pressure on Rate Capability, Lifetime, and Expansion of Multilayer Pouch Cells with Silicon-Dominant Anodes

Silicon-dominant (Si) anodes with microscale silicon particles meet the requirements of high energy density and low costs due to its ten times higher theoretical electrochemical capacity of 3579 mAh/gSi (Li15Si4) compared to graphite,1 lifetime extension due to partial lithiation,1-2 and high abundance and economic availability due to existing industrial infrastructure.1-2 The major drawback of silicon is the large volume expansion of nearly 300% upon full lithiation. This hinders the broad application of silicon as an active anode material due to continuous SEI (re-) formation and electrochemical milling of particles. Additionally, the volume expansion impacts the overall electrode stability, leading to thickness changes, the disruption of the electronic pathways, and the decoupling of particles. Although the approach of partial lithiation of microscale1 Si eases these effects by lowering the overall volume expansion, these problems still exist.2,3 In this work, the effect of different mechanical cell pressures on lithium-ion batteries with partially lithiated silicon-dominant anodes is investigated with 5.4 Ah multilayer pouch cells as a follow-up study of our previous work with laboratory T-Cells.3 Methodologically, a novel cell holder and pressure device were developed and validated to apply different mechanical cell pressures. Our investigation covers a pressure range from uncompressed as zero (ZP, 0.00 MPa) to high (HP, 0.50 MPa) external cell pressure to determine the optimal pressure for high rate capacity, cyclic lifetime, energy density, and low thickness gain. The cells were tested by checkup cycles at C/10, rate tests up to 3C, and cycled at C/2 until 70% state of health (SoH). Electrochemical impedance spectroscopy was conducted at different SoHs to quantify the effect of mechanical pressures on the impedance response.4 The post-mortem analysis after reaching 70% SoH and operando thickness measurements in a compression test5 bench give insights into the electrode and cell thickness gain.In the electrochemical results, the discharge capacity Q DCH was immediately reduced by decreasing the mechanical pressure from 0.20 MPa to 0.00 MPa or 0.05 MPa, both for the cells in the cell holder (see inset in Figure 1a) and the compression test bench (not shown). This pressure change was also quantified by an increased charge-averaged full cell potential during charging and a decreased charge-averaged full cell potential during discharging. The impedance was reduced for higher mechanical pressure, especially the cathode contact resistance initially and over aging, resulting in lower temperature increases during the rate tests. The capacity retention Q DCH and the total charge throughput were increased to 360 cycles until 70% SoH for higher mechanical pressures at NP (normal pressure, 0.20 MPa) and HP (see Figure 1) compared to 181 cycles for ZP. Overall, applying higher mechanical pressures reduced the thickness increase, as shown by operando thickness measurements and the post-mortem analysis. A dependency of the reversible thickness on the charged capacity was found. Moreover, the porosity decreased with increasing pressure, which was measured with mercury intrusion porosimetry (MIP) and pycnometry. The anode mass increase correlates to the total charge throughput, which is pressure-dependent and the highest for NP.Our findings demonstrate that applying the optimal mechanical cell pressure is significant when using microscale silicon-dominant anodes. We recommend a mechanical pressure of 0.50 MPa for increased rate capacity, minimizing impedance, heat evolution, and thickness gain, and 0.20 MPa for increased energy density. Acknowledgments: S.F. gratefully acknowledges the financial support from the BMBF (Federal Ministry of Education and Research, Germany) under the auspices of the ExZellTUM III project (grant number 03XP0255). The authors want to thank the research battery production team of iwb at TUM for the multi-layer pouch cell production. We also thank Wacker Chemie for kindly providing the microscale silicon material.

Influence of Cycling in Different State-of Charge Windows on Lifetime and Electrode Expansion of Microscale Silicon-Dominant Lithium-Ion Batteries

