Charging the Future: Harnessing Nature's Designs for Bioinspired Molecular Electrodes.

The transition toward electric-powered devices is anticipated to play a pivotal role in advancing the global net-zero carbon emission agenda aimed at mitigating greenhouse effects. This shift necessitates a parallel focus on the development of energy storage materials capable of supporting intermittent renewable energy sources. While lithium-ion batteries, featuring inorganic electrode materials, exhibit desirable electrochemical characteristics for energy storage and transport, concerns about the toxicity and ethical implications associated with mining transition metals in their electrodes have prompted a search for environmentally safe alternatives. Organic electrodes have emerged as promising and sustainable alternatives for batteries. This review paper will delve into the recent advancements in nature-inspired electrode design aimed at addressing critical challenges such as capacity degradation due to dissolution, low operating voltages, and the intricate molecular-level processes governing macroscopic electrochemical properties.

Investigating the Emulsifying Mechanism of Stereoisomeric Sugar Fatty Acyl Molecular Gelators.

The emulsifying mechanism of supramolecular stereoisomeric sugar fatty acyl molecular gelators was evaluated. In-house-synthesized mannitol dioctanoate (M8) and sorbitol dioctanoate (S8) were tested. The stereoisomeric difference between the sugar groups significantly affected the gelation and emulsifying properties of the gelators. M8 and S8 formed oleogels at 2 and 3.5% (w/v) and emulsified water up to 30 and 60% (v/v), respectively. Microscopy showed that the gelator fibers are at the W/O interfaces, demonstrating a solid particle or network mode of stabilization. The long fibers of M8 were unable to completely encompass the water droplets, resulting in poor emulsification. Small, hair-like fibers of S8 showed better emulsification. When sunflower wax (SFW, 1% w/v) was added as a coemulsifier, synergetic action between the wax and S8 improved the stability of emulsions. Such synergy was not seen between SFW and M8, henceforth emulsion stability was not improved. This study proved that a subtle stereoisomeric difference at the molecular level can greatly alter the supramolecular and emulsifying properties of sugar-fatty acyl compounds.

Fingerprick Microsampling Methods Can Replace Venepuncture for Simultaneous Therapeutic Drug Monitoring of Tacrolimus, Mycophenolic Acid, and Prednisolone Concentrations in Adult Kidney Transplant Patients.

BACKGROUND: Kidney transplant patients undergo repeated and frequent venepunctures during allograft management. Microsampling methods that use a fingerprick draw of capillary blood, such as dried blood spots (DBS) and volumetric absorptive microsamplers (VAMS), have the potential to reduce the burden and volume of blood loss with venepuncture. METHODS: This study aimed to examine microsampling approaches for the simultaneous measurement of tacrolimus, mycophenolic acid, mycophenolic acid glucuronide (MPAG), and prednisolone drug concentrations compared with standard venepuncture in adult kidney transplant patients. DBS and VAMS were simultaneously collected with venepuncture samples from 40 adult kidney transplant patients immediately before and 2 hours after immunosuppressant dosing. Method comparison was performed using Passing-Bablok regression, and bias was assessed using Bland-Altman analysis. Drug concentrations measured through microsampling and venepuncture were also compared by estimating the median prediction error (MPE) and median absolute percentage prediction error (MAPE). RESULTS: Passing-Bablok regression showed a systematic difference between tacrolimus DBS and venepuncture [slope of 1.06 (1.01-1.13)] and between tacrolimus VAMS and venepuncture [slope of 1.08 (1.03-1.13)]. Tacrolimus values were adjusted for this difference, and the corrected values showed no systematic differences. Moreover, no systematic differences were observed when comparing DBS or VAMS with venepuncture for mycophenolic acid and prednisolone. Tacrolimus (corrected), mycophenolic acid, and prednisolone microsampling values met the MPE and MAPE predefined acceptability limits of <15% when compared with the corresponding venepuncture values. DBS and VAMS, collected in a controlled environment, simultaneously measured multiple immunosuppressants. CONCLUSIONS: This study demonstrates that accurate results of multiple immunosuppressant concentrations can be generated through the microsampling approach, with a preference for VAMS over DBS.

