The European Union (EU) has recently adopted several supply chain laws. The 2023 EU Deforestation Regulation (EUDR) and the 2024 Corporate Sustainability Due Diligence Directive (CSDDD) are still the subject of fierce debate. This article examines the extent to which the new legislation complements, or even falls short of, existing voluntary sustainability standards (VSS). The focus is on the two affected commodities with the highest share of certified sustainable production, cocoa (41.8 %) and coffee (24.7 %). Using an analytical framework of scope, process and enforceability, I compare EUDR and CSDDD with the most widely used certification initiatives, Rainforest Alliance and Fairtrade International, for cocoa and coffee. The results show that the public legislation is more stringent than the VSS in some aspects, in particular, reporting (procedure) and supervision (enforcement). Nevertheless, other aspects of the new legislation are already addressed by the VSS and implementation of the laws would provide first-mover advantages to certified companies. It is thus in their interest to weaken the public legislation but not to abolish it.

The European Union (EU) recently adopted the Corporate Sustainability Due Diligence Directive (CSDDD), which its 27 member states must now transpose into national law. Starting in mid-2026, the Directive aims to encourage sustainable and responsible corporate behavior in global supply chains. France and Germany had already independently enacted their own national supply chain laws, the 2017 Loi de Viligence (LdV) and the 2021 Lieferkettensorgfaltspflichtengesetz (LkSG). This article examines the extent to which the new supply chain legislation addresses environmental burden shifting through international trade. We develop an analytical framework on scope, procedure and enforceability with respect to the environment. To do so, we identify the central demands of environmental non-governmental organizations (ENGOs), drawing on their campaign materials, expert interviews, and participant observation at stakeholder events. Our results show a regulatory ’race to the top’ with ‘bends’ in the sense that the German law lags behind the French law in some aspects, but the new CSDDD is the most precise and comprehensive in all aspects of supply chain legislation. We conclude that the stage is set for the ’greening’ of international trade.

Adverse and stressful early life events can impact on later-life cognitive, physiological and neurological outcomes, but direct mechanisms through which these so-called “programming effects” occur are still under investigation. In this review, we systematically examine early-life stress (ELS) paradigms in non-human animals, focusing on three key biological systems: the hypothalamic-pituitary-adrenal (HPA) axis, immune system and oxytocinergic system. We developed a ranking system to assess and compare stress severity across different ELS paradigms. We also consider how different theoretical frameworks influence the interpretation of ELS outcomes, from primarily adaptive to pathological. Effects of chronic ELS on peripheral measures of HPA- and oxytocinergic system function were variable, but centrally, ELS more consistently triggered region-specific alterations in mRNA expression, including increased hypothalamic corticotropin-releasing hormone (CRH) mRNA and decreased oxytocin (OXT) mRNA in the amygdala. Altered gene expression in amygdala was linked to later-life behavioral alterations. Central markers of immune function were consistently altered following ELS, including higher microglia or astrocyte densities or ameboid microglial morphology. These changes are likely mechanisms linking ELS to cognitive deficits and depressive symptoms, which were consistently found across studies assessing behavior. Other behaviors, including anxiety and risk-taking, were less consistently altered by ELS. Increasing stress severity scores of ELS paradigms predicted the likelihood of long-term alterations in key biological systems, emphasizing the importance of greater standardization of ELS paradigms to increase comparability across studies. Interventions that provided social support during ELS, or increased post-ELS maternal care showed promise for promoting resilience, and deserve more attention in future studies.

The dynamic coupling of a vibrating molecular bond to its responsive liquid environment can be described by non-Markovian friction in the framework of the generalized Langevin equation (GLE) and gives rise to line shifts as well as homogeneous and inhomogeneous spectral line broadening. By perturbation theory, we investigate how the interplay of nonharmonic bond-potential contributions and non-Markovian friction determines vibrational line shapes and positions. The accuracy of our perturbation theory is checked by simulations of the GLE. Based on bond potentials and time-dependent friction functions extracted from ab initio molecular dynamics simulations, our analytic theory traces the inhomogeneous line broadening of the infrared OH-stretch band of liquid water back to the coupling of non-Markovian friction to cubic and quartic bond-potential contributions.