Silicon (Si) is a promising active anode material for next-generation lithium-ion batteries due to its high theoretical electrochemical capacity of 3579 mAh/gSi (Li15Si4) and low costs using microscale Si particles.1,2 However, the wide usage of Si as an active anode material is hindered due to its lower lifetime compared to graphite anodes. The degradation in silicon-containing batteries can be suppressed by partial lithiation strategies,2,3,4 with applications for automotive cells leading to improved lifetime.5 However, the lifetime problem still exists in partially lithiated microscale Si particles with lower volume expansion2,3 with ≈200 cycles for one-third silicon utilization, i.e., 1200 mAh/gSi 2. Moreover, we confirmed in our previous study6 as reported by Wetjen et al.4 and Haufe et al.2 that lower cell discharge cut-off voltages and thus higher silicon delithiation potentials versus Li+/Li led to accerlated aging and should be avoided.Thus, the motivation for this study is to avoid these high anode delithiation potentials by operating the cells in a high full cell state of charge (SoC) and to investigate the influence of different SoC windows on lifetime with laboratory 182.1 ± 0.7 mAh/gNCA Swagelok T-cells comprising a microscale silicon-dominant anode and a NCA cathode. The electrode-specific aging is monitored with the lithium metal reference electrode based on the anode and cathode potentials and pulse tests. To investigate the aging in different SOC regimes, three cycling conditions were chosen in the low (LV), middle (MV) and high voltage (HV) window and compared to cells cycled between 2.8 and 4.2 V as full voltage6. The voltage window of LV, MV and HV were chosen to represent cycling between 0-50%, 25-75%, and 50-100% SOC, respectively. Formation and checkups were the same for all cells with 2.80 V to 4.20 V. After reaching the end-of-life criterion of 55% state of health (SoH), the cells were disassembled and anode and cathodes were re-assembled in half-cells for a post-mortem analysis to reveal loss of lithium inventory (LLI) and loss of active material of the anode LAMAn, and the cathode LAMCat of the respective full-cells. Complementary to the electrochemical aging, dilatometer measurements7 were conducted to quantify the electrode expansion for the different silicon anode SoC windows since particle decoupling is expected to be one of the major aging mechanisms for microscale silicon2, which is expected for high electrode expansions.For the electrochemical results, the lifetime can be drastically increased from ≈230 to ≈560 equivalent full cycles (EFCs) for operating the full cell in the HV compared to the FV window, as shown in Fig. 1a. One EFCs is defined as the total charge throughput for charging and discharging one cycle normalized to the capacity of the initial checkup cycle. Over aging, the full cell degradation correlates very well with the end of discharge potential of the silicon anodes. Moreover, the electrode-specific pulse results show strong anode degradation while the cathode remains intact. The post-mortem results reveal LLI as most dominenat aging mode, which was very similar for all voltage windows. The HV cells showed both the highest LAMNE and LAMPE, whereas LAMNE was more dominant compared to LAMPE. The silicon amorphization was the lowest for the LV anodes and the highest for the HV anodes at the same SoH. The dilatometer results show that the silicon electrode expansion is the lowest for the low lithiation, i.e., LV, and the highest for the highest lithiation, i.e., HV. From the dilatometry results, we conclude that the mechanical electrode stability does not limit lifetime.Our results demonstrate that lifetime can be significantly improved by a factor of ≈2.4 based on the EFCs if operating cells with silicon dominant anodes in high SoCs and that low SoCs should be avoided. Acknowledgments: S. F. gratefully acknowledges the financial support from the BMBF (Federal Ministry of Education and Research, Germany) under the auspices of the ExZellTUM III project (grant number 03XP0255). The authors want to thank our student worker, Maximilian Reichl, for the fabrication of the NCA coatings. We also thank Wacker Chemie AG for kindly providing the microscale silicon material.

Disease-specific T cell receptors maintain pathogenic T helper cell responses in postinfectious Lyme arthritis.

Antibiotic-Refractory Lyme Arthritis (ARLA) involves a complex interplay of T cell responses targeting Borrelia burgdorferi antigens succeeding towards autoantigens by epitope spreading. However, the precise molecular mechanisms driving the pathogenic T cell response in ARLA remain unclear. Our aim was to elucidate the molecular program of disease-specific Th cells. Using flow cytometry, high-throughput T cell receptor (TCR) sequencing and scRNA-seq of CD4+ Th cells isolated from the joints of European ARLA patients, we aimed at inferring antigen specificity through unbiased analysis of TCR repertoire patterns, identifying surrogate markers for disease-specific TCRs and connecting TCR specificity to transcriptional patterns. PD-1hiHLA-DR+CD4+ effector T cells were clonally expanded within the inflamed joints and persisted throughout disease course. Among these cells, we identified a distinct TCRβ motif restricted to HLA-DRB1*11 or *13 alleles. These alleles, being underrepresented in North American ARLA patients, were unexpectedly prevalent in our European cohort. The identified TCRβ motif served as surrogate marker for a convergent TCR response specific to ARLA, distinguishing it from other rheumatic diseases. In the scRNA-seq dataset, the TCRβ motif particularly mapped to peripheral T helper (TPH) cells displaying signs of sustained proliferation, continuous TCR signaling, and expressing CXCL13 and IFN-γ. By inferring disease-specific TCRs from synovial T cells we identified a convergent TCR response in the joints of ARLA patients that continuously fueled the expansion of TPH cells expressing a pathogenic cytokine effector program. The identified TCRs will aid in uncovering the major antigen targets of the maladaptive immune response. Supported by the German Research Foundation (DFG) MO 2160/4-1; the Federal Ministry of Education and Research (BMBF; Advanced Clinician Scientist-Program INTERACT; 01EO2108) embedded in the Interdisciplinary Center for Clinical Research (IZKF) of the University Hospital Würzburg; the German Center for Infection Research (DZIF; Clinical Leave Program; TI07.001_007) and the Interdisciplinary Center for Clinical Research (IZKF) Würzburg (Clinician Scientist Program, Z-2/CSP-30).

Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Federal Ministry of Education and Research. Background/Introduction To increase vaccine safety, adverse events of COVID-19 vaccines are continuously monitored. This also includes rare complications of the cardiovascular system. However, it has so far been scarcely investigated whether chronic and subtle, clinically inapparent myocardial and/or vascular injury occurs in a COVID-19 vaccinated population on a broader basis. Purpose The aim of this study was to analyse chronic and subclinical adverse effects of COVID-19 vaccines on the cardiovascular system. Vaccine-associated myocardial involvement was examined by measuring high-sensitive troponin T (hsTnT) while mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction. Methods This was a prospective observational study with a vulnerable population of healthcare workers (HCWs) and elderly (> 70 years) patients who were vaccinated with either the ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) and the BNT162b2 mRNA vaccine (BNT), or with BNT/BNT between the 12th of January and 30th of November 2021 (Figure 1). HsTnT and MR-proADM was measured in blood samples at three visits (V1: 1st baseline, immediately before vaccination; V2: 3-4 weeks after 1st vaccination; V3: 3-4 weeks after 2nd vaccination). HsTnT levels were further compared with a healthy reference cohort. Results 120 participants were included (V1=119, V2=120, V3=120). 50 (41.7%) received AZ/BNT. 70 (58.3%) were vaccinated with BNT/BNT of whom 20 (16.7%) were elderly and 50 (41.7%) were HCWs. Median hsTnT levels were at 4ng/L, 5ng/L and 4ng/L (V1-V3) for AZ/BNT and at 6ng/L, 6ng/L and 6ng/L (V1-V3) for BNT/BNT, respectively (Figure 2). Levels of MR-proADM were 0.43nmol/L, 0.46nmol/L and 0.44nmol/L (V1-V3) in the AZ/BNT cohort and 0.49nmol/L, 0.43nmol/L and 0.49nmol/L in the BNT/BNT group. Change of hsTnT and MR-proADM values between visits did not show significant increases. Two cases had a transient (7ng/L, 19ng/L, 5ng/L; male, 29 years) or permanent (15ng/L, 21ng/L, 25ng/L; male, 37 years) increase in hsTnT levels, exceeding the upper reference limit (≥ 14ng/L). Compared to the reference population (n=300), median hsTnT was significantly higher at all visits for both vaccination groups (p<0.05), without significant differences between the AZ/BNT and BNT/BNT cohorts. Conclusion(s) With two individual exceptions, no overall chronic myocardial injury or endothelial involvement was observed up to 4 weeks after the 2nd SARS-CoV-2 vaccination when comparing hsTnT and MR-proADM after both vaccinations to baseline values.Figure 1Vaccination scheme.Figure 2.hsTnT values at V1-V3.

The Impact of Passive Social Media Viewers in Influence Maximization

A frequently studied problem in the context of digital marketing for online social networks is the influence maximization problem that seeks for an initial seed set of influencers to trigger an information propagation cascade (in terms of active message forwarders) of expected maximum impact. Previously studied problems typically neglect that the probability that individuals passively view content without forwarding it is much higher than the probability that they forward content. Considering passive viewing enables us to maximize more natural (social media) marketing metrics, including (a) the expected organic reach, (b) the expected number of total impressions, or (c) the expected patronage, all of which are investigated in this paper for the first time in the context of influence maximization. We propose mathematical models to maximize these objectives, whereby the model for variant (c) includes individual’s resistances and uses a multinomial logit model to model customer behavior. We also show that these models can be easily adapted to a competitive setting in which the seed set of a competitor is known. In a computational study based on network graphs from Twitter (now X) and from the literature, we show that one can increase the expected patronage, organic reach, and number of total impressions by 36% on average (and up to 13 times in particular cases) compared with seed sets obtained from the classical maximization of message-forwarding users. History: Accepted by Andrea Lodi, Area Editor for Design & Analysis of Algorithms—Discrete. Funding: This work was supported by the Federal Ministry of Education, Science and Research of Austria and by the Austrian Agency for International Mobility and Cooperation in Education, Science and Research [Reference ICM-2019-13384]. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2023.0047 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2023.0047 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .

Service Quality Implications of Long Periods of Consecutive Working Days: An Empirical Study of Neonatal Intensive Care Nursing Teams

Problem definition: We examine the effects of prolonged consecutive working days without breaks on care quality and explore its association with daily staffing levels in neonatal intensive care nursing teams. Academic/practical relevance: Healthcare organizations typically base staffing guidelines on safe daily metrics like nurse-to-patient ratios. However, in response to unforeseen demand spikes or staff shortages, managers often depend on staff working additional consecutive days to bridge staffing gaps. This approach, although addressing immediate staffing needs, can inadvertently impact care quality and safety, potentially undermining the benefits of higher staffing levels. Methodology: Using longitudinal data from 62 German neonatal units, we analyze the effect of nursing teams’ consecutive working days on the time from admission to full enteral feeding for 847 low-birth-weight babies, considering nurse-to-patient ratios and patient complexity. Results: Longer consecutive working periods harmfully affect care quality, especially during staffing shortages. The detrimental impact on days with low staffing is particularly pronounced in patients with less complex medical needs. Limiting the team-average number of consecutive working days to two days would have reduced the time to full enteral feeding in our study by 6.4%. Shifting from half a day less to half a day more than the average number of consecutive working days has an impact equal to 20% of the difference in time taken to reach full enteral feeding between low- and high-birth-weight babies. Managerial implications: Limiting consecutive working days could significantly improve intensive care outcomes. Management should monitor consecutive working days alongside daily staffing levels. Policy makers should consider introducing limits on the number of consecutive working days for intensive care nurses. Funding: This work was supported by the Federal Ministry of Education and Research in Germany [Grant 01GY1152]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0021 .

Clinical Supervision for Quality Education Delivery in Public Schools in Nigeria

This paper discussed clinical supervision for quality education delivery in public schools in Nigeria. Clinical supervision is a formal process of professional support and learning that enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice, and enhance consumer protection and safety of care in complex clinical situations. Clinical supervision stands as the cornerstone of educational excellence in Nigerian public schools, offering a dynamic and transformative approach to elevate the quality of education delivery. The paper emphasized that clinical supervision can bring about quality education delivery in several key aspects which include: Professional Growth and Development, Contextual Adaptation, Innovative Pedagogies and Technology Integration, Quality Assurance and Standardization, Professional Collaboration and Peer Learning, Emotional and Social Well-being, Observation and Feedback, Assessment of Teacher Competencies and Reflective practices. Also, identified the impacts of clinical supervision on quality education delivery, which includes: Enhanced Teaching Practices, Professional Development, Increased Teacher Self-Efficacy, Alignment with Standards, Retention and Job Satisfaction, Technology Integration, Positive Student Outcomes, Promotion of Reflective Practice, Enhanced Collaboration, Leadership Development and Quality Assurance. It therefore concluded that clinical supervision emerges not merely as a pedagogical process but as a transformative force poised to elevate the landscape of education delivery in public schools across Nigeria. The paper likewise made some outstanding suggestions that; School Administrators should clearly define the objectives of clinical supervision, outlining specific goals for professional development, teaching improvement, and student outcomes. This clarity provides a roadmap for both supervisors and educators. Finally, Federal ministry of education should offer regular professional development opportunities aligned with the needs identified through clinical supervision. Provide access to workshops, training sessions, and resources to enhance educators' skills and knowledge.

Evaluation of all-cause mortality and cardiovascular safety in patients receiving chimeric antigen receptor T cell therapy: a prospective cohort study

Assessment of cardiovascular risk is critical for patients with cancer. Previous retrospective studies suggest potential cardiotoxicity of CAR T cell therapies. We aimed to prospectively assess cardiotoxicity and the predictive value of cardiac biomarkers and classical risk factors (age, cardiac function, diabetes, arterial hypertension, smoking) for cardiac events and all-cause mortality (ACM). In this prospective cohort study, all patients treated with CAR T cell constructs (axi-cel, tisa-cel, brexu-cel, ide-cel, or the 3rd generation CAR HD-CAR-1) from Oct 1, 2018, to Sept 30, 2022at the University Hospital Heidelberg were included. Surveillance included cardiac assessment with biomarkers (high-sensitive Troponin T (hs-cTnT), N-terminal brain natriuretic peptide (NT-proBNP)), 12-lead-ECG, and 2D echocardiography. ACM was defined as the primary study endpoint, while cardiotoxicity, defined by clinical syndromes of heart failure or decline in ejection fraction, served as a secondary endpoint. Overall, 137 patients (median age 60, range 20-83, IQR 16), were included in the study. 46 patients died during the follow up period (median 0.75 years, range 0.02-4.33, IQR 0.89) 57 month, with a median survival of 0.57 years (range 0.03-2.38 years, IQR 0.79). A septal wall thickness above 11mm (HR 2.48, 95%-CI=1.10-5.67, p=0.029) was associated with an increased risk of ACM, with a trend seen for reduced left ventricular ejection fraction prior to therapy (LVEF <40%; HR 9.17, 95%-CI=1.30-183.11, p=0.051). Secondary endpoint was reached by 93 patients while no baseline parameter was able to predict an elevated risk. However, hs-cTnT change from baseline of 50% or more during the first 14 days after CAR infusion predicted ACM (HR 3.81, 95%-CI=1.58-9.45; p=0.003). None of the baseline characteristics was able to predict the incidence of cardiac events. Reduced pre-lymphodepletion ejection fraction and early post-infusion biomarker kinetics may be associated with increased ACM and cardiotoxicity events. These findings may help to identify patients who could benefit from intensified cardio-oncological surveillance. The German Center for Cardiovascular Research, German Research Foundation, and the Federal Ministry of Education and Research.

