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This chapter sums up the characteristics of legal language, specific grammatical and terminological features that give the language of the law in general and the language of canon law in particular its specific sound. These features often include the use of a challenging syntax, an excessive use of the passive voice, and an alien terminology, including technical terms, terms in foreign languages, and neologisms. With regard to the terminology of the law, the chapter addresses the use of common terms as legal terms and the development of a specialist legal language based on common language. A critical issue in legal terminology is the use of indeterminate terms, allowing for some flexibility in legal application but undermining legal certainty and the rule of law. Canon law makes wide use of indeterminate terms (“grave necessity”, “just cause”). This poses a particular problem for legal certainty in church.

This chapter takes up the idea that law is communication and can therefore be explained using communication models. Understanding the language of the law as an attempt to convey meaning from a sender to a receiver through the use of signs primarily focuses on linguistic signs—written text or speech—as being key for legal communication. A core function of legal communication is connected with performative language, which brings about the reality that it describes. The performative functioning of legal statements mirrors the way sacraments function in the church. So there is a common root to legal and sacramental thought and to legal and religious ritual, which affects the language of the law.

In discovering the meaning of norms, canon law follows a plain meaning rule. Consequently, the doubts of scholars who question the existence of a plain and proper meaning of terms are also relevant for canon law. Rules on interpretation provide for cases in which meaning is more difficult to obtain. The church, interestingly, provides the appliers of its law not only with legal rules for interpreting the law but also with a mixed approach combining textualist, contextualist, and intentionalist approaches, thereby forming a pragmatic bundle of interpretation rules. However, with regard to interpretive authority, canon law also shows a strong tendency to rely on the legislator for matters of interpretation. This centralist temptation to maintain control over the law may be received critically as one sign of mistrust toward the local appliers of the law.

If Latin as the language of canon law gives way to a multi-language law, it will be necessary to address doubts about whether legal communications across cultural and language borders are even possible. Theorists who believe language fully determines our thought doubt whether it is realistic to hope for true communication across cultural borders. Representatives of weak language theories deem this possible albeit difficult. The study discusses several lawmaking models for multi-language communities with regard to their use of canon law: accepting one model law in one language from which translations are fabricated; working with a limited number of official legal languages; or publishing legal documents in all official languages. For canon law, the last model might give ample expression to the idea that the church is a unity of plural churches.

As canonical procedures are heavily textual, spoken language plays a reduced role. However, speech is key in the hearings, the only context in which most parties are confronted with ecclesiastical tribunal staff in person. The language of hearings is therefore of vital importance in a twofold sense: it provides the tribunal with evidence and influences public opinion about ecclesiastical judicature. As the tribunals mostly depend on the voluntary participation of the parties and witnesses, a good reputation is one precondition for their work. In addition, forensic communication is also about silence as an instrument of communication, as suggested by the Latin saying “Qui tacet consentire videtur” (“she or he who is silent is taken to agree”). In some contexts, silence is suggested or requested by law, for instance, when the law allows a suspect to remain silent when faced with a charge.

The conclusion sums up the findings of this book. It then makes two suggestions what practical consequences one can draw from them: first, invest more effort in the analysis of canon law and language; second, change the language of canon law. In-depth linguistic studies of canon law are worthy academic endeavors in their own right. Adding to this, there is a need to study ecclesiastical legal language in the light of ecclesiological concerns. The church understands itself as promoting the Word of God, which has embodied itself in human culture and language. It is therefore confronted with the challenge of examining whether its message is communicated understandably and of correcting its language whenever it becomes difficult to comprehend. As the current language of canon law is provoking many legal subjects’ misunderstanding and resentment, it is in need of reform, including changing from Latin to local vernaculars.

The introduction sheds some light on the fundamental role of language for the church and its law. It identifies studies on the language of canon law as part of the broader law and language debate. It opens up the field of research on the language of canon law and presents the current state of research. While some studies do already exist on canon law terminology and on interpreting the law of the church, canon law has yet to receive the interdisciplinary findings which the law and language debate has generated over recent decades. There is a need to discuss what canonists can learn about canon law from linguistic findings on the language of the law.

This chapter deals with selected problems of legal comprehension which are particularly relevant when it comes to comprehending canon law: ambiguities in legal language, transfer problems, and genre mixes. For several reasons, canon law not only contains many ambiguous terms (“christifidelis”), it also contains syntactic ambiguities which blur the meaning of canonical norms. Drawing terms from everyday language into legal language has resulted in transfer problems as church members without legal training attribute a meaning to these terms which differs from that of the law. A critical example is the “nullity” terminology with which the church approaches invalid marriages. In mixing legal norms with theological statements, canon law also blends diverse genres, often obscuring the intended meaning of the law.

