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Although autografts represent the gold standard for anterior cruciate ligament (ACL) reconstruction, tissue-engineered ACLs provide a prospect to minimize donor site morbidity and limited graft availability. This study characterizes the ligamentogenesis in embroidered poly(L-lactide-co-ε-caprolactone) (P(LA-CL)) / polylactic acid (PLA) constructs using a dynamic nude mice xenograft model. (P(LA-CL))/PLA scaffolds remained either untreated (co) or were functionalized by gas fluorination (F), collagen foam cross-linked with hexamethylene diisocyanate (HMDI) (coll), or F combined with the foam (F + coll). Cell-free constructs or those seeded for 1 week with lapine ACL ligamentocytes were implanted into nude mice for 12 weeks. Following explantation, cell vitality and content, histo(patho)logy of scaffolds (including organs: liver, kidney, spleen), sulphated glycosaminoglycan (sGAG) contents and biomechanical properties were assessed.Scaffolds did not affect mice weight development and organs, indicating no organ toxicity. Moreover, scaffolds maintained their size and shape and reflected a high cell viability prior to and following implantation. Coll or F + coll scaffolds seeded with cells yielded superior macroscopic properties compared to the controls. Mild signs of inflammation (foreign-body giant cells and hyperemia) were limited to scaffolds without collagen. Microscopical score values and sGAG content did not differ significantly. Although remaining stable after explantation, elastic modulus, maximum force, tensile strength and strain at Fmax were significantly lower in explanted scaffolds compared to those before implantation, with no significant differences between scaffold subtypes, except for a higher maximum force in F + coll compared with F samples (in vivo). Scaffold functionalization with fluorinated collagen foam provides a promising approach for ACL tissue engineering. Graphical abstract a Lapine anterior cruciate ligament (LACL): red arrow, posterior cruciate ligament: yellow arrow. Medial anterior meniscotibial ligament: black arrow. b Explant culture to isolate LACL fibroblasts. c Scaffold variants: co: controls; F: functionalization by gas-phase fluorination; coll: collagen foam cross-linked with hexamethylene diisocyanate (HMDI). c1-2 Embroidery pattern of the scaffolds. d Scaffolds were seeded with LACL fibroblasts using a dynamical culturing approach as depicted. e Scaffolds were implanted subnuchally into nude mice, fixed at the nuchal ligament and sacrospinal muscle tendons. f Two weeks after implantation. g Summary of analyses performed. Scale bars 1 cm (b, d), 0.5 cm (c). (sketches drawn by G.S.-T. using Krita 4.1.7 [Krita foundation, The Netherlands]).

