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Abstract Background The number of advanced heart failure patients with left ventricular assist devices (LVAD) is increasing. Despite guideline-recommendations, little is known about specialist palliative care involvement in LVAD-patients, especially in Europe. This study aims to investigate timing and setting of specialist palliative care in LVAD-patients. Methods We conducted a retrospective multicenter study in 2022. Specialist palliative care services in German LVAD-centers were identified and invited to participate. Forty adult LVAD-patients (mean age 65 years (SD 7.9), 90% male) from seven centers that received a specialist palliative care consultation during hospitalization were included. Results In 37 (67.3%) of the 55 LVAD-centers, specialist palliative care was available. The median duration between LVAD-implantation and first specialist palliative care contact was 17 months (IQR 6.3–50.3 months). Median duration between consultation and death was seven days (IQR 3–28 days). 65% of consults took place in an intensive/intermediate care unit with half of the patients having a Do-Not-Resuscitate order. Care planning significantly increased during involvement (advance directives before: n = 15, after: n = 19, p

IMPORTANCE:. Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care. OBJECTIVES:. This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed. DESIGN, SETTING, AND PARTICIPANTS:. A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical). ANALYSIS:. The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz. RESULTS:. Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors). CONCLUSIONS:. Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.

PurposeFor children with blindness and visual impairment (BVI) of all ages, disability sport and/or regular Physical Activity (PA) are deemed beneficial, promoting physical and mental health as well as increasing wellbeing and life satisfaction. In this regard, Physical Education (PE) serves as a foundation to regular and lifelong participation in PA, mainstream and/or disability sport. Research points towards manifold participation barriers for children with BVI in PE, which so far have mainly been investigated in inclusive settings and from the perspectives of sighted