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The study explores the influence of vividness, content quality, and system quality in virtual reality (VR) experiences on guests’ behavioural intentions in the hotel industry in the National Capital Region. It specifically examines how these factors affect guests’ engagement and decision-making processes. Using the Partial Least Square with Hierarchical Component Model Analysis, the results highlight the importance of immersive and high-quality VR content in enhancing guest experiences and influencing their future behaviours, such as revisiting or recommending the hotels. Additionally, the study underscores the role of system quality in ensuring a seamless and engaging VR experience. The findings through the use of the mediating effect, suggest that investment in superior VR technology can be a strategic tool for hotels to differentiate themselves in a competitive market and align with evolving consumer preferences as well as the cognitive absorption of the hotel guests.

ABSTRACT Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a Gram-positive bacterial pathogen that infects humans and is closely related to group A streptococcus (GAS). Compared with GAS, far less is known about SDSE pathobiology. Increased rates of invasive SDSE infections have recently been reported in many countries. One SDSE emm type (stG62647) is known to cause severe diseases, including necrotizing soft-tissue infections, endocarditis, and osteoarticular infections. To increase our understanding of the molecular pathogenesis of stG62647 SDSE isolates causing human infections, we sequenced to closure the genomes of 120 stG62647 SDSE isolates. The genomes varied in size from 2.1 to 2.24 Mb pairs. The great majority of stG62647 isolates had IS1548 integrated into the silB gene, thereby inactivating it. Regions of difference, such as mobile genetic elements, were the largest source of genomic diversity. All 120 stG62647 isolates were assayed for virulence using a well-established mouse model of necrotizing myositis. An unexpectedly wide range of virulence was identified (20% to 95%), as assessed by near-mortality data. To explore the molecular mechanisms underlying virulence differences, we analyzed RNAseq transcriptome profiles for 38 stG62647 isolates (comprising the 19 least and most virulent) grown in vitro. Genetic polymorphisms were identified from whole-genome sequence data. Collectively, the results suggest that these SDSE isolates use multiple genetic pathways to alter virulence phenotype. The data also suggest that human genetics and underlying medical conditions contribute to disease severity. Our study integrates genomic, mouse virulence, and RNAseq data to advance our understanding of SDSE pathobiology and its molecular pathogenesis.IMPORTANCEThis study integrated genomic sequencing, mouse virulence assays, and bacterial transcriptomic analysis to advance our understanding of the molecular mechanisms contributing to Streptococcus dysgalactiae subsp. equisimilis emm type stG62647 pathogenesis. We tested a large cohort of genetically closely related stG62647 isolates for virulence using an established mouse model of necrotizing myositis and discovered a broad spectrum of virulence phenotypes, with near-mortality rates ranging from 20% to 95%. This variation was unexpected, given their close genetic proximity. Transcriptome analysis of stG62647 isolates responsible for the lowest and highest near-mortality rates suggested that these isolates used multiple molecular pathways to alter their virulence. In addition, some genes encoding transcriptional regulators and putative virulence factors likely contribute to SDSE emm type stG62647 pathogenesis. These data underscore the complexity of pathogen–host interactions in an emerging SDSE clonal group.

Background. Recurrent glomerulonephritis (GN) is an important cause of allograft loss after transplantation when GN is the primary cause of kidney failure. Retransplantation after allograft loss from recurrent disease requires careful consideration. We aimed to determine the probability of relisting and the risk of allograft loss after retransplantation in recipients with prior allograft loss from recurrent GN. Methods. Using data from the Australia and New Zealand Dialysis and Transplant Registry and multivariable Cox modeling, we compared the probability of waitlisting and allograft loss after second transplantation between those with and without prior allograft loss from recurrent disease. Results. Of 3276 patients who received a second kidney transplant, 179 (5%) lost their first allograft from recurrent GN. Between 2006 and 2021, 1524 patients with failed first allografts (6% with recurrent GN, 45% with primary GN but no disease recurrence) were relisted for transplantation. Compared with patients without primary GN, the adjusted hazard ratios (95% confidence intervals) for relisting in patients with primary GN, with and without disease recurrence, were 1.09 (0.88-1.34) and 1.16 (1.05-1.29), respectively. The respective adjusted hazard ratios for allograft loss after repeat transplantation were 0.77 (0.59-1) and 1.02 (0.9-1.16). Of the 81 patients who received a second allograft after losing their first allograft to GN recurrence, 18 patients (22%) also lost their second allograft because of recurrent GN. Conclusions. Patients with prior allograft loss from GN recurrence were not disadvantaged, with comparable waitlist potential and allograft outcome after repeat transplantation. However, >20% of those with prior allograft loss from disease recurrence also lost their second allografts from recurrent disease.

Abstract Background Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students Methods A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average Results Student’s experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P

Abstract Background Pollen food allergy syndrome (PFAS) is an immunoglobulin E (IgE) mediated reaction that causes oropharyngeal pruritus or angioedema due to homologous proteins present in the culprit food as well as a sensitizing aeroallergen. This cross-reactivity has been well established between pollen and fruits/vegetables. Given the evolutionary similarity between all fungi; cross-reactivity between spore forming microfungi and edible macrofungi have been suggested, however only a limited number of case reports have ever been published on this phenomenon. We present a case of a patient who experiences pollen food allergy syndrome-like symptoms following lightly cooked mushroom ingestion who otherwise was able to tolerate cooked mushrooms. We then review the literature to highlight the limited studies of an underrecognized PFAS cross-reactivity between molds and mushrooms. Case presentation A 15-year-old male presents with symptoms of seasonal and perennial allergic rhinitis was found to have multiple environmental sensitizations to molds via skin prick testing (C. gramineum, A. Pullulans and B. cinerea) and ImmunoCAP serum-specific IgE (A. alternata, C. herbarum, and P. notatum). He developed throat pruritus and subjective throat tightness following ingestion of mushroom containing pizza. ImmunoCAP serum specific IgE to whole mushroom was negative but fresh food prick testing to fresh portobello mushroom and cremini mushroom were both positive with a negative test to canned mushroom. The patient then underwent a graded oral challenge and successfully tolerated canned mushrooms. Conclusion This case highlights the potential cross-reactivity between microfungi aeroallergens and edible fungi, leading to PFAS-like reactions in susceptible individuals. The patient’s ability to tolerate canned mushrooms suggests a possible heat-labile protein as the cause of the reaction, similar to PFAS patients tolerating cooked but not raw fruits/vegetables. Positive skin prick test to both spore-forming fungi and edible fungi with negative and whole mushroom IgE results further support the hypothesis of cross-reactivity and sensitization. Further research is needed to identify the specific allergenic proteins involved in these cross-reactions and the susceptible species of mold and mushroom. Understanding these components will contribute to improved diagnosis and management of mold and mushroom allergies, and enhance our knowledge of allergenic cross-reactivity in general.