Cigarette smoking and risky alcohol consumption co-occur and are undertreated. Nicotine receptor partial agonists and nicotine replacement therapy (NRT) treat smoking but are unproven for alcohol, and clinical trials rarely include individuals with HIV, substance use, and mental health conditions.To compare the effects on drinking and smoking of nicotinic acetylcholine receptor partial agonists varenicline and cytisine with those of NRT.This 4-group randomized, double-blinded, placebo-controlled clinical trial was conducted from July 2017 to December 2020 in St Petersburg, Russia. Included participants were 400 individuals with HIV who engaged in risky drinking (≥5 prior-month heavy-drinking days [HDDs]) and daily smoking; they were followed up for 12 months after enrollment. Data were analyzed from May 2021 through June 2022.Participants received alcohol and tobacco counseling, 1 active medication, and 1 placebo in 1 of 4 groups: active varenicline and placebo NRT (group 1), placebo varenicline and active NRT (group 2), active cytisine and placebo NRT (group 3), or placebo cytisine and active NRT (group 4).The primary outcome was number of prior-month HDDs at 3 months. Secondary outcomes included biochemically validated abstinence from alcohol at 3 months and smoking at 6 months.Among 400 participants (263 [65.8%] men; mean [SD] age, 39 [6] years), 97 individuals (24.3%) used opioids and 156 individuals (39.1%) had depressive symptoms. These individuals had a mean (SD) CD4 count of 391 (257) cells/mm3, smoked a mean (SD) of 21 [8] cigarettes/d, and reported a mean (SD) of 9.3 (5.8) HDDs in the prior 30 days. At 3 months, the mean (SD) number of HDDs was decreased vs baseline across all groups (group 1: 2.0 [3.8] HDDs vs. 9.5 [6.1] HDDs; group 2: 2.1 [4.3] HDDs vs 9.3 [5.7] HDDs; group 3: 1.5 [3.3] HDDs vs 8.9 [5.0] HDDs; group 4: 2.4 [5.2] HDDs vs 9.6 [6.3] HDDs). There were no significant differences at 3 months between groups in mean (SD) HDDs, including group 1 vs 2 (incident rate ratio [IRR], 0.94; 95% CI, 0.49-1.79), 3 vs 4 (IRR, 0.60; 95% CI, 0.30-1.18), and 1 vs 3 (IRR, 1.29; 95% CI, 0.65-2.55). There were no significant differences at 6 months between groups in smoking abstinence, including group 1 vs 2 (15 of 100 individuals [15.0%] vs 17 of 99 individuals [17.2%]; odds ratio [OR],0.89; 95% CI, 0.38-2.08), 3 vs 4 (19 of 100 individuals [19.0%] vs 19 of 101 individuals [18.8%]; OR, 1.00; 95% CI, 0.46-2.17), and 1 vs 3 (OR, 0.79; 95% CI, 0.35-1.78). Post hoc analyses suggested lower mean (SD) HDDs (eg, at 3 months: 0.7 [1.8] HDDs vs 2.3 [4.6] HDDs) and higher alcohol abstinence (eg, at 3 months: 30 of 85 individuals [35.3%] vs 54 of 315 individuals [17.1%]) among those who quit vs continued smoking.This study found that among individuals with HIV who engaged in risky drinking and smoking, varenicline and cytisine were not more efficacious than NRT to treat risky drinking and smoking but that behavior change rates were high in all groups.ClinicalTrials.gov Identifier: NCT02797587.

In 2020, during the COVID-19 pandemic, nursing professional governance (NPG) clinical nurse leaders at Yale New Haven Hospital developed an innovative way to engage nurses in their practice. Utilizing an electronic platform, NPG leaders established a way to harvest best practices, innovations, and resources from clinical nurses and reputable sources to share with all nurses in every practice area. Support for NPG leaders to have dedicated time for this work accelerated the process and allowed them to engage with nursing leaders to enhance communication and support clinical nurses. This work demonstrated the value of NPG during a time of crisis.

The Congregation for the Doctrine of the Faith recently published a Vademecum to guide the ecclesiastical investigation and adjudication of cases of sexual abuse of minors committed by Catholic clergy. By collecting existing regulations, the Vademecum provides some remarkable insights into how the congregation operates its penal trials. The document inter alia discloses that the congregation operates with three verdicts in penal trials, ‘constat’, ‘non constat’, and ‘constat de non’, which roughly correlate with the verdicts ‘guilty’, ‘not proven’, and ‘not guilty’ of Scottish law. It is particularly this differentiation of two acquittals, with the same legal effects but different implications, which fundamentally impacts how the congregation decides penal cases. I will shed more light on this issue by introducing the regular canonical verdict system and the congregation’s innovation, by comparing it with secular two- and three-verdict systems, and by discussing my findings to discover the merits and demerits of three verdicts.

In 2008 and 2020, the Congregation for the Doctrine of the Faith published two responses to questions posed regarding the validity of modified baptismal formulas. When administering baptism, some Catholic ministers had altered the prescribed formula with regard to the naming of the Trinity and with regard to the declarative introduction of the formula (ie ‘We baptise you …’ instead of ‘I baptise you …’). The Congregation dismissed all of these formulas as invalidating baptism and demanded that individuals baptised with these formulas be baptised again. In explaining its 2020 response the Congregation referred to Thomas Aquinas, who addressed these and similar issues in his sacramental theology. This reference is evidently due to Aquinas’ pioneering thoughts on the issue. However, in studying Aquinas’ work on the subject it is surprising to find that they reveal a far less literalist approach than the Congregation suggests. In fact, his considerations point at an alternative reading, namely that sacramental formulas should be understood as acts of communication which, based on the ministers’ intention of doing what the Church does, aim at communicating God's grace to the receivers in an understandable way.