In the digital health domain, ethical data collection practices are crucial for ensuring the availability of quality datasets that drive medical advancement. Data donation, allowing patients to share their medical data for secondary research purposes, presents a promising resource for such datasets. Yet, current consent user interfaces mediating data-sharing decisions are found to favor data collectors' values over those of data subjects. Seeking to establish value-centered data collection practices in digital health, we investigate the design of consent user interfaces that support end-users in making value-congruent data-sharing decisions. Focusing our research efforts on the situated context of health data donation at the psychosomatic unit of a university hospital, we demonstrate how a human-centered design can ground technology within the perspective of a vulnerable group. We employed an exploratory sequential mixed-method approach consisting of five phases: (1) Participatory workshops elicit patient values, informing the (2) design of a proposed Value-Centered Consent Interface. An (3) online experiment demonstrates our interface element's effect, increasing value congruence in data-sharing decisions. Our proposed consent user interface design is then adapted to the research context through a (4) co-creation workshop with domain experts and (5) a user interface evaluation with patients. Our work contributes to recent discourse in CSCW concerning ethical implications of new data practices within their socio-technological context by exploring patient values on medical data-sharing, introducing a novel consent interface leveraging reflection to support value-congruent decision-making, and providing a situated evaluation of the proposed consent user interface with patients.

On the surface of the text, Ištar is absent from Enūma elîš. She is never mentioned by name, yet there is circumstantial evidence of her presence in three parts of the epic: the enthronement of Kingu, the first elevation of Marduk, and the catasterism of Marduk’s bow. The article is a detailed analysis of these three passages using the techniques of hyleme analysis, among others. Based on these observations, it is here argued that the epic seems to undertake a radical redefinition of the goddess by splitting off individual aspects of her personality and then transforming each aspect separately through transformation and recontextualization. In this way, Enūma elîš delegitimizes Ištar’s legitimizing role in the political concept of the sacred marriage; it devalues her famous descent into the netherworld, and it has Marduk absorb her qualities as a heroine and goddess of war. The assault on Ištar is compounded subsequently by the additional application of damnatio memoriae. It is furthermore argued that Enūma elîš is part of a pattern in mythical narratives that depict and promote the displacement of female deities from their traditional roles in the ancient Mesopotamian pantheon. The analysis of Ištar’s displacement in Enūma elîš is, as a side effect, helpful in identifying a new supra-divine status that has a disrupting effect on the hierarchy of the pantheon and is a key factor in Marduk’s ascent to and eventual seizing of the throne. The ontic levels (divine, supra-divine) of the key players along with their gender, determine their success or failure in the course of the narrative.

Worum es mir im Folgenden geht, sind nicht die Karrieren von Leonhard Thurneysser und Georg am Wald als solche, sondern die Frage nach dem, was ihre Karrieren – spezifisch in der zweiten Hälfte des 16. Jahrhunderts – möglich gemacht hat. Wie der Autor zu zeigen hofft, sind es paracelsi(sti)sche Einflüsse, die sich in diesen Karrieren widerspiegeln. Nachdem er deshalb kurz die Karrieren – erstens – Thurneyssers und – zweitens – am Walds skizziert hat, zeigt er drittens, inwiefern Paracelsus und seine neue Medizin – und mehr noch: die Reputation von Paracelsus – diese Karrieren ermöglicht haben. In einem vierten Schritt wendet er sich denselben biographischen Elementen in fiktiven Biographien von Heiler-Figuren zu, darunter insbesondere Salomon Trismosin, Christian Rosenkreuz und ein anonymer Rosenkreuzer, der 1615 in Wetzlar gesichtet wurde. Aus dem Vergleich dieser Biographien sollte hervorgehen, wie die historische Reputation des Paracelsus in diesen fiktiven Biographien gleichsam überformt wird. Sichtbar werden soll damit das Koordinatensystem eines geteilten historischen Raumes, in dem sich diese Karrieren in ihren unterschiedlichen Ausprägungen vollziehen.