Elementary School Teachers’ Dispositions about the Assessment of Students

The study aim was to assess teachers’ dispositions towards student assessment based on national standards. National Standards for teachers’ professional development were developed under the Federal Ministry of Education; Government of Pakistan in 2009. For this end, interviews with 32 teachers working in elementary schools were conducted. It was observed that most of the teachers have different valuable viewpoints regarding the process of student assessment. However, this study explored that mostly teachers were involved in administering the verbal assessment and on paper assessment, and practical tasks, i.e., debates, demonstrations, individual as well as group activities effectively. The study further also revealed that teachers gave the same attention to all students and showed nothing likes or dislikes during assessment. The rubrics and answer keys were prepared in advance by teachers to ensure the accuracy of the results. Besides this, student learning outcomes, fairness and objectivity in assessment, etc. were assessed to authenticate the quality of education in the region. The given study also added the recommendations.

Verification and Processing of Academic Certificates Using Web Services

A web service is a set of code of a server application that performs a specific task or service whenever it is invoked through a Remote Procedure Call (RPC) by a client application that is connected to the server over the Internet. Web services are one of the digital strategies that can be used by the government for curtailing academic certificate scandals being perpetrated by fraudulent individuals in various sectors of the economy. The traditional method of checking academic records and certificates manually is inefficient and prone to forgery by unscrupulous elements. Similarly, the e-transcript system being adopted by some organizations to authenticate the academic qualifications of individuals for possible admission or employment still involves a manual process. The objective of this work therefore is to show how web services for certificate verification of all tiers of the educational system in Nigeria can be maintained by one central body which is the Federal Ministry of Education in Nigeria to enable various end-users (such as educational institutions, commercial organizations, etc) use the web services to authenticate and process the academic records of individuals effortlessly. A simulated data of 20 SSCE results of students who completed their secondary school education at various institutions was used to illustrate the application of a web service. The web service program was written in Java. A client application which was also written in Java was used to query the web service through RPC to authenticate and process the certificate claims of a sample of five students for admission into a tertiary institution. Results showed that the web service excellently ascertained the eligible candidates for admission and those that were not. The web service technology is therefore highly recommended for use by the federal ministry of education in Nigeria to eradicate the academic certificate scandals amongst the citizenry.

Medical studies at the University of Freiburg in retrospect - study conditions, study quality and skills acquisition from the perspective of graduates.

As part of the MERLIN project (Medical Education Research - Lehrforschung im Netz BW), funded by the Federal Ministry of Education and Research, graduate surveys were carried out at the Medical Faculty of Freiburg from 2012-2020. This article will primarily address the question of how the study conditions and competence orientation in Freiburg are assessed and where there is still a need for optimization. The surveys were conducted among graduates of human medicine at the Freiburg Medical Faculty 1.5 years after graduation. Participation was possible using paper and online questionnaires. The response rates were 36%-43%. The study conditions were largely rated as good. There is a need for optimization, especially in the area of scientific work. The level of skills acquired was assessed as good to moderate. There were discrepancies between the level of competence achieved during the course of study and the level of competence required to start a career. There is a need for development in terms of preparation for starting a career. Compared to the professionally required level of competence, self-assessment was worse in most competence domains. In Freiburg there are approaches to further promote the acquisition of skills during studies. In order to evaluate these developments and future changes in the context of studies, graduate surveys are relevant. Graduate surveys are suitable for generating data on the basis of which curriculum design can be carried out or which can be used to prepare for change processes. The surveys in Freiburg will therefore be continued and supplemented with new, needs-based questions.