Clinical and economic burden of benign and malignant skin lesions in renal transplant recipients.

BACKGROUND: Studies evaluating the economic burden of dermatological care in the transplant setting are currently not available in Australia. AIMS: To evaluate the clinical and economic burden of benign and malignant skin lesions in renal transplant recipients in Central Queensland. METHODS: A bottom-up approach was used to determine the clinical burden and direct costs from patient-level Medicare data obtained from Service Australia for skin lesions. RESULTS: Seventy-six percent of the renal transplant population in Central Queensland participated in this study. The median age was 57.0 years (standard deviation ± 13.6) and the majority (61.8%) of participants were men. The mean duration after transplant surgery was 99.9 months (interquartile range, 73.2-126.6 months). During a 2-year follow-up, 22 (40%) patients were diagnosed with benign skin lesions, 21 (38%) with nonmelanoma skin carcinoma (NMSC) and one (2%) with melanoma. There was a total of 231 visits to clinicians for diagnostic and therapeutic skin procedures and the direct costs to Medicare was $48 806 Australian Dollars (AUD) or $30 427 US Dollars (USD). Approximately 86% of the total direct costs was spent for nonNMSC and mean direct costs for NMSC was $763 AUD (or $476 USD). CONCLUSION: This Medicare data-based study provides further insight into the burgeoning clinical and economic burden of the care for benign and malignant skin lesions in the renal transplantation setting in Australia.

Rethinking local resilience for extreme heat events.

OBJECTIVE: This study aims to provide insights into how local resilience structures in England can be leveraged to deliver a whole-of-society approach to managing a national response to extreme heat events during summer months. STUDY DESIGN: A communication based on the literature review of currently available research on health emergency response and extreme heat events in England. METHODS: This communication draws insights from the authors' research programmes, which examined national-level public health emergency response during the COVID-19 pandemic and literature review of the latest available English research on health and extreme heat events. RESULTS: Periods of extreme heat are on the rise in England. Local resilience forums (LRFs), due to their multiagency nature, offer a shared situational awareness and understanding of the need in their local communities. Such information is critical to ensure messaging about heat risks and available resources are tailored to reach specific targeted groups within their communities. Scenario planning and adaptation efforts require a more local articulation which LRFs are well placed to manage. CONCLUSIONS: LRFs are well suited as key structures in the English emergency response to extreme heat events. We suggest that English public health and hospital organisations, working with community partners via the LRFs, must develop their thinking about pressures from adverse weather in the summer months.

A Heat Transfer Model and Supporting Experiments to Guide the Uniform Gelation of Molecular Oleogels During Scale-up.

The quest for novel vegetable oil structuring strategies has been progressing since the discovery of the deleterious impacts of trans fats. Although oleogelation using bioderived molecular gelators has been proven to be successful as an alternative to traditional hydrogenation methods, efforts are needed to meet the industrial requirements. A major constraint during the fabrication of oleogels is to achieve consistency in physical properties during scale-up. Experiments showed that gelation fails to occur when larger volumes were prepared based on the minimum gelation concentration (MGC) of gelators, determined using the smallest oil volume (1 mL), a general laboratory practice. This observation was consistent with all the molecular gelators used in this study; sorbitol dioctanoate, mannitol dioctanoate, and 12-hydroxystearic acid. To understand this behavior, a mathematical model was developed since gelator network propagation is governed by the cooling rate. The model indicates that maintenance of a minimal thermal gradient via uniform heat dissipation and gelation time is necessary to achieve homogeneous gel propagation across the vial. With these predictions, we hypothesized and confirmed that oleogels with constant surface area-to-volume ratio could result in identical gelation times and consistent physical properties (MGC, melting temperature, melting enthalpy, yield stress, solid phase content, and oil binding capacity) during scale-up.

Self-assembled Trehalose Amphiphiles as Molecular Gels: A Unique Formulation to Wax-free Cosmetics.