This article examines East Berlin media criticism post-1990, focusing on the unequal distribution of symbolic resources between East and West Germans. Utilising Giddens’s structuration and identity theories, we link the discursive side of inequality with media and define media criticism as one response of marginalised groups’ to hegemonic discourses. We conducted 37 biographical interviews with East Berliners to examine their media criticism and experiences of exclusion in media discourse. We found that hegemonic media narratives about East Germany have influenced East Berlin media criticism. This criticism is directed at systemic media biases, particularly in public service broadcasting. The study identified a latent consciousness of structural factors shaping media realities among East Berliners, often linked to their experiences of social declassing and the socioeconomic challenges after reunification. A range of East Berliners criticised the portrayal of German Democratic Republic (GDR) life in the media, particularly the focus on the Stasi and negative stereotypes, which they feel misrepresent their lived experiences. The persistence of these stereotypes has, for some, reinforced an East German identity and fostered media criticism as a form of identity work.

Background

CD4⁺ T cell responses are key to adaptive immunity, yet the mechanisms underlying peptide selection and immunodominance across MHC class II variants in humans remain poorly defined. Two non-mutually exclusive models — First Bind-then cut (FBtc) and First Cut-then bind (FCtb) — have been proposed to explain immunodominant peptide selection, but experimental evidence in humans is mostly limited to a single allotype (HLA-DRB1*01:01).

Methods

To generalize processing mechanisms across DRB1 alleles we developed an integrative strategy combining in silico prediction and a reconstituted antigen processing system. The independent and combined outcome of both approaches was validated on curated SARS-CoV-2 epitope data (IEDB) for responses to the Spike and Nucleocapsid proteins across a panel of 11 DRB1 allotypes, covering over 90% of European Caucasian populations. Potential immunogenic regions identified by the combination of both methods enabled the design of minimalistic peptide pools whose performance was validated via flow cytometry and ELISpot assays in post-Covid19 and pre-pandemic donors. Mechanistic insights for the selection of immunodominant peptides were derived analyzing biophysical parameters and proteolysis of the model antigens.

Results

Three prediction tools used showed limited concordance for some allotypes (< 5%), but their combined output for all allotypes considered revealed potential immunogenic hotspots in the model antigens. Complementary, the reconstituted in vitro system identified allotype-dependent and promiscuous peptide candidates. Minimal peptide pools designed from the overlap of both methods featured improved performance to identify IEDB entries and induced robust CD4⁺ T cell activation in post-COVID-19 donors. Mechanistic modeling classified most immunodominant peptides from the Spike protein as arising via FCtb while FBtc predominated for Nucleocapsid. Epitope selection pathways are therefore antigen-dependent defined by proteolytic resistance and solvent accessibility.

Conclusions

We establish a scalable, genomics-informed framework for decoding CD4⁺ T cell immunodominance across diverse HLA contexts. Our findings reveal that antigen-intrinsic features govern the preferential processing pathway — FCtb for Spike and FBtc for Nucleocapsid — and validate the utility of minimal peptide pools for population-level immune-monitoring. These insights inform the design of personalized immunotherapies and broadly effective vaccines.

The hierarchical sparsity framework , and in particular the HiHTP algorithm(Hierarchical Hard Thresholding Pursuit), has been successfully applied to many relevant communication engineering problems recently, particularly when the signal space is hierarchically structured. In this paper, the applicability of the HiHTP algorithm for solving the bi-sparse blind deconvolution problem is studied. The bi-sparse blind deconvolution setting here consists of recovering hand bfrom the knowledge of h∗(Qb), where Qis some linear operator, and both band hare assumed to be sparse. The approach rests upon lifting the problem to a linear one, and then applying HiHTP, through the hierarchical sparsity framework . Then, for a Gaussian draw of the random matrix Q, it is theoretically shown that an s-sparse h∈Kμand σ-sparse b∈Knwith high probability can be recovered when μ≳slog(s)2log(μ)log(μn)+sσlog(n).

Bone material contains a hierarchical network of micro- and nano-cavities and channels, known as the lacuna-canalicular network (LCN), that is thought to play an important role in mechanobiology and turnover. The LCN comprises micrometer-sized lacunae, voids that house osteocytes, and submicrometer-sized canaliculi that connect bone cells. Characterization of this network in three dimensions is crucial for many bone studies. To quantify X-ray Zernike phase-contrast nanotomography data, deep learning is used to isolate and assess porosity in artifact-laden tomographies of zebrafish bones. A technical solution is proposed to overcome the halo and shade-off domains in order to reliably obtain the distribution and morphology of the LCN in the tomographic data. Convolutional neural network (CNN) models are utilized with increasing numbers of images, repeatedly validated by 'error loss' and 'accuracy' metrics. U-Net and Sensor3D CNN models were trained on data obtained from two different synchrotron Zernike phase-contrast transmission X-ray microscopes, the ANATOMIX beamline at SOLEIL (Paris, France) and the P05 beamline at PETRA III (Hamburg, Germany). The Sensor3D CNN model with a smaller batch size of 32 and a training data size of 70 images showed the best performance (accuracy 0.983 and error loss 0.032). The analysis procedures, validated by comparison with human-identified ground-truth images, correctly identified the voids within the bone matrix. This proposed approach may have further application to classify structures in volumetric images that contain non-linear artifacts that degrade image quality and hinder feature identification.