Clinical and genetic keys to cerebellar ataxia due to FGF14 GAA expansions

SCA27B caused by FGF14 intronic heterozygous GAA expansions with at least 250 repeats accounts for 10-60% of cases with unresolved cerebellar ataxia. We aimed to assess the size and frequency of FGF14 expanded alleles in individuals with cerebellar ataxia as compared with controls and to characterize genetic and clinical variability. We sized this repeat in 1876 individuals from France sampled for research purposes in this cross-sectional study: 845 index cases with cerebellar ataxia and 324 affected relatives, 475 controls, as well as 119 cases with spastic paraplegia, and 113 with familial essential tremor. A higher frequency of expanded allele carriers in index cases with ataxia was significant only above 300 GAA repeats (10.1%, n=85) compared with controls (1.1%, n=5) (p<0.0001) whereas GAA250-299 alleles were detected in 1.7% of both groups. Eight of 14 index cases with GAA250-299 repeats had other causal pathogenic variants (4/14) and/or discordance of co-segregation (5/14), arguing against GAA causality. We compared the clinical signs in 127 GAA≥300 carriers to cases with non-expanded GAA ataxia resulting in defining a key phenotype triad: onset after 45 years, downbeat nystagmus, episodic ataxic features including diplopia; and a frequent absence of dysarthria. All maternally transmitted alleles above 100 GAA were unstable with a median expansion of+18 repeats per generation (r2=0.44; p<0.0001). In comparison, paternally transmitted alleles above 100 GAA mostly decreased in size (-15 GAA (r2=0.63; p<0.0001)), resulting in the transmission bias observed in SCA27B pedigrees. SCA27B diagnosis must consider both the phenotype and GAA expansion size. In carriers of GAA250-299 repeats, the absence of documented familial transmission and a presentation deviating from the key SCA27B phenotype, should prompt the search for an alternative cause. Affected fathers have a reduced risk of having affected children, which has potential implications for genetic counseling. This work was supported by the Fondation pour la Recherche Médicale, grant number 13338 to JLM, the Association Connaître les Syndrome Cérébelleux - France (to GS) and by the European Union's Horizon 2020 research and innovation program under grant agreement No 779257 ("SOLVE-RD" to GS). DP holds a Fellowship award from the Canadian Institutes of Health Research (CIHR). SK received a grant (01GM1905C) from the Federal Ministry of Education and Research, Germany, through the TreatHSP network. This work was supported by the Australian Government National Health and Medical Research Council grants (GNT2001513 and MRFF2007677) to MB and PJL.

High-Dose Glucocorticoids for the Treatment of Sudden Hearing Loss

BackgroundSystemic glucocorticoids are commonly used for primary therapy of idiopathic sudden sensorineural hearing loss (ISSNHL). However, the comparative effectiveness and risk profiles of high-dose over lower-dose regimens remain unknown.MethodsWe randomly assigned patients with sudden hearing loss of greater than or equal to 50 dB within 7 days from onset to receive either 5 days of high-dose intravenous prednisolone at 250 mg/d (HD-Pred), 5 days of high-dose oral dexamethasone at 40 mg/d (HD-Dex), or, as a control, 5 days of oral prednisolone (Pred-Control) at 60 mg/d followed by 5 days of tapering doses. The primary outcome was the change in hearing threshold (pure tone average) in the three most affected contiguous frequencies from baseline to day 30. Secondary outcomes included speech understanding, tinnitus, communication competence, quality of life, hypertension, and insulin resistance.ResultsA total of 325 patients were randomly assigned. Mean change in 3PTAmost affected hearing threshold from baseline to 30 days was 34.2 dB (95% CI, 28.4 to 40.0) in the HD-Pred group, 41.4 dB (95% CI, 35.6 to 47.2) in the HD-Dex group, and 41.0 dB (95% CI, 35.2 to 46.8) in the Pred-Control group (P=0.09 for analysis of variance). There were more adverse events related to trial medication in the HD-Pred (n=73) and HD-Dex (n=76) groups than in the Pred-Control group (n=46).ConclusionsSystemic high-dose glucocorticoid therapy was not superior to a lower-dose regimen in patients with ISSNHL, and it was associated with a higher risk of side effects. (Funded by the Federal Ministry of Education and Research [BMBF]; EudraCT number, 2015‐002602‐36.)

Effect of Mechanical Pressure on Lifetime, Expansion, and Porosity of Silicon Dominant Anodes in Laboratory Lithium-Ion Cells