A coordinated multi-year ocean exploration campaign on the Blake Plateau offshore of the southeastern U.S. has mapped what appears to be the most expansive cold-water coral (CWC) mound province thus far discovered. Nearly continuous CWC mound features span an area up to 500 km long and 110 km wide, with a core area of high-density mounds up to 254 km long by 42 km wide. This study synthesized bathymetric data from 31 multibeam sonar mapping surveys and generated a standardized geomorphic classification of the region in order to delineate and quantify CWC mound habitats and compare mound morphologies among subregions of the coral province. Based on the multibeam bathymetry, a total of 83,908 individual peak features were delineated, providing the first estimate of the overall number of potential CWC mounds mapped in the region to date. Five geomorphic landform classes were mapped and quantified: peaks (411 km2), valleys (3598 km2), ridges (3642 km2), slopes (23,082 km2), and flats (102,848 km2). The complex geomorphology of eight subregions was described qualitatively with geomorphic “fingerprints” (spatial patterns) and quantitatively by measurements of mound density and vertical relief. This study demonstrated the value of applying an objective automated terrain segmentation and classification approach to geomorphic characterization of a highly complex CWC mound province. Manual delineation of these features in a consistent repeatable way with a comparable level of detail would not have been possible.

This paper examines the use by California’s direct market farmers (DMFs) of online sales and market­ing during the early onset of the COVID-19 pan­demic in the United States, from March through December 2020. The pandemic caused market dis­ruptions that accelerated the trend toward market digitalization. This paper reports quantitative find­ings based on 364 responses to an online survey of DMFs in California and qualitative findings from participant observation and 33 semi-structured interviews with DMFs and technical assistance providers. We found that online sales and market­ing tools, such as social media and websites, were important for withstanding economic disruptions associated with the pandemic, and farmers who had an online presence were more likely to increase their sales and profitability during its early onset. However, we also found that many farmers lacked the necessary resources to access these tools and use them effectively, and that technical assistance providers experienced challenges in helping farm­ers with online technology use. We argue that DMFs need reliable access to the internet, as well as advice, resources, and training to access and benefit from online sales and marketing tools. These resources must be available in languages other than English (e.g., Spanish). Research-informed programs and policies can help DMFs navigate market digitalization and strengthen their resilience to future economic disruptions.

Abstract Coral reefs are iconic ecosystems that support diverse, productive communities in both shallow and deep waters. However, our incomplete knowledge of cold-water coral (CWC) niche space limits our understanding of their distribution and precludes a complete accounting of the ecosystem services they provide. Here, we present the results of recent surveys of the CWC mound province on the Blake Plateau off the U.S. east coast, an area of intense human activity including fisheries and naval operations, and potentially energy and mineral extraction. At one site, CWC mounds are arranged in lines that total over 150 km in length, making this one of the largest reef complexes discovered in the deep ocean. This site experiences rapid and extreme shifts in temperature between 4.3 and 10.7 °C, and currents approaching 1 m s−1. Carbon is transported to depth by mesopelagic micronekton and nutrient cycling on the reef results in some of the highest nitrate concentrations recorded in the region. Predictive models reveal expanded areas of highly suitable habitat that currently remain unexplored. Multidisciplinary exploration of this new site has expanded understanding of the cold-water coral niche, improved our accounting of the ecosystem services of the reef habitat, and emphasizes the importance of properly managing these systems.

One of the key aims of post-primary education in Ireland is to develop all aspects of the individual, such as the creative, critical, and intellectual to prepare them for working life, for living in the community, and for leisure. Student self-confidence and student agency are critical to the students’ development at this stage. The flipped classroom is a model within the blended learning pedagogy and is one that has gained considerable attention in educational circles since school closures due to the COVID-19 pandemic. The benefits of the flipped classroom toward developing student self-confidence are noteworthy. However, at the national and international level, the vast majority of research on the flipped classroom is third-level focused. This paper discusses a number of issues that arose from data collected from research carried out by the author and how the flipped classroom could benefit adolescents preparing for the Irish Leaving Certificate Chemistry summative examination. The results obtained in this study are significant as little research has been carried out on the implementation of the flipped classroom within an Irish secondary school setting. Video lessons are often seen as the core resource in the implementation of the flipped classroom. However, video lessons alone were insufficient for developing student self-confidence. Students required multiple resources, particularly resources focused on assessment, to bolster their self-esteem. It was found that the successful implementation of the flipped classroom was achievable, but scaffolding was required for these adolescents. Some scaffolding was also required initially for teachers as almost all teachers involved in this study were not familiar with the flipped classroom concept. Teachers required a guide in terms of the implementation of new teaching methods. The technology is currently available to create high quality resources for the flipped classroom; however, in respect to policy development, the support for online learning should be pedagogy led as opposed to technology led.