Successful anterior cruciate ligament (ACL) reconstructions strive for a firm bone-ligament integration. With the aim to establish an enthesis-like construct, embroidered functionalized scaffolds were colonized with spheroids of osteogenically differentiated human mesenchymal stem cells (hMSCs) and lapine (l) ACL fibroblasts in this study. These triphasic poly(L-lactide-co-ε-caprolactone) and polylactic acid (P(LA-CL)/PLA) scaffolds with a bone-, a fibrocartilage transition- and a ligament zone were colonized with spheroids directly after assembly (DC) or with 14-day pre-cultured lACL fibroblast and 14-day osteogenically differentiated hMSCs spheroids (=longer pre-cultivation, LC). The scaffolds with co-cultures were cultured for 14 days. Cell vitality, DNA and sulfated glycosaminoglycan (sGAG) contents were determined. The relative gene expressions of collagen types I and X, Mohawk, Tenascin C and runt-related protein (RUNX) 2 were analyzed. Compared to the lACL spheroids, those with hMSCs adhered more rapidly. Vimentin and collagen type I immunoreactivity were mainly detected in the hMSCs colonizing the bone zone. The DNA content was higher in the DC than in LC whereas the sGAG content was higher in LC. The gene expression of ECM components and transcription factors depended on cell type and pre-culturing condition. Zonal colonization of triphasic scaffolds using spheroids is possible, offering a novel approach for enthesis tissue engineering.

Background Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting. Objective This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy. Methods We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy. Results A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener. Conclusions We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions.

In Roman Catholic canon law, moral certitude describes the ecclesiastical judge’s full conviction that a defendant is guilty or that a statement of claim made by a civil plaintiff is rightful. Moral certitude is the requirement for a conviction or a civil sentence in favour of the party under the burden of proof. Secular legal orders apply other standards. Anglo-American legal cultures mostly refer to the beyond a reasonable doubt standard in criminal cases, the preponderance of evidence, or the clear and convincing evidence standard in civil matters. Continental European cultures predominantly refer to the standard of full conviction in criminal and civil matters alike. This article compares those standards of proof with moral certitude in order to better understand its merits and limits. Based on this comparison, it examines the arguments both in favour of and against abiding with moral certitude as a standard of proof in the Catholic Church.

This case study presents the results of an interdisciplinary Virtual Exchange (VE) that was arranged between Finnish and Polish students in 2019. During their six-week collaboration, the students of language studies at the University of Jyväskylä, Finland, worked in teams together with their Polish peers specialising in information and communications technology and management in tourism at Adam Mickiewicz University in Poznań, Poland. The international teams combined their linguistic and tourism-promotion expertise, and, using collaborative digital tools, grappled with the tasks of analysing the official municipal city websites and promoting the lesser-known aspects of their sister cities (Jyväskylä and Poznań) in jointly created videos. peerReviewed

Reconstruction of ruptured anterior cruciate ligaments (ACLs) is limited by the availability and donor site morbidity of autografts. Hence, a tissue engineered graft could present an alternative in the future. This study was undertaken to determine the performance of lapine (L) ACL-derived fibroblasts on embroidered poly(l-lactide-co-ε-caprolactone) (P(LA-CL)) and polylactic acid (PLA) scaffolds in regard to a tissue engineering approach for ACL reconstruction. Surface modifications of P(LA-CL)/PLA by gas-phase fluorination and cross-linking of a collagen foam using either ethylcarbodiimide (EDC) or hexamethylene diisocyanate (HMDI) were tested regarding their influence on cell adhesion, growth and gene expression. The experiments were performed using embroidered P(LA-CL)/PLA scaffolds that were seeded dynamically or statically with LACL-derived fibroblasts. Scaffold cytocompatibility, cell survival, numbers, metabolic activity, ultrastructure and sulfated glycosaminoglycan (sGAG) synthesis were evaluated. Quantitative real-time polymerase chain reaction (QPCR) revealed gene expression of collagen type I (COL1A1), decorin (DCN), tenascin C (TNC), Mohawk (MKX) and tenomodulin (TNMD). All tested scaffolds were highly cytocompatible. A significantly higher cellularity and larger scaffold surface areas colonized by cells were detected in HMDI cross-linked and fluorinated scaffolds compared to those cross-linked with EDC or without any functionalization. By contrast, sGAG synthesis was higher in controls. Despite the fact that the significance level was not reached, gene expressions of ligament extracellular matrix components and differentiation markers were generally higher in fluorinated scaffolds with cross-linked collagen foams. LACL-derived fibroblasts maintained their differentiated phenotype on fluorinated scaffolds supplemented with a HMDI cross-linked collagen foam, making them a promising tool for ACL tissue engineering.