Silicon (Si) is a promising next-generation anode material for lithium-ion batteries due to its nearly ten times higher specific capacity of 3579 mAh/gSi 1. The high and economic availability of Si due to existing industrial infrastructure is another non-technical advantage.2 The main drawback of Si is its large volume expansion of nearly 300% during full lithiation causing SEI (re-) formation, electrochemical milling, and electrode instability leading to thickness changes resulting in the disruption of the electronic pathways and decoupling of particles.2 These problems still exist in partially lithiated µm-sized Si particles with lower volume expansion.2 In this work, we study the influence of compressive force on electrode stability in full cells composed of NCA3 cathodes and silicon-dominant anodes based on µm-sized particles.2 The different mechanical pressures were applied using spring-compressed 3.34 mAh Swagelok™ T-cells (A = 0.94 cm²) with metallic lithium reference electrodes. The investigated mechanical pressure ranges from 0.02 MPa as low pressure (LP) to 2.00 MPa, as high high pressure (HHP) to determine the optimal pressure for cyclic lifetime. Firstly, we introduce an experimental methodology to precisely adjust the common three-electrode SwagelokTM cell setup. Therefore, we take the compression from the single components into account, which were measured in a universal testing machine4 for the pressure range mentioned above. The cells were built with different mechanical pressures and cycled with C/2 until a SoH of 80% of the initial capacity was reached which was measured periodically in CheckUp tests. In the post-mortem analysis, Si anodes cycled at different mechanical pressures are prepared for scanning electron microscopy using a focused ion beam cross-section polisher. The images are then analyzed regarding electrochemical milling, thickness increase, and porosity decrease at 80% SoH by comparing them to the pristine state.The HHP cells with 2 MPa show a detrimental effect on lifetime during cell cycling as depicted in Figure 1 and with only 100 cycles nearly a halved lifetime compared to a normal pressure (NP) of 0.20 MPa. Moreover, the specific discharge capacity is significantly reduced for HHP or LP compressed cells compared to NP cells (see Figure 1b). The post-mortem analysis showed a dependency of the porosity and thickness of the aged Si anodes on the applied pressure. On the particle level, no electrochemical milling was observed due to the partial lithiation of the Si anodes. Vein-like microstructures were observed for the lithiated probes which might originate from different lithiation pathways of polycrystalline Si.5 Based on these experimental results, multilayer pouch cells with the same electrode setup and balancing are produced and cycled, and the expansion of the cells is measured operando in a compression test bench. Acknowledgments: S. F. gratefully acknowledges the financial support from the BMBF (Federal Ministry of Education and Research, Germany), under the auspices of the ExZellTUM III project (grant number 03XP0255). The authors want to thank the research battery production team of iwb for the manufacturing of the electrodes

Electrochemical Impedance Analysis of Direct Ammonia Fuel Cell Operation and Clamping Effects

In addition to being an essential chemical for fertilizers, ammonia can also be used as a hydrogen carrier or directly as a fuel. Compared to hydrogen, the main advantages are that ammonia can be liquefied in mild conditions and the technology for ammonia shipping and pipelines already exists. Compared to carbon-based synthetic fuels, no carbon dioxide is produced by the oxidation, only water and nitrogen. The theoretical voltage of a direct ammonia fuel cell (DAFC) is 1.17 V, nearly equal to the 1.23 V of hydrogen fuel cells (HFC) but a central drawback is the slow kinetics of the ammonia oxidation reaction (AOR). The AOR is even slower than the oxygen reduction reaction (ORR) at the cathode, which in turn is the main voltage loss component in HFCs. Consequently, due to the AOR kinetics, DAFCs typically require significantly higher platinum group metal (PGM) catalyst loadings than HFCs for the same power output.To improve the performance of our aqueous-feed DAFC, especially using non-PGM catalysts, we carried out comparisons of catalysts and anion exchange membranes (AEM), and supplemented the comparison of power, voltage, and current parameters with electrochemical impedance spectroscopy (EIS). Additionally, we also compared measurements in two different test cells to try to identify the cause of measurement repeatability issues that we had when using one of the cells.Initially, we assumed that the reproducibility of catalyst deposition (or lack of it) and AEM or catalyst degradation in the ammonia-containing electrolyte had caused our repeatability problems. However, following a preliminary analysis of measurement statistics, we consider problems with the cell itself a more likely cause. The maximum power of the cell depended almost inversely on the series resistance (R S, i.e., the high-frequency resistance/real-axis intercept of the EIS spectrum), and the current at given voltage varied more than the differences in the resistance alone could explain when most measurement parameters were not varied (e.g., ammonia and hydroxide concentrations, liquid and gas flow rates). The general inverse dependence on R S remained also when measuring the same electrodes in different cells, and the performance did not necessarily degrade over time so, clearly, degradation and differences between electrodes could not explain everything. When testing different screw torques and gaskets in our AEM electrolyser, we had noticed that the voltage differences were often high compared to the R S differences, and it is known that clamping torque can affect the operation of fuel cells and electrolysers significantly. Nevertheless, more detailed analysis is ongoing to determine possible other contributing factors, to optimize the use of the cell(s) in measurements, and to guide future work.This research was done under the TELEGRAM project. This project has received funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement No 101006941. The project started on the 1st of November 2020 with a duration of 42 months. The authors acknowledge support from the Federal Ministry of Education and Research in the framework of the project Catlab (03EW0015A). Figure 1

Characterizing Reversible and Irreversible Degradation Effects of PEM Water Electrolyzer Stacks