Abstract Objective: Reducing children’s exposure to unhealthy food marketing is crucial to combat childhood obesity. We aimed to estimate the reduction of children’s exposure to food marketing under different policy scenarios and assess exposure differences by socio-economic status. Design: Data on children’s exposure to unhealthy food marketing were compiled from a previous cross-sectional study in which children (n 168) wore wearable cameras and Global Positioning System (GPS) units for 4 consecutive days. For each exposure, we identified the setting, the marketing medium and food/beverage product category. We analysed the percentage reduction in food marketing exposure for ten policy scenarios and by socio-economic deprivation: (1) no product packaging, (2) no merchandise marketing, (3) no sugary drink marketing, (4) no confectionary marketing in schools, (5) no sugary drink marketing in schools, (6) no marketing in public spaces, (7) no marketing within 400 m of schools, (8) no marketing within 400 m of recreation venues, (9) no marketing within 400 m of bus stops and (10) no marketing within 400 m of major roads. Setting: Wellington region of New Zealand. Participants: 168 children aged 11–14 years. Results: Exposure to food marketing varied by setting, marketing medium and product category. Among the ten policy scenarios, the largest reductions were for plain packaging (60·3 %), no sugary drink marketing (28·8 %) and no marketing in public spaces (22·2 %). There were no differences by socio-economic deprivation. Conclusions: The results suggest that plain packaging would result in the greatest decrease in children’s exposure to food marketing. However, given that children are regularly exposed to unhealthy food marketing in multiple settings through a range of marketing mediums, comprehensive bans are needed to protect children’s health.

Abstract Background The disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians’ motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction. Methods We describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians’ motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas. Results Through formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group (n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes. Conclusions Clinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes.

The purpose of this investigation was to determine the validity and reliability of the Humac360 linear position transducer (LPT) as compared to Tendo Weightlifting Analyzer. Seventeen recreationally active men and women completed three visits. Visit one included maximal strength assessments via one-repetition maximum (1RM) for the barbell back squat. On visits two and three, participants completed two sets of three repetitions at 30-, 50-, 60-, and 70% 1RM. Mean Concentric Velocity (MCV), Peak Velocity (PV), Displacement (D), and Duration (T) were collected. Repetition data agreement was assessed with Intraclass Correlation Coefficients (ICCs) and were categorized as poor (0.90). Significance was accepted at an alpha (p) value < 0.05. Repetition-to-repetition comparisons between devices demonstrate varying degrees of agreement, with significant differences between devices across all intensities and all measurements (p < 0.001). Inter-set reliability was excellent for MCV, PV, D, and T with the exceptions of MCV and PV at 70% 1RM (ICC2,k = 0.548 and 0.816). Inter-session reliability data demonstrated reduced agreeableness in an intensity-dependent manner, with ICCs decreasing and SEMs increasing with increases in intensity. The Humac360 LPT does not appear to be valid when compared to the criterion reference, though we contend it maintains construct validity. Coaches may use the Humac360 LPT as a tool to monitor fatigue, and the associated changes in trainee movement velocity on an inter-set and inter-session basis.

L'investigation secrète (art. 285a ss CPP) peut être mise en œuvre également contre une personne physique pour la poursuite d'une infraction grave. Lorsque l'agent infiltré intervient en vue d'obtenir des aveux du prévenu, le droit de ne pas s'auto-incriminer de ce dernier réduit considérablement l'étendue de l'intervention. En cas de provocation d'aveux, se pose la question des conséquences sur les déclarations ainsi obtenues. Le Tribunal fédéral a répondu à cette question dans l'ATF 148 IV 205, mais sans traiter les cas moins évidents que celui dont il a été amené à juger. La présente contribution revient sur cet arrêt de principe pour identifier les solutions qui pourraient être appliquées en cas de légère provocation, notamment sous l'angle de l'art. 293 al. 4 CPP. -- Die verdeckte Ermittlung (Art. 285a ff. StPO) kann auch gegen eine einzelne Person zur Verfolgung schwerer Straftaten eingesetzt werden. Wenn der verdeckte Ermittler tätig wird, um ein Geständnis des Beschuldigten zu erwirken, schränkt dessen Recht, sich nicht selbst belasten zu müssen, den Umfang der Ermittlung erheblich ein. Wird auf diese Weise ein Geständnis provoziert, stellt sich die Frage nach dessen Verwertbarkeit. Das Bundesgericht hat sich damit in BGE 148 IV 205 beschäftigt, allerdings ohne Regeln für weniger eindeutige Fälle aufzustellen. Dieser Beitrag greift dieses Grundsatzurteil auf und zeigt insbesondere unter Berücksichtigung von Art. 293 Abs. 4 StPO Lösungen auf, die im Falle leichter Geständnis-Provokationen angewandt werden könnten.

Measurement(s) park Technology Type(s) Geographic Information System Sample Characteristic - Environment County • Tract Sample Characteristic - Location United States

A rare occurrence of an atypical case of multiple evanescent white dot syndrome (MEWDS) in a 75-year-old man without viral prodrome or white dots on fundus that presented with acute, severe left eye visual loss, which returned to baseline without treatment in several weeks. Multimodal imaging, including fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine green angiography (ICG), and optical coherence tomography (OCT) demonstrated classical presentation of MEWDS with wreath-like lesions and inflammatory foci in the retinal pigment epithelium that correlated among modalities. Possible underlying systemic disorders were ruled out through extended work up. To the best of our knowledge, this is the first report to show atypical MEWDS in an elderly man with classic changes on FA, FAF, ICG, and OCT.