The difficulty of understanding legal language is socially costly and defies the modern definition of democratic, liberal, and egalitarian society. Shielding the law from public understanding has an exclusivist and elitist flavor—and a clericalist one in the church—as Latin canon law is intended solely for the comprehension of a clerical elite. The plain language movement responds to these problems by proposing how to make the language of the law easier to comprehend. These proposals are also relevant for canon law. Here, however, one major point in the debate has to be the elemental question of whether to abide with Latin as canon law’s authentic language.

This book explores the language of canon law, the legal order of the Roman Catholic Church. It seeks to bring the language of canon law into the law and language debate and in doing so helps readers better understand how the Roman Catholic Church communicates as a legal institution. It examines the function of canon law language in ecclesiastical communications. It studies the character of canonical language, the grammar and terminology of canon law, and how canon law makes use of linguistic tricks and techniques to create its typical sound. The book discusses the comprehension difficulties that arise out of ambiguities in the law, out of transfer problems between legal and common language, and out of canon law’s confusing mix of legal, doctrinal, and moral norms. It reviews the potential consequences of a plain language agenda in the church. This includes an evaluation of whether dead Latin is the appropriate language for a global and cross-cultural legal order such as canon law, and a discussion of how to improve multi-language communication. It takes a closer look at ecclesiastical interpretation theory. The book examines forensic language, the language of ecclesiastical tribunals, in its problematic shifting between orality and textuality. It addresses readers with an interest in law and language, theology and religion, and the sociology of law and religion. To scholars of secular law, the book may serve as a point of departure for approaching religious law through its language.

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 HIV/AIDS is now a chronic illness due to effective antiretroviral therapy (ART) and involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mHealth, which includes cell phone-delivered services OBJECTIVE Here we describe cell phone use and its relationship with alcohol use in a cohort of persons with HIV (PWH) and latent tuberculosis (TB). METHODS We performed a cross-sectional analysis of baseline data from a cohort of PWH and latent TB in HIV care in south-western Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use, a common modifiable behaviour among PWH. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months, and/or phosphatidylethanol (an alcohol biomarker) ≥8 ng/ml. RESULTS A total of 300 participants were included in the analysis, with a median age of 40 years; 48.7% were male. Majority (89.0%) of participants had access to a phone and of these 9.7% shared the phone with someone else. Eighty-seven percent owned a cell phone that is turned on at least half of the time; the majority (89.7%) rarely or never sent text messages, and over two-thirds (66.9%) rarely or never received text messages. 71.3% had any alcohol use. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted OR [aOR]: 0.48, 95% confidence interval [CI]: 0.18-1.25, p-value=.13), or sending (aOR: 0.82, 95% CI: 0.28-2.37, p-value=.71) or receiving (aOR: 1.31, 95% CI: 0.70-2.47, p-value= .40) of text messages. CONCLUSIONS There is hope that mHealth interventions in this population can be carried out using cell phones due to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. CLINICALTRIAL NCT 03302299

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.

BACKGROUND Alcohol brief interventions are effective for reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often under-reported. Self-administered digital health screeners may improve reporting. OBJECTIVE Our first aim was to develop a brief touch-screen tablet based health screener to be administered in an HIV clinic waiting room, to increase reporting of unhealthy alcohol use for persons with HIV in Uganda. Our second aim was to pilot test the health screener developed in Aim 1 to examine acceptability, ease of use, comfort with reporting, and to discuss how the results of such screening might be used. 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 assessed behaviors regarding general health, HIV care, mental health, as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions (FGD) with clinicians and patients of the Mbarara ISS Clinic with HIV who consume alcohol to obtain input on the need for, 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 semi-structured in-depth interviews (IDIs) with 20 prior alcohol study participants, including those who previously under-reported use and those with low literacy. RESULTS Forty-five people (five clinicians and forty Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% were male, 43% had low literacy, and all had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing staff burden, and mitigating 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. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language, found the screener easy to use, although many required help. 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 there were concerns about confidentiality and training. Such a screener may be useful to improve reporting of unhealthy alcohol use for referral to interventions. CLINICALTRIAL N/A

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.

It takes complexity to beat complexity. —Uhl-Bien and Arena 1 Nursing professional governance (NPG) is one of the most significant advances in nursing practice in the last 50 years in the United States and abroad. Although there have been advances in how NPG is designed and operationalized, in many health care organizations, NPG essentially operates as a complicated rule-bound bureaucracy, mimicking the organization's overall operational architecture and processes. This traditional bureaucratic design was appropriate, given its relatedness to the hierarchical structure in which health care systems flourished for many years, yet the evolving health care landscape demands a new approach to the governance of professional nursing practice. The purpose of the article is to demonstrate that NPG, if reimagined and operationalized as a complex adaptive system (CAS), can become the nexus for nursing and interprofessional engagement, experimentation, and innovation.

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