Background Obesity is a known cardiovascular risk factor and associated with higher postoperative complication rates in patients undergoing cardiac surgery. In heart failure (HF), conflicting evidence in terms of survival has been reported, whereas sarcopenia is associated with poor prognosis. An increasing number of HF patients require left ventricular assist device (LVAD) implantations. The postoperative mortality has improved in recent years but is still relatively high. The impact of body composition on outcome in this population remains unclear. The aim of this investigation was to examine the preoperative computed tomography (CT) body composition as a predictor of the postoperative outcome in advanced HF patients, who receive LVAD implantations.

Methods Preoperative CT scans of 137 patients who received LVADs between 2015 and 2020 were retrospectively analysed using an artificial intelligence (AI)-powered automated software tool based on a convolutional neural network, U-net, developed for image segmentation (Visage Version 7.1, Visage Imaging GmbH, Berlin, Germany). Assessment of body composition included visceral and subcutaneous adipose tissue areas (VAT and SAT), psoas and total abdominal muscle areas and sarcopenia (defined by lumbar skeletal muscle indexes). The body composition parameters were correlated with postoperative major complication rates, survival and postoperative 6-min walk distance (6MWD) and quality of life (QoL).

Results The mean age of patients was 58.21 ± 11.9 years; 122 (89.1%) were male. Most patients had severe HF requiring inotropes (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile I–III, 71.9%) secondary to coronary artery diseases or dilated cardiomyopathy (96.4%). Forty-four (32.1%) patients were obese (body mass index ≥ 30 kg/m2), 96 (70.1%) were sarcopene and 19 (13.9%) were sarcopene obese. Adipose tissue was associated with a significantly higher risk of postoperative infections (VAT 172.23 cm2 [54.96, 288.32 cm2] vs. 124.04 cm2 [56.57, 186.25 cm2], P = 0.022) and in-hospital mortality (VAT 168.11 cm2 [134.19, 285.27 cm2] vs. 135.42 cm2 [49.44, 227.91 cm2], P = 0.033; SAT 227.28 cm2 [139.38, 304.35 cm2] vs. 173.81 cm2 [97.65, 254.16 cm2], P = 0.009). Obese patients showed no improvement of 6MWD and QoL within 6 months postoperatively (obese: +0.94 ± 161.44 months, P = 0.982; non-obese: +166.90 ± 139.00 months, P < 0.000; obese: +0.088 ± 0.421, P = 0.376; non-obese: +0.199 ± 0.324, P = 0.002, respectively). Sarcopenia did not influence the postoperative outcome and survival within 1 year after LVAD implantation.

Conclusions Preoperative AI-based CT body composition identifies patients with poor outcome after LVAD implantation. Greater adipose tissue areas are associated with an increased risk for postoperative infections, in-hospital mortality and impaired 6MWD and QoL within 6 months postoperatively.

Introduction. Cervical dystonia (CD) is viewed as a circumscribed movement disorder. However, beyond motor symptoms, it can imply subtle cognitive change, among others with respect to theory of mind (ToM) capacities. Here, affective and cognitive ToM performances and potential relations to other mental functions were investigated to refine the concept of social cognitive dysfunction in CD. Methods. 20 persons with CD were clinically assessed, together with 20 healthy controls engaged in overview cognitive testing, executive function (EF) tasks, and the Faux Pas Recognition Test (FPRT) as well as the Reading the Mind in the Eyes Tests (RMET) addressing cognitive and affective ToM functions, respectively. Results. Persons with CD showed lower cognitive, but not affective ToM performance than controls. Further, they had abnormally low word production in verbal fluency (VF) tasks, imposing high EF demands. Generally, ToM performance correlated with VF and, further, with the decreased quality of life score in persons with CD. Conclusion. Cognitive ToM deficits seem to occur in the context of executive dysfunction in CD. They belong to an underrecognized spectrum of nonmotor symptoms of likely clinical relevance.