Abstract Background Tophi are lesions commonly present at sites of bone erosion in gout-affected joints. The tophus comprises a core of monosodium urate (MSU) crystals surrounded by soft tissue that contains macrophages and other immune cells. Previous studies found that MSU crystals directly reduce osteoblast viability and function. The aim of the current study was to determine the indirect, macrophage-mediated effects of MSU crystals on osteoblasts. Methods Conditioned medium from the RAW264.7 mouse macrophage cell line cultured with MSU crystals was added to the MC3T3-E1 mouse osteoblastic cell line. Conditioned medium from the THP-1 human monocytic cell line cultured with MSU crystals was added to primary human osteoblasts (HOBs). Matrix mineralization was assessed by von Kossa staining. Gene expression was determined by real-time PCR, and concentrations of secreted factors were determined by enzyme-linked immunosorbent assay. Results In MC3T3-E1 cells cultured for 13 days in an osteogenic medium, the expression of the osteoblast marker genes Col1a1, Runx2, Sp7, Bglap, Ibsp, and Dmp1 was inhibited by a conditioned medium from MSU crystal-stimulated RAW264.7 macrophages. Mineral staining of MC3T3-E1 cultures on day 21 confirmed the inhibition of osteoblast differentiation. In HOB cultures, the effect of 20 h incubation with a conditioned medium from MSU crystal-stimulated THP-1 monocytes on osteoblast gene expression was less consistent. Expression of the genes encoding cyclooxygenase-2 and IL-6 and secretion of the proinflammatory mediators PGE2 and IL-6 were induced in MC3T3-E1 and HOBs incubated with conditioned medium from MSU crystal-stimulated macrophages/monocytes. However, inhibition of cyclooxygenase-2 activity and PGE2 secretion from HOBs indicated that this pathway does not play a major role in mediating the indirect effects of MSU crystals in HOBs. Conclusions Factors secreted from macrophages stimulated by MSU crystals attenuate osteoblast differentiation and induce the expression and secretion of proinflammatory mediators from osteoblasts. We suggest that bone erosion in joints affected by gout results from a combination of direct and indirect effects of MSU crystals.

Objectives To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions.Design We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting.Setting Australian primary care.Participants Registered physiotherapists who are members of a practice-based research network (n=31).Results The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application.Conclusion High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.

Abstract Background Consistent condom use in women, defined as the self-reported usage of male condom in every sexual encounter of the respondent with her most recent partner in the last 12 months, had been perennially low in the Philippines. This is despite consistent condom use being a tested and proven public health intervention to prevent unwanted pregnancy and sexually transmitted infections. Considering the high fertility rate, teenage pregnancy rate, and the rapidly increasing incidence of HIV in the country, we identified the determinants of consistent condom use in the Philippines. Methods We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to identify factors associated with consistent condom use. Results Out of 25,074 respondents, only 261 (1.13%) have used condoms consistently with their most recent partner. Reach of information and education campaigns on contraceptive use via different media ranged from 62% via television to 7% via short messaging service. After adjusting for confounders, those who were able to ask their partners to use condoms during sexual intercourse have 6.18 times (adjusted odds ratio (aOR): 6.18; 95% Confidence Interval (95% CI): 2.02. 18.94) greater odds of consistent condom use than those who were unable to ask their partners to use condoms during sexual intercourse. Meanwhile, HIV knowledge (aOR: 1.16; 95% CI: 0.98, 1.38) and hearing about contraception in television (aOR: 1.54; 95% CI: 1.00, 2.38) have weaker associations with consistent condom use. Conclusions The low percentage of those who use condoms consistently, together with the low reach of information and education campaigns, highlight the need to implement multi-faceted and context-specific interventions to promote sexual agency and/or consistent condom use to address the burden of unwanted pregnancies and HIV in the Philippines.

Abstract Objective: To explore the views of stakeholders in Australia concerning skin cancer primary prevention and identify successful strategies used that may be translatable to other jurisdictions. Methods: In‐depth stakeholder interviews with experts engaged in skin cancer prevention advocacy and action in Australia. Results: A number of important facilitators were identified including: the use of good scientific evidence (including economic), strong leadership, legislation and strategic documents, engaging the media particularly with the use of personal stories and garnering public support. A number of barriers were also identified including: a lack of funding (particularly nationally), variation by state, apathy and the long latency of skin cancer. Conclusions: Advocates identified a number of key strategies that were used to gain momentum in achieving Australia's comprehensive Sunsmart program. These included: strong leadership, legislation including that banning solaria and workplace health and safety legislation, a critical mass of key advocates from a range of disciplines including clinicians and patients, and the advantageous use of media to drive change. Implications for public health: Australia demonstrates what can be achieved when skin cancer prevention is taken seriously. The challenge for other nations is to apply the lessons learnt in Australia to our own jurisdictions.

Abstract Background Assess the associations between ten severe maternal hardships and food insecurity experienced during pregnancy. Methods Data on 14,274 low-income/lower-income women (below 400% of the income to federal poverty guideline ratio) from the statewide-representative 2010–2012 California Maternal and Infant Health Assessment were used to estimate food security status prevalence. Prevalence of severe maternal hardships by food security status was estimated. Multinomial logistic regression was used to assess the associations between severe maternal hardship and food security status, adjusting for sociodemographic characteristics. Results Food insecurity was common among low- and lower-income pregnant women in California; 23.4% food insecure and an additional 11.5% marginally secure. In adjusted analysis, nine of ten hardships were associated with food security status. Only the respondent or someone close to the respondent having a problem with alcohol or drugs was not associated with food security status after adjusting for socioeconomic factors. Husband/partner losing a job, depressive symptoms, not having practical support and intimate partner violence were consistently associated with marginal, low and very low food security status. Each additional severe maternal hardship a woman experienced during pregnancy was associated with a 36% greater risk of reporting marginal food security (Relative Risk Ratio 1.36, 95% CI: 1.27, 1.47), 54% for low food security (Relative Risk Ratio 1.54, 95% CI: 1.44, 1.64), and 99% for very low food security (Relative Risk Ratio 1.99, 95% CI: 1.83, 2.15). Conclusions Food security status was strongly linked with several maternal hardships that could jeopardize maternal and/or infant health. Services—including prenatal care and nutritional assistance—for a large proportion of pregnant women should address a wide range of serious unmet social needs including food insecurity.