Kirchenrecht in den Medien – das ist ein wenig wahrge nommenes und doch prasentes Thema, vor allem in den vergangenen Jahren, in denen in der medialen Aufarbeitung des Missbrauchs skandals kirchliches Strafrecht und amterrechtliche Fragen offentlich diskutiert wurden. Doch nicht nur kirchliche Skandale haben einen rechtlichen Bezug; vielmehr lasst sich uber die in der Welt verfasste Kirche – eine Glaubensgemeinschaft in Rechtsgestalt – kaum sprechen, ohne zumindest indirekt auf ihre rechtliche Organisation abzustellen, denn diese durchzieht die Kirche als strukturelle Perspektive. Auch im Kern des medial vermittelten Kirchendiskurses findet sich daher zumeist ein kirchenrechtlicher Gehalt. Kirchenrecht in den Medien – eine Analyse dazu muss exemplarisch bleiben. In der Studie „Kirchenrecht in den Medien“, deren Ergebnisse hier vorgestellt werden, wurde der kirchenrechtliche Gehalt in den zentralen Nachrichtensendungen der offentlich-rechtlichen Fernsehsender ARD und ZDF im Jahr 2010 erhoben. Von A wie Abendmahl, B wie Beichtsiegelbruch bis Z wie Zolibat erweist sich 2010 als ein Jahr voller brisanter Themen, dominiert von der Berichterstattung uber die Missbrauchsfalle in kirchlichen Einrichtungen. English Canon Law in the Media. Analysis of the Coverage in the News Programs of ARD and ZDF. Canon law in the media – this is a little perceived, yet present topic, especially in recent years during which questions related to Church structures and criminal legal issues have been pub licly discussed. However, not only Church scandals have a legal reference; instead it is nearly impossible to speak about the Church constituted as part of the world – a religious community with an inherent legal structure – without at least indirectly addressing the Church as a legal organization insofar as it pervades the Church from a structural perspective. Therefore, at the core of Church media coverage one can often find canonical content. Canon Law in the media – such an analysis must be exemplary. In the study Canon Law in the Media , the results of which are presented in this article, a survey was made of the canonical content of coverage presented by the main news programs of German public television (ARD and ZDF) in 2010. From A as in “Abendmahl” (Eucharist), B as in Beichtsiegelbruch (breaking the seal of the confessional) to Z as in Zolibat (Celibacy), the year 2010 proved to be filled with controversial topics, dominated by coverage of cases of abuse in ecclesial institutions.

The Independent Evaluation Group (IEG) has established three Strategic Engagement Areas (SEAs) around which it has organized its work program. One of those SEAs is Sustained Service Delivery for the Poor. This paper is one of two (the second one addresses behavior change) that will develop frameworks and tools to be employed to supplement IEG evaluations in urban transport, water and sanitation, and nutrition. This paper serves three purposes. First, it defines service delivery and its key concepts and features as well as provides examples of how the World Bank Group has supported service delivery. Second, the paper serves a practical purpose within IEG in developing a framework and analytical protocol to evaluate service delivery as part of three ongoing sector evaluations in urban transport, water and sanitation, and nutrition. Finally, the paper discusses how to integrate service delivery when designing and implementing other sector evaluations.

The Independent Evaluation Group (IEG) has established three Strategic Engagement Areas (SEAs) around which it has organized its work program. One of those SEAs is Sustained Service Delivery for the Poor. This paper is one of two (the second one addresses behavior change) that will develop frameworks and tools to be employed to supplement IEG evaluations in urban transport, water and sanitation, and nutrition. This paper serves three purposes. First, it defines service delivery and its key concepts and features as well as provides examples of how the World Bank Group has supported service delivery. Second, the paper serves a practical purpose within IEG in developing a framework and analytical protocol to evaluate service delivery as part of three ongoing sector evaluations in urban transport, water and sanitation, and nutrition. Finally, the paper discusses how to integrate service delivery when designing and implementing other sector evaluations.