Polymer electrolyte membrane water electrolyzers (PEMEL) have been identified as a key component in a decarbonized large-scale energy system, as they can produce high-purity hydrogen from renewable electricity sources for the chemical industry or energy storage. However, the long-term durability and performance of PEM electrolyzers remain a major challenge, with degradation being a critical factor that limits their lifespan and efficiency. Recent studies have focused on developing accelerated stress test (AST) protocols for PEM electrolyzers to better understand the conditions and mechanisms that lead to degradation.1, 2 Especially the reversible rise in cell potential, which in the literature is often regarded as apparent or reversible degradation, must be further investigated to find mitigation strategies for operation.3, 4 We present our research on the development of two testing protocols (static, dynamic) characterizing reversible and irreversible degradation effects for PEMEL stacks in different operation modes. Our aim is to gain a better understanding of the variance of these phenomena in general and the recovery of reversible effects across PEMEL stacks. The measurements are carried out on a commercialized Greenlight E400 test bench equipped with a 7kW 8 cell PEMEL stack (Hydrogen Innovation GmbH). The potential of all cells will be monitored during testing. The measurements include repeated electrochemical characterization protocols measuring i/E-curves, HFR and impedance spectroscopy (EIS) of the PEMEL stack and if possible, every single cell. These protocols include the introduction of low potential regeneration phases before every characterization during the test protocol to distinguish between reversible effects and the irreversible cell degradation. This was seen to be effective for potential recovery by Suermann et al. 2019 for single PEMEL cells.4 The results consist of a description of the two testing procedures and the used equipment. Due to the duration of each test protocol (3000 h) only results of the static test protocol can be presented.The contribution of the presented research is threefold. Firstly, we break down the degradation across a whole stack. Giving valuable insights regarding the distribution of cell efficiency and degradation effects. Secondly, the presented test protocols characterize and account for the reversible rise in cell/stack potential. Thirdly, the characterization of the recovery time of the cell potential across the stack will have implications for the operation of stacks to mitigate or recover these performance losses. We address both static and dynamic operation modes aiming to simulate the application of PEMEL stacks for a constant production of hydrogen used in downstream processes and the volatile operation due to a direct coupling with renewable energy sources.This publication is to be seen as presentation of first results in our ongoing research to find test protocols for short stack systems to develop operation strategies, which can be applied to large scale electrolyzer systems. Furthermore, we try to deepen the understanding of the reversible cell potential rise as well as standardize the general testing of PEMEL stacks.This work is funded by the Federal Ministry of Education and Research (BMBF) in the project “hyBit” under the grant 03SF0687E. The authors declare that the opinions expressed in this submission are their own and are based on a thorough review of existing scientific literature. Sources 1. G. Tsotridis and A. Pilenga, EU harmonized protocols for testing of low temperature water electrolysis, Publications Office of the European Union, Luxembourg (2021). 2. A. Voronova, H.-J. Kim, J. H. Jang, H.-Y. Park and B. Seo, International Journal of Energy Research, 46 (2022) 11867. 3. C. Rakousky, U. Reimer, K. Wippermann, S. Kuhri, M. Carmo, W. Lueke and D. Stolten, Journal of Power Sources, 342 (2017) 38. 4. M. Suermann, B. Bensmann and R. Hanke-Rauschenbach, Journal of The Electrochemical Society, 166 (2019) F645-F652.

Literary Critical Understanding of Šantić’s “Mythical” Fame With a Contribution to the Review of the Archive Collection of Aleksa Šantić in the National and University Library of Bosnia and Herzegovina

The paper consists of two, methodological and analytical, separate parts, which share the character and work of Aleksa Šantić. The first part tries, through an overview of critical valorisation, to literary critically understand the entire poetic creation of Aleksa Šantić, posing the fundamental research question of why Šantić is considered a great poet, even though his poetry, taken as a whole, viewed from an aesthetic perspective, cannot be qualified as “great”. Above all, based on the insight of criticism into the consideration of the aesthetic value of Šantić’s poetry and the conclusions derived from the comparison of already existing and own reflections, the above question is answered with the hypothesis that Šantić’s “mythical” greatness is the result of the “ordinariness” of his poetry and the ability to give that “ordinariness” a sublime sense of the “topos” of spiritual preoccupation, on the semantic level, and on the syntactic level, expressed in a simple style and phrases close to the cognitive needs of the peoples’ consciousness.&#x0D; The second part of the paper presents a documentary-historical and archival-library contribution to the research of the character and works of Aleksa Šantić, and appears as a separate review of the legacy of manuscript material kept by the National and University Library of Bosnia and Herzegovina within the Department of Special Collections. The legacy consists of letters, correspondence, photographs, letter cards, and postcards. These biographical and historical documents serve as a source for a factual introduction to a part of Šantić’s life and activities.&#x0D; The work is the result of research conducted on the basis of the project “Unification of materials on the cultural and historical heritage of Aleksa Šantić” financed by the Federal Ministry of Education and Science.