Background: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. Methods: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. Results: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. Conclusion: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications. Résumé: Introduction: Les grandes lignes directrices sociétales recommandent une interruption de cinq jours avant l’intervention chirurgicale du cœur des patients atteints d’un syndrome coronarien aigu qui prennent du clopidogrel. Toutefois, comme il s’agit pour plusieurs d’entre eux de patients de haute acuité, le chirurgien penche vers l’utilisation d’une interruption plus courte. Par conséquent, la présente étude avait pour objectif de déterminer les conséquences de la durée et du moment de la cessation du clopidogrel sur les événements hémorragiques indésirables. Méthodes: La présente étude de cohorte rétrospective portait sur les patients qui avaient subi une intervention chirurgicale au cœur entre 2009 et 2016 dans un centre de soins tertiaires. Nous avons utilisé les modèles multivariés de régression logistique ajustés à l’interruption du clopidogrel, à l’âge, à l’urgence de l’intervention chirurgicale et au type d’intervention chirurgicale pour quantifier les effets des caractéristiques démographiques initiales cliniquement pertinentes sur la fréquence des transfusions massives ainsi que sur les issues des complications hémorragiques. Résultats: Un total de 5 748 patients ont subi une intervention chirurgicale au cœur. Dans cette cohorte, parmi les 1 743 patients (30,3 %) qui avaient reçu du clopidogrel avant l’opération, 884 (50,7 %) avaient cessé le clopidogrel cinq jours avant leur admission à la salle d’opération. L’administration du clopidogrel un à deux jours avant l’intervention chirurgicale (ratio d’incidence approché 1,97; intervalle de confiance [IC] à 95 % : de 1,18 à 3,29) était un prédicteur indépendant des transfusions massives et des complications hémorragiques (ratio d’incidence approché 1,85; [IC] à 95 % : de 1,01 à 3,37). Le groupe de l’interruption de trois à quatre jours n’a pas montré de risque accru de complications hémorragiques graves. Le risque de transfusions massives et de complications hémorragiques a aussi contribué à l’augmentation de l’urgence et de la complexité de l’intervention chirurgicale. Conclusion: Une interruption du clopidogrel de trois à quatre jours avant l’opération n’a pas été associée à un risque accru de complications hémorragiques graves.

Introduction: Carotid artery pseudoaneurysm is a rare but potentially morbid complication of central venous catheter insertion. Traditionally managed by open surgical or endovascular repair, this article describes a case that used percutaneous thrombin injection. Delivered at the point of care under ultrasound guidance, it offers a less invasive and less resource dependent approach where conventional therapies are unsuccessful. Case report: A 63 year old man re-presented to hospital with a right common carotid artery pseudoaneurysm following internal jugular vein catheterisation for a staged transcatheter aortic valve implantation. An attempt was made at coil occlusion by the neuro-interventional radiology team, but this was unsuccessful given inability to pass a delivery catheter to the pseudoaneurysm tract in the setting of a tortuous and calcified proximal circulation. Subsequently, direct percutaneous thrombin injection, administered under ultrasound guidance was undertaken as an alternative approach. Complete thrombosis was achieved with no complications and the patient was discharged on day three of admission. Discussion: While percutaneous thrombin injection is commonly used in the treatment of femoral pseudoaneurysms, there remains a paucity of evidence regarding its use in the management of carotid pseudoaneurysms. This case demonstrates its effectiveness in treating this complication. Percutaneous thrombin injection may offer a highly effective treatment option for carotid pseudoaneurysm, particularly where more conventional therapies have been unsuccessful or are relatively contraindicated.

Abstract The histone H3 variant H3.3, encoded by two genes H3-3A and H3-3B, can replace canonical isoforms H3.1 and H3.2. H3.3 is important in chromatin compaction, early embryonic development, and lineage commitment. The role of H3.3 in somatic cancers has been studied extensively, but its association with a congenital disorder has emerged just recently. Here we report eleven de novo missense variants and one de novo stop-loss variant in H3-3A (n = 6) and H3-3B (n = 6) from Baylor Genetics exome cohort (n = 11) and Matchmaker Exchange (n = 1), of which detailed phenotyping was conducted for 10 individuals (H3-3A = 4 and H3-3B = 6) that showed major phenotypes including global developmental delay, short stature, failure to thrive, dysmorphic facial features, structural brain abnormalities, hypotonia, and visual impairment. Three variant constructs (p.R129H, p.M121I, and p.I52N) showed significant decrease in protein expression, while one variant (p.R41C) accumulated at greater levels than wild-type control. One H3.3 variant construct (p.R129H) was found to have stronger interaction with the chaperone death domain-associated protein 6.

BackgroundChildren under 18 years of age account for approximately 1 in 3 internet users worldwide. Largely unregulated, the internet-based world is evolving rapidly and becoming increasingly intrusive. There is a dearth of objective research globally on children’s real-time experiences of the internet-based world. ObjectiveThis paper reports an objective methodology to study the nature and extent of children’s internet-based world, their engagement with it, and how this impacts their health and well-being. MethodsA total of 180 year 8 students from 12 schools will be recruited into the study within the Wellington region of Aotearoa, New Zealand. Children use Zoom video teleconferencing software to record real-time, screen-shared internet-based content, for 4 consecutive days. Data on demographics, health and well-being, and attitudes and perceived behaviors in relation to the internet-based world are collected. Phone screen-time balances are retrieved. Data collection commenced in June 2021 and is anticipated to be completed in 2023. ResultsRecordings show children exploring diverse web-based settings and content, including personalized content curated by algorithms on platforms such as TikTok, YouTube, and Instagram. Preliminary analysis shows that the data can be used to study a wide range of topics. Behavioral Observation Research Interaction Software is being used to manually code recordings. Artificial Intelligence techniques are also being applied, including hashtag extraction, optical character recognition, as well as object, pattern, speech, and lyric recognition. ConclusionsThis novel methodology reveals the unique internet-based experiences of children. It is underpinned by a commitment to ensuring that their rights are protected. It seeks to provide concrete evidence on internet usage in this group and to facilitate appropriate political and societal action to effectively regulate the internet-based world to prevent harm to children. International Registered Report Identifier (IRRID)DERR1-10.2196/39017

Abstract Background The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. Methods We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. Results A total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. Conclusions The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. Trial registration NCT04530591.