Background Subcutaneous allergen immunotherapy (SCIT) with depigmented, polymerized (DPP) birch pollen extract has been marketed at doses of up to 1000 DPP units/mL since 2001. We sought to determine the dose-dependent efficacy of a DPP birch pollen extract formulation in patients suffering from birch-pollen-induced allergic rhinitis or rhinoconjunctivitis with or without intermittent asthma.

Methods A titrated conjunctival provocation test (CPT) was applied as a surrogate marker. This Phase II randomized, double-blind, parallel-group, dose-ranging clinical trial was performed at 39 centres in Germany, Lithuania and Poland. After randomization to four dose-level groups (100, 1000, 5000 and 10,000 DPP units/mL) and up-dosing, participants received maintenance SCIT with five monthly subcutaneous injections. The primary endpoint was the proportion of patients in whom a higher concentration of birch pollen (vs. baseline) was needed to elicit a positive CPT.

Results Three hundred forty-three patients were included (mean (range) age: 42.6 (19–70)). The highest CPT responder rates were seen in the higher dose-level groups. In the intention-to-treat analysis, the difference between the 100 and 10,000 groups was statistically significant (p = 0.0118). Although the proportion of patients with ≥1 treatment-emergent adverse events increased with the dose, almost all these events were mild (65.6%) or moderate (18.5%).

Conclusion Judging by the results of a CPT, the efficacy/safety ratio in SCIT appears to be favourable for a high-dose-level preparation of a DPP birch pollen extract.

Background

Vasoregulatory autoantibodies including autoantibodies targeting G‐protein–coupled receptors might play a functional role in vascular diseases. We investigated the impact of vasoregulatory autoantibodies on clinical outcome after ischemic stroke.

Methods and Results

Data were used from the PROSCIS‐B (Prospective Cohort With Incident Stroke–Berlin). Autoantibody‐targeting receptors such as angiotensin II type 1 receptor (AT1R), endothelin‐1 type A receptor, complement factor‐3 and ‐5 receptors, vascular endothelial growth factor receptor‐1 and ‐2, vascular endothelial growth factor A and factor B were measured. We explored associations of high antibody levels with (1) poor functional outcome defined as modified Rankin Scale >2 or Barthel Index <60 at 1 year after stroke, (2) Barthel Index scores over time using general estimating equations, and (3) secondary vascular events (recurrent stroke, myocardial infarction) or death up to 3 years using Cox proportional hazard models. We included 491 patients with ischemic stroke with data on autoantibody levels and outcome. In models adjusted for demographics and vascular risk factors, high autoantibody concentrations (quartile 4) targeting complement factor C3a receptor, vascular endothelial growth factor receptor‐2, and vascular endothelial growth factor B were associated with poor functional outcome at 1 year: (odds ratio, 2.0 [95% CI, 1.1–3.6]; odds ratio, 1.8 [95% CI, 1.1–3.2]; and odds ratio, 2.1 [95% CI, 1.2–3.6], respectively) and with lower Barthel Index scores over 3 years (complement factor C3a receptor: adjusted β=−3.3 [95% CI, −5.7 to −0.5]; VEGF‐B: adjusted β=−2.4 [95% CI, −4.8 to −0.06]). Patients with high autoantibody levels were not at higher risk for secondary vascular events or death.

Conclusions

High levels of autoantibodies against vascular endothelial growth factor receptor‐2, vascular endothelial growth factor B, and complement factor C3a receptor measured are associated with poor functional outcome after stroke but not with recurrent vascular events or death.

Registration

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01363856.

Objective Retrograde trans-synaptic neuroaxonal degeneration is considered a key pathological factor of subclinical retinal neuroaxonal damage in multiple sclerosis (MS). We aim to evaluate the longitudinal association of optic radiation (OR) lesion activity with retinal neuroaxonal damage and its role in correlations between retinal and brain atrophy in people with clinically isolated syndrome and early MS (pweMS).