Trehalose has been used as an emollient and antioxidant in cosmetics. However, we aimed to explore trehalose amphiphiles as oil structuring agents for the preparation of gel-based lip balms as part of wax-free cosmetics. This article describes the synthesis of trehalose fatty acyl amphiphiles and their corresponding oleogel-based lip balms. Trehalose dialkanoates were synthesized by esterifying the two primary hydroxyls of trehalose with fatty acids (C4-C12) using a facile, regioselective lipase catalysis. The gelation potential of as-synthesized amphiphiles was evaluated in organic solvents and vegetable oils. Stable oleogels were subjected to X-ray diffraction (XRD), thermal (DSC), and rheological studies and further used for the preparation of lip balms. Trehalose dioctanoate (Tr8), trehalose didecanoate (Tr10) were found to be super gelators as their minimum gelation concentration is ≤ 0.2 wt%. XRD studies revealed their hexagonal columnar molecular packing while forming the fibrillar networks. Rheometry proved that the fatty acyl chain length of amphiphiles can influence the strength and flow properties of oleogels. Further rheometry (at 25 °C, 37 °C, and 50 °C) and DSC studies have validated that Tr8- and Tr10-based oleogels are stable for commercial applications. Tr8- and Tr10-based olive oil oleogels were used for the preparation of lip balms. The preliminary results suggested that the cumulative effect of trehalose's emolliency and vegetable oil gelling nature can be achieved with trehalose amphiphiles, specifically, Tr8 and Tr10. This study has also demonstrated that Tr8- and Tr10-based lip balms can be used as an alternative to beeswax and plant wax lip balms, indicating their huge potential to succeed as a new paradigm to formulate wax-free cosmetics.

Treatment resistant M-type phospholipase A2 receptor associated membranous nephropathy responds to obinutuzumab: a report of two cases.

BACKGROUND: Membranous Nephropathy (MN) is a common cause of nephrotic syndrome (NS) in adults. Recognition of MN as an antibody mediated autoimmune disease has enabled the introduction of anti-B-cell therapy. Rituximab, a type I anti-CD20 antibody has been used in the management of MN, but has a 35-45% failure rate. Obinutuzumab, a fully humanised type II anti-CD20 monoclonal antibody produces greater CD20 depletion and is superior to rituximab in the treatment of certain B-cell malignancies. In the two reports published to date involving nine patients with M-type phospholipase A2 receptor (PLA2R) associated MN (six of whom were rituximab resistant), treatment with obinutuzumab lead to immunological remission (IR) in 75% of patients, with improvement of proteinuria, normalisation of serum albumin and stable renal function in all patients. CASE PRESENTATION: We report on two cases of PLA2R-associated MN, two males aged 33 and 36-years, who presented with NS and bilateral sub massive pulmonary emboli requiring anticoagulation. Both were diagnosed serologically as PLA2R-associated MN where a renal biopsy was initially deferred due to bleeding risk on anticoagulation, but later confirmed. Both patients were refractory to multiple lines of therapy including rituximab, but achieved IR, normalistation of serum albumin, improved proteinuria and stable renal function with obinutuzumab. CONCLUSIONS: Our cases add to the current limited literature on the successful use of obinutuzumab in PLA2R associated MN refractory to standard therapy including rituximab.

Light-Assisted Rechargeable Lithium Batteries: Organic Molecules for Simultaneous Energy Harvesting and Storage.

Lithium batteries that could be charged on exposure to sunlight will bring exciting new energy storage technologies. Here, we report a photorechargeable lithium battery employing nature-derived organic molecules as a photoactive and lithium storage electrode material. By absorbing sunlight of a desired frequency, lithiated tetrakislawsone electrodes generate electron-hole pairs. The holes oxidize the lithiated tetrakislawsone to tetrakislawsone while the generated electrons flow from the tetrakislawsone cathode to the Li metal anode. During electrochemical operation, the observed rise in charging current, specific capacity, and Coulombic efficiency under light irradiation in contrast to the absence of light indicates that the quinone-based organic electrode is acting as both photoactive and lithium storage material. Careful selection of electrode materials with optimal bandgap to absorb the intended frequency of sunlight and functional groups to accept Li-ions reversibly is a key to the progress of solar rechargeable batteries.

Discovery of aspirin-triggered eicosanoid-like mediators in a Drosophila metainflammation blood tumor model.