Abstract Population studies in Aotearoa New Zealand found higher bone mineral density and lower rate of hip fracture in people of Polynesian ancestry compared to Europeans. We hypothesised that differences in osteoblast proliferation and differentiation contribute to the differences in bone properties between the two groups. Osteoblasts were cultured from bone samples obtained from 30 people of Polynesian ancestry and 25 Europeans who had joint replacement surgeries for osteoarthritis. The fraction of cells in S-phase was determined by flow cytometry, and gene expression was analysed by microarray and real-time PCR. We found no differences in the fraction of osteoblasts in S-phase between the groups. Global gene expression analysis identified 79 differentially expressed genes (fold change > 2, FDR P

Abstract Background Irradiation of the heart during cancer radiotherapy is associated with a dose-dependent risk of heart failure. Animal studies have demonstrated that irradiation leads to an inflammatory response within the heart as well as a reduction in cardiac reserve. In the current study we aimed to evaluate whether inflammatory biomarkers correlated with changes in cardiac function and reserve after radiotherapy for breast or lung cancer. Methods and results We studied 25 subjects with a history of breast or lung cancer without a prior diagnosis of cardiovascular disease or heart failure, 1.8 years [0.4–3.6] post-radiotherapy involving at least 5 Gray (Gy) to at least 10% of the heart. High-sensitivity C-reactive protein (CRP) was abnormal (≥2 mg/L) in 16 (64%) subjects. Cardiac function and reserve was measured with Doppler echocardiography before and after exercise and defined as left-ventricular ejection fraction (LVEF), early diastolic mitral annulus velocity (e’), and increase in LV outflow tract velocity time integral cardiac output (cardiac reserve) with exercise. Subjects with abnormal CRP had significantly lower LVEF (51 [44–59] % vs 61 [52–64] %, P = 0.039), lower e’ (7.4 [6.6–7.9] cm/sec vs 9.9 [8.3–12.0] cm/sec, P = 0.010), and smaller cardiac reserve (+ 1.5 [1.2–1.7] L/min vs + 1.9 [1.7–2.2] L/min, P = 0.024). Conclusion Elevated systemic inflammation is associated with impaired left-ventricular systolic and diastolic function both at rest and during exercise in subjects who have received radiotherapy with significant incidental heart dose for the treatment of cancer.

Sport is a useful area of study to test assumptions of international law. International law has traditionally focused on states and on international organizations that oversee specialized areas of human activity. International sport is overseen by an NGO—the International Olympic Committee (IOC). Yet sport is of great interest to states, serving as a testing ground of national superiority by providing a simple narrative of “winners” and “losers” in competition. Meanwhile, entities that are not yet states have historically been able to participate in international sport more readily than in other areas of international relations. This essay will examine the connection between participation in the Olympic Games and claims to statehood. In doing so, this essay will outline the modern approach to statehood, consider sport's role in that approach, and examine two case studies: the German Democratic Republic, and Kosovo.

Machine vision has demonstrated its usefulness in the livestock industry in terms of improving welfare in such areas as lameness detection and body condition scoring in dairy cattle. In this article, we present some promising results of applying state of the art object detection and classification techniques to insects, specifically Black Soldier Fly (BSF) and the domestic cricket, with the view of enabling automated processing for insect farming. We also present the low-cost “Insecto” Internet of Things (IoT) device, which provides environmental condition monitoring for temperature, humidity, CO2, air pressure, and volatile organic compound levels together with high resolution image capture. We show that we are able to accurately count and measure size of BSF larvae and also classify the sex of domestic crickets by detecting the presence of the ovipositor. These early results point to future work for enabling automation in the selection of desirable phenotypes for subsequent generations and for providing early alerts should environmental conditions deviate from desired values.

Abstract The phenotypic variability associated with pathogenic variants in Lysine Acetyltransferase 6B (KAT6B, a.k.a. MORF, MYST4) results in several interrelated syndromes including Say‐Barber‐Biesecker‐Young‐Simpson Syndrome and Genitopatellar Syndrome. Here we present 20 new cases representing 10 novel KAT6B variants. These patients exhibit a range of clinical phenotypes including intellectual disability, mobility and language difficulties, craniofacial dysmorphology, and skeletal anomalies. Given the range of features previously described for KAT6B‐related syndromes, we have identified additional phenotypes including concern for keratoconus, sensitivity to light or noise, recurring infections, and fractures in greater numbers than previously reported. We surveyed clinicians to qualitatively assess the ways families engage with genetic counselors upon diagnosis. We found that 56% (10/18) of individuals receive diagnoses before the age of 2 years (median age = 1.96 years), making it challenging to address future complications with limited accessible information and vast phenotypic severity. We used CRISPR to introduce truncating variants into the KAT6B gene in model cell lines and performed chromatin accessibility and transcriptome sequencing to identify key dysregulated pathways. This study expands the clinical spectrum and addresses the challenges to management and genetic counseling for patients with KAT6B‐related disorders.