Methods Eighty-five pweMS were retrospectively screened from a prospective cohort (Berlin CIS cohort). Participants underwent 3T magnetic resonance imaging (MRI) for OR lesion volume and brain atrophy measurements and optical coherence tomography (OCT) for retinal layer thickness measurements. All pweMS were followed with serial OCT and MRI over a median follow-up of 2.9 (interquartile range: 2.6–3.4) years. Eyes with a history of optic neuritis prior to study enrollment were excluded. Linear mixed models were used to analyze the association of retinal layer thinning with changes in OR lesion volume and brain atrophy.

Results Macular ganglion cell-inner plexiform layer (GCIPL) thinning was more pronounced in pweMS with OR lesion volume increase during follow-up compared to those without (Difference: −0.82 μm [95% CI:-1.49 to −0.15], p = 0.018). Furthermore, GCIPL thinning correlated with both OR lesion volume increase (β [95% CI] = −0.27 [−0.50 to −0.03], p = 0.028) and brain atrophy (β [95% CI] = 0.47 [0.25 to 0.70], p < 0.001). Correlations of GCIPL changes with brain atrophy did not differ between pweMS with or without OR lesion increase (  = 5.92e−7, p = 0.762).

Interpretation Faster GCIPL thinning rate is associated with increased OR lesion load. Our results support the value of GCIPL as a sensitive biomarker reflecting both posterior visual pathway pathology and global brain neurodegeneration.

The DNA damage response (DDR) acts as a barrier to malignant transformation and is often impaired during tumorigenesis. Exploiting the impaired DDR can be a promising therapeutic strategy; however, the mechanisms of inactivation and corresponding biomarkers are incompletely understood. Starting from an unbiased screening approach, we identified the SMC5-SMC6 Complex Localization Factor 2 (SLF2) as a regulator of the DDR and biomarker for a B-cell lymphoma (BCL) patient subgroup with an adverse prognosis. SLF2-deficiency leads to loss of DDR factors including Claspin (CLSPN) and consequently impairs CHK1 activation. In line with this mechanism, genetic deletion of Slf2 drives lymphomagenesis in vivo. Tumor cells lacking SLF2 are characterized by a high level of DNA damage, which leads to alterations of the post-translational SUMOylation pathway as a safeguard. The resulting co-dependency confers synthetic lethality to a clinically applicable SUMOylation inhibitor (SUMOi), and inhibitors of the DDR pathway act highly synergistic with SUMOi. Together, our results identify SLF2 as a DDR regulator and reveal co-targeting of the DDR and SUMOylation as a promising strategy for treating aggressive lymphoma.

Bone has the fascinating ability to self-regenerate. However, under certain conditions, such as type 2 diabetes mellitus (T2DM), this ability is impaired. T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels that is associated with reduced bone regeneration capability, high fracture risk, and eventual non-union risk after a fracture. Several mechanical and biological factors relevant to bone regeneration have been shown to be affected in a diabetic environment. However, whether impaired bone regeneration in T2DM can be explained due to mechanical or biological alterations remains unknown. To elucidate the relevance of either one, the aim of this study was to investigate the relative contribution of T2DM-related alterations on either cellular activity or mechanical stimuli driving bone regeneration. A previously validated in silico computer modeling approach that was capable of explaining bone regeneration in uneventful conditions of healing was further developed to investigate bone regeneration in T2DM. Aspects analyzed included the presence of mesenchymal stromal cells (MSCs), cellular migration, proliferation, differentiation, apoptosis, and cellular mechanosensitivity. To further verify the computer model findings against in vivo data, an experimental setup was replicated, in which regeneration was compared in healthy and diabetic after a rat femur bone osteotomy stabilized with plate fixation. We found that mechanical alterations had little effect on the reduced bone regeneration in T2DM and that alterations in MSC proliferation, MSC migration, and osteoblast differentiation had the highest effect. In silico predictions of regenerated bone in T2DM matched qualitatively and quantitatively those from ex vivo & mu;CT at 12 weeks post-surgery when reduced cellular activities reported in previous in vitro and in vivo studies were included in the model. The presented findings here could have clinical implications in the treatment of bone fractures in patients with T2DM.

Alternative medicine methods and treatments enjoy great popularity. However, many users fail to recognise the dangers associated with these methods. One of these is called Black Ointment or Black Salve. Oncologists and attending physicians should be aware of alternative medical methods such as these and be in a position to provide appropriate advice, intervention, if necessary, at any time when counselling patients in difficult situations.