Epidemiologic studies have linked the use of aspirin to a decline in chronic inflammation that underlies many human diseases, including some cancers. Aspirin reduces the levels of cyclooxygenase-mediated pro-inflammatory prostaglandins, promotes the production of pro-resolution molecules, and triggers the production of anti-inflammatory electrophilic mono-oxygenated (EFOX) lipid mediators. We investigated the effects of aspirin in fruit fly models of chronic inflammation. Ectopic Toll/NF-κB and JAK/STAT signaling in mutant D. melanogaster results in overproliferation of hematopoietic blood progenitors resulting in the formation of granuloma-like tumors. Ectopic JAK-STAT signaling also leads to metabolic inflammation. We report that aspirin-treated mutant flies experience reduction in metabolic inflammation, mitosis, ectopic immune signaling, and macrophage infiltration. Moreover, these flies synthesize 13-HODE, and aspirin triggers 13-oxoODE (13-EFOX-L2) production. Providing the precursor of 13-HODE, linoleic acid, or performing targeted knockdown of the transcription factor STAT in inflammatory blood cells, boosts 13-EFOX-L2 levels while decreasing metabolic inflammation. Thus, hematopoietic cells regulate metabolic inflammation in flies, and their effects can be reversed by pharmaceutical or dietary intervention, suggesting deep phylogenetic conservation in the ability of animals to resolve inflammation and repair tissue damage. These findings can help identify novel treatment targets in humans.

Platinum-Pemetrexed Chemotherapy for Recurrent Ovarian Cancer (ROC): A Single Center Experience.

In this retrospective analysis of 36 patients with recurrent ovarian cancer (ROC) treated with platinum pemetrexed doublet ± bevacizumab, the median age was 54.5 years (47-60) and 33 (91.7%) had serous histology. The overall response rate [ORR = complete (CR)+partial (PR) response] was 83.3%. At a median follow-up of 16 months, the median PFS was 13.8 months (95% CI: 10.849-20.580) and median OS 30.6 months, (95% CI: 21.46 months-NR). The incidence of Grade 3/4 anemia, thrombocytopenia, neutropenia and non-hematological toxicity was 19.4%, 3.9%, 16.6%, and 8.3%. Platinum pemetrexed chemotherapy in ROC is safe and effective treatment option.

Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry.

OBJECTIVES: To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. METHODS AND RESULTS: Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). CONCLUSIONS: Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.

Phase-Selective Gelation of the Water Phase in an Oil-Water Mixture: An Approach Based on Oil-Activated Nanoparticle Assembly in Water.

Phase-selective gelation refers to the selective gelation of one phase in an immiscible mixture. Thus far, all such examples have involved a molecular gelator forming nanofibers in (and thus gelling) the oil phase in an oil/water mixture. Here, for the first time, we report the counterpart to the above phenomenon, i.e., selective gelation of the water phase in an oil/water mixture (while leaving the oil undisturbed). This has been a challenging problem because moieties that gel water tend to be either amphiphilic or oil-soluble; thus, if combined with an oil/water mixture, they invariably form an emulsion. Our approach solves this problem by exploiting the tunable self-assembly of laponite (LAP) nanoparticles. Initially, LAP nanoparticles (25 nm disks) are dispersed in water, where they remain unaggregated due to the steric stabilization provided by a triblock copolymer (Pluronic P123) adsorbed on their surface. Thus, the dispersion is initially a low-viscosity sol. When an immiscible oil such as hexadecane is introduced above the sol, the mixture remains biphasic, and both phases remain unaffected. Next, an organic acid such as butanoic acid (BA) is added to the oil. The BA is oil-soluble but also has limited solubility in the water. Over about 30 min, some of the BA enters the water, whereupon it "activates" the self-assembly of LAP particles into a three-dimensional "house-of-cards" network. Ultimately, the water phase is converted into a homogeneous gel with a sufficient yield stress: the aqueous gel holds its weight in the inverted vial while the oil phase remains a thin liquid that can be poured out of the vial. On the whole, the concept advanced here is about activating nanoparticle assembly in water through an adjacent, immiscible phase. This concept could prove useful in conducting certain separations or reactions in the laboratory as well as in enhanced oil recovery.

Post-transplant complications, patient, and graft survival in pediatric and adolescent kidney transplant recipients at a tropical tertiary care center across two immunosuppression eras.