Background: Percutaneous LAAO represents an alternative for stroke prevention in patients not tolerating anticoagulation. While women are at higher risk of complications during percutaneous coronary or valvular interventions, the impact of gender on LAAO outcomes is not well characterized. The current study assessed potential gender-related differences in procedural and long-term outcomes following left atrial appendage occlusion (LAAO). Methods: 1088 AF patients were enrolled in the prospective, multicenter, Amplatzer™ Amulet™ Observational Study and followed for 2 years with scheduled adverse event assessments. The prespecified primary outcome was ischemic stroke, systemic embolism or cardiovascular (CV) death at 2 years. We also compared the rate of procedural success, device-related thrombus (DRT) and major bleeding between genders. Results: 702 men and 386 women underwent LAAO. Implant successwas high, and similar between men and women (98.9 vs 99.5%, p = 0.58). Similarly, no difference was observed in the primary outcome (12.0 vs 12.5%, p = 0.82). Compared to the CHA2DS2-VASc predicted rate, we observed a numerically greater absolute risk reduction of ischemic stroke in women (from 7.6 to 2.1%/year) than men (from 6.2 to 2.2%/year). DRT through 2 years was similar between groups (1.6%, p = 0.96). We found no significant gender difference in terms of periprocedural or long-term (7.1 vs 7.6%/year) major bleeding. Conclusions: In this large group of patients undergoing LAAO using the Amplatzer™ Amulet™ device we found no significant gender difference in terms of procedural or long-term clinical outcomes. Similarly to oral anticoagulation, device-based LAA occlusion renders AF-related stroke risk similar in women and men. Clinical trial registration: Clinicaltrials.gov Identifier: NCT02447081.https://clinicaltrials.gov/ct2/show/NCT02447081.

Abstract Background Alternative grafts are needed to improve the healing of bone non-union. Here, we assessed a bovine bone product which retains the inorganic and organic components of bone, as an alternative bone graft. Methods Bovine bone matrix proteins (BBMPs) were isolated from bovine bone particulates (BBPs) and tested in vitro. Primary rat osteoblast viability, differentiation, and mineralisation were assessed with alamarBlue®, real-time PCR, and von Kossa staining assays, respectively. Osteoclast formation was assessed in primary murine bone marrow cultures with TRAP staining. Human osteoblast growth and differentiation in the presence of BBPs was evaluated in 3D collagen gels in vitro using alamarBlue® and real-time PCR, respectively. The efficacy of BBPs as an alternative bone graft was tested in a rat critical-size calvarial defect model, with histology scored at 4 and 12 weeks post-surgery. Results In vitro, the highest concentration of BBMPs increased mineral deposition five-fold compared to the untreated control group (P

Wildland fire literacy is the capacity for wildland fire professionals to understand and communicate fundamentals of fuel and fire behavior within the socio-ecological elements of the fire regime. While wildland fire literacy is best developed through education, training, and experience in wildland fire science and management, too often, development among early-career professionals is deficient in one or more aspects of full literacy. We report on a hands-on prescribed fire methods workshop designed to provide training and experience in measuring and conducting prescribed fire, with a focus on grassland ecosystems. The workshop was held in March 2022 at The Nature Conservancy’s Dunn Ranch Prairie in northern Missouri. It consisted of hands-on training and experience in measuring fuels, fire weather, and fire behavior. Prescribed fire operations training facilitated both hands-on learning and vicarious learning by rotating squad roles among several small sub-units on the first day of live fire exercises. Participants then gained experience as crew members for two larger prescribed burns (60 and 200 ha). We report here on the successes and lessons learned from the perspectives of both participants and the instructor cadre for what was widely regarded as a successful workshop.

Indonesia adalah negara dengan intensitas bencana alam yang cukup sering, khususnya gempa. Bencana alam telah menimbulkan dampak kerugian yang cukup signifikan terhadap pertumbuhan ekonomi di daerah terdampak. Pemerintah harus hadir sebagai bagian dari solusi, khususnya dalam memulihkan ekonomi. Salah satu upaya untuk mendukung pemulihan kondisi perekonomian dilakukan dengan memberikan perlakuan khusus terhadap kredit atau pembiayaan bank dengan jumlah tertentu dan kredit atau pembiayaan yang direstrukturisasi. Pemerintah melalui Otoritas jasa Keuangan membuat kebijakan khusus berupa pelonggaran aturan untuk restrukturisasi, penilaian kualitas kredit atau pembiayaan syariah, dan/atau pemberian kredit/pembiayaan syariah baru dengan Peraturan Otoritas Jasa Keuangan Nomor 45/POJK.03/2017 tentang Perlakuan Khusus terhadap Kredit atau Pembiayaan Bank bagi Daerah-daerah Tertentu di Indonesia yang Terkena Bencana Alam. Melalui kebijakan khusus ini, perusahaan pembiayaan dapat memberikan relaksasi kepada debitur berupa rescheduling pembayaran angsuran, diskon biaya administratif, dan penghapusan denda akibat keterlambatan pembayaran angsuran. Di dalam implementasinya kebijakan ini menemui berbagai problematika.

Water quality is very important for plant’s growth and development. Some of the important part of the water qualities are TDS(Total Dissolved Solid), EC(Electrical Conductivity), pH(Acidity). Cultivation inside a greenhouse provides some benefits but also have some deficiency, such as lack of soil nutrition because most plants inside greenhouse uses non soil growing media. To overcome the deficiency, An automated and remote system is needed to ease the controlling of water quality and nutrition feeding to the plant. This study aims to create low-cost greenhouse water quality monitoring that automatically display the real time data on a website. This research is done by using an engineering design methods. This system can be integrated with auto-pot watering system . The result shows that the system can adjust the TDS and pH as programmed, which are TDS= 1000-1200, and pH =5.5-6.5(these are recommended needs for Tomato plant). The TDS sensor in this reseach have the limitation of reading 0~1500ppm.