BACKGROUND: We report pediatric PAKT patient and graft outcomes at a large tropical tertiary center spanning two transplant eras. METHODS: In this retrospective cohort study, all children ≤18 years who underwent kidney transplantation at our center between 1991 and 2016 were included. Data pertaining to their baseline characteristics, post-transplant events, and outcome were retrieved from transplant records and compared between transplant eras (1991-2005 and 2006-2016). RESULTS: A total of 139 children (mean age 15.2 ± 2.9 years) underwent PAKT during this period. The incidence of UTIs, CMV disease, BKVN, invasive fungal infections, new-onset diabetes after transplant, leucopenia, and recurrent NKD was higher in the 2006-2016 era (P < .001 for all), while 1-year cumulative BPAR was comparable (P = .100). Five-year graft and patient survival in the two eras were 89.9% and 94.2% (P = .365) and 92.1% and 95.3% (P = .739), respectively. Incidence of CMV disease, BKVN, graft loss, and death was lower in the calcineurin withdrawal group. Non-adherence accounted for 36% of graft loss; infections caused 43.7% of deaths. On multivariate Cox proportional hazards analysis, independent predictors for graft loss were UTIs and blood transfusion naïve status and for death were serious infections and glomerular NKD. CONCLUSIONS: PAKT in India has excellent long-term graft outcomes, though patient outcomes remain suboptimal owing to a high burden of infections. Current immunosuppression protocols need to be re-examined to balance infection risk, graft, and patient survival.

Cefiderocol: A Siderophore Cephalosporin.

OBJECTIVE: This article reviews the available data on the chemistry, spectrum of activity, pharmacokinetic and pharmacodynamic properties, clinical efficacy, and potential place in therapy of cefiderocol. DATA SOURCES: A literature search through PubMed, Google Scholar, and ClinicalTrials.gov was conducted (2009 to March 2020) using the search terms cefiderocol and S-649266. Abstracts presented at recent conferences, prescribing information, and information from the US Food and Drug Administration (FDA) and the manufacturer's website were reviewed. STUDY SELECTION AND DATA EXTRACTION: All relevant published articles, package inserts, and unpublished meeting abstracts on cefiderocol were reviewed. DATA SYNTHESIS: Cefiderocol is the first siderophore antibiotic to be approved by the FDA. It was shown to be active against a wide range of resistant Gram-negative pathogens, including multidrug-resistant (MDR) Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacteriaceae, and Stenotrophomonas maltophilia. Cefiderocol was studied in the treatment of adult patients with complicated urinary tract infections (cUTIs) and nosocomial pneumonia and was well tolerated. In a recently completed prospective study, higher mortality was observed with cefiderocol in the treatment of serious infections caused by carbapenem-resistant (CR) Gram-negative pathogens. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: The approval of cefiderocol provides a new option in the treatment of cUTIs and potentially treatment of nosocomial pneumonia caused by resistant Gram-negative pathogens. Given the higher mortality observed with cefiderocol, its use in the treatment of CR Gram-negative infections should be carefully considered. CONCLUSION: Cefiderocol shows promising activity against MDR Gram-negative pathogens. Its use in the treatment of serious infections caused by CR Gram-negative bacteria needs further evaluation in phase III clinical studies.

T-cell adoptive immunotherapy for BK nephropathy in renal transplantation.

INTRODUCTION: BK virus (BKPyV) nephropathy occurs in 1%-10% of kidney transplant recipients, with suboptimal therapeutic options. CASE: A 54-year-old woman received a transplant in March 2017. BKPyV was detected at 1.5 × 102  copies/mL within a month, necessitating halving of mycophenolate and addition of leflunomide. Allograft histology in December showed polyomavirus nephropathy treated with intravenous immunoglobulin and cessation of mycophenolate. In February 2018, cidofovir and ciprofloxacin were commenced. In April, tacrolimus was reduced while introducing everolimus. A second graft biopsy in August showed increasing polyoma virus infection and a subsequent biopsy in September for worsening renal function showed 30% of tubular reactivity for simian virus 40 (SV40). Allogeneic BKPyV-reactive T cells were generated from the patient's daughter and infused over 10 sessions starting late September. The fourth allograft biopsy in November 2018 demonstrated involvement of BKPyV in 50% of tubules. Allograft function continued to decline, requiring hemodialysis from December 2018. Allograft nephrectomy after 6 months showed <1% SV40 in preserved tubules and 80% interstitial fibrosis. DISCUSSION: We conclude that the T-cell adoptive immunotherapy reduced BKPyV load significantly despite extensive infection, but attendant fibrosis and tubular atrophy led to graft failure. Early intervention with T-cell therapy may prove efficacious in BKPyV nephropathy.