This paper is an exploration of the elements for developing a program of liturgical formation according to the principles and themes indicated in Pope John Paul II’s Dilecti Amici. It is in line with the celebration of the 2019 Year of the Youth, as it endeavors to get to know the youth better in view of ministering to them more effectively. Indicated in the paper is a general overview of the current situation of the youth, highlighting such features as those pertinent to their interests and capacity for liturgical participation. By learning the proper exercise of their ministry and being imbued with the true spirit of the liturgy, they will be able to bring themselves and the people whom they serve to a more devout and fruitful participation in liturgical celebrations. The paper offered an exposition of Pope John Paul II’s Apostolic Letter Dilecti Amici to bring to clearer light his vision for young people in and for the Church and cues that are pertinent and relevant for the liturgical formation of the youth today. Moreover, the paper articulates some considerations and indications for forming young people in and for the liturgy to help them grow spiritually in their formative years and thus equip them with the needed skills and values to make a positive impact on the Church and on the society both now and in their future. References Bacani, T., A Spirituality for Ministry, Manila 2006. Bauerschmidt, F.- Buckley, J., Catholic Theology: An Introduction, Oxford 2017. Catholic Bishops' Conference of the Philippines-Episcopal Commission on Youth (CBCP-ECY) and the Catholic Educational of Association of the Philippines (CEAP), "The National Filipino Catholic Youth Study", Manila 2015. Chupungco, A., "Active Participation," in Pastoral Liturgy: Shepherding God's Flock, ed. G. Diwa, Manila 2013, 29-61. Chupungco, A., "A Definition of Liturgy," in Handbook for Liturgical Studies 1: Introduction to the Liturgy, A.J. Chupungco, Collegeville 2000, p. 3-10. Chupungco, A., "Lay Liturgical Ministries," in Liturgy for the Filipino Church, ed. J. Manabat, Manila 2004, 199-208. Clemens, J., "The Church's Commitment to the Young: From John Paul II to Pope Francis," presented at the International Meeting on World Youth Day (Rio 2013-Krakow 2016) on 10-13 April 2014 at Sassone di Ciampino, Rome, p. 1-17. in Episcopal Commission on Catechism and Catholic Education of the Catholic Bishops' Conference of the Philippines, Catechism for Filipino Catholics (CFC), Manila 1997. Episcopal Commission on Catechism and Catholic Education of the Catholic Bishops' Conference of the Philippine, Catechism of the Catholic Church, (CCC), Manila 1994. John Paul II, Address to young people: "After his first Angelus at the end of the solemn liturgy that inaugurated his pontificate, 22 October 1978", International Meeting on WYD, Rio 2013 - Krakow 2016, The Church commitment to the young: from John Paul II to Pope Francis, (12 April 2014.) John Paul II, Catechesi tradendae, on Catechesis in our Time (16 October 1979) in Vatican Council II. More Post Conciliar Documents 2, ed. A. Flannery, Pasay City 1996, 762-814. John Paul II, Post-Synodal Apostolic Exhortation Christifideles laici on the Vocation and the Mission of the Lay Faithful in the Church and in the World (30 December 1988), Pasay City 2014. John Paul II, Apostolic Letter Dilecti Amici, (31 March 1984) to the Youth of the World on the Occasion of the International Youth Year. 1984. John Paul II, Encyclical Letter Ecclesia de Eucharistia on the Eucharist in its Relationship to the Church (April 17, 2003). John Paul II, Apostolic Letter Vicesimus Quintus Annus on the 25th Anniversary of the Promulgation of the Conciliar Constitution Sacrosanctum Concilium on the Sacred Liturgy (4 December 1988). L’Osservatore Romano (23-24 October 1978), p. 2. Mazza, E., Mystagogy, A Theology of Liturgy in the Patristic Age, New York 1989. Paul VI, "Apostolic Letter Ministeria Quaedam on the First Tonsure, Minor Orders, and Subdiaconate (15 August 1972)," in Vatican Council II. The Conciliar and Post Conciliar Documents, Vol. 1 ed. A. Flannery, New York 1996, 427-432. Pontifical Committee on International Eucharistic Congress, "Christ in You our Hope of glory", The Eucharist: source and goal of the Church's mission, Theological and pastoral reflections in preparation for the 51st International Congress, Cebu, Philippines 2016. Pontifical Council for the Laity, A Dicastery of the Roman Curia at the Service of the Laity (21 January 2014) Feast of St. Agnes, 2., Pope Francis message for the 29th World Youth Day. Pope Francis to the young people in celebration of Apostolic Journey to Rio de Janeiro on the occasion of the 28th World Youth Day, presented during the prayer vigil with the young people on 27 July 2013 at Copacabana, Rio de Janeiro. in Raas, B., "Ministries," in Liturgy, Ministries and the Bible, Manila 1992, 77-131. Second Vatican Council, Constitution Sacrosanctum Concilium on the Sacred Liturgy (4 December 1963): AAS 56 (1964) 97-138. Eng. tr.: Vatican Council II. The Conciliar and Post-Conciliar Documents, ed. Flannery, 1-36. Second Vatican Council, “Declaration Gravissimum Educationis on Christian Education (28 October 1965),” AAS 58 (1966) 728-739. Eng. tr.: Vatican Council II, ed. Flannery, 725-737. Second Vatican Council, "Dogmatic Constitution Lumen Gentium on the Church (21 November 1964)," in Vatican Council II. The Conciliar and Post Conciliar Documents, Vol. 1, ed. A. Flannery, New York 1996, 350-426. Second Vatican Council, "Pastoral Constitution Gaudium et Spes on the Church in the Modern World: AAS (1965). Eng. tr.: Vatican Council II, ed. Flannery, 903-1014.

Objective To evaluate the safety and efficacy of percutaneous left atrial appendage occlusion (LAAO) using conscious sedation (CS).Background Several percutaneous structural heart disease interventions are safely and efficiently performed using CS instead of general anaesthesia (GA). This concept has not been evaluated in a large multicenter cohort of patients undergoing LAAO.Methods Patients from the prospective, global Amplatzer Amulet Occluder Observational Study were divided into two groups (GA vs CS). Baseline information, periprocedural and postprocedural efficacy and complications, as well as outcomes through 7 days post implant were compared.Results Patients undergoing transesophageal-guided implants were categorised by GA (n=607, 64%) or CS (n=342, 36%) usage. Mean age was 75 years in both groups. LAAO technical success was achieved in 99% of both groups. The procedure duration (GA: 35±22 min vs CS: 27±19 min, p

Aims To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, pConclusion Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.