Protocol and establishment of a Queensland renal biopsy registry in Australia.

BACKGROUND: Renal biopsy is often required to obtain information for diagnosis, management and prognosis of kidney disease that can be broadly classified into acute kidney injury (AKI) and chronic kidney disease (CKD). The most common conditions identified on renal biopsy are glomerulonephritis and tubulo-interstitial disorders. There is a paucity of information on management strategies and therapeutic outcomes in AKI and CKD patients. A renal biopsy registry will provide information on biopsy-proven kidney disorders to improve disease understanding and tracking, healthcare planning, patient care and outcomes. METHODS: A registry of patients, that includes biopsy-proven kidney disease, was established through the collaboration of nephrologists from Queensland Hospital and Health Services and pathologists from Pathology Queensland services. The registry is in keeping with directions of the Advancing Kidney Care 2026 Collaborative, established in September 2018 as a Queensland Health initiative. Phase 1 of the registry entailed retrospective acquisition of data from all adult native kidney biopsies performed in Queensland, Australia, from 2002 to 2018. Data were also linked with the existing CKD.QLD patient registry. From 2019 onwards, phase 2 of the registry involves prospective collection of all incident consenting patients referred to Queensland public hospitals and having a renal biopsy. Annual reports on patient outcomes will be generated and disseminated. DISCUSSION: Establishment of the Queensland Renal Biopsy Registry (QRBR) aims to provide a profile of patients with biopsy-proven kidney disease that will lead to better understanding of clinico-pathological association and facilitate future research. It is expected to improve patient care and outcomes.

"Doctor, teacher, translator:" International medical students' experiences of clinical teaching on an English language undergraduate medical course in China.

Background: Like many Chinese universities, Ningbo University (NBU) has two undergraduate medical courses - one taught in Mandarin for domestic students, and one taught in English for international students. This study examines the experiences of medical students who recently completed the English language program that has a particular focus on clinical placements. Methods: In-depth, face-to-face, semi-structured interviews were conducted with 10 final year medical students at NBU in April 2019. Transcripts were analyzed using inductive thematic analysis. Results: All medical student participants were non native English speakers and had a limited grasp of Chinese. Their clinical teachers were all fluent in Chinese and had variable command of English. The large majority of patients in the teaching hospitals where placements took place spoke only in Chinese. Despite the obvious challenges arising from this, students still had predominantly positive experiences of clinical placements. Although students recognized that their clinical teachers' English proficiency was variable, they felt that other attributes, such as enthusiasm, interactivity, and a desire to teach were more important factors to their learning experiences. Discussion: Despite challenging linguistic circumstances, non native English-speaking students were able to navigate the challenges of studying clinical medicine from teachers with limited English language skills and with patients who spoke virtually no English. Further studies should explore the perceptions of teachers of the program, and graduate outcomes when these students enter the workplace. Educators involved in supporting international medical students should note that non technical curricular areas such as professionalism may require greater attention where language barriers exist.

Two-Excitation Routing via Linear Quantum Channels.

Routing quantum information among different nodes in a network is a fundamental prerequisite for a quantum internet. While single-qubit routing has been largely addressed, many-qubit routing protocols have not been intensively investigated so far. Building on a recently proposed many-excitation transfer protocol, we apply the perturbative transfer scheme to a two-excitation routing protocol on a network where multiple two-receivers block are coupled to a linear chain. We address both the case of switchable and permanent couplings between the receivers and the chain. We find that the protocol allows for efficient two-excitation routing on a fermionic network, although for a spin-12 network only a limited region of the network is suitable for high-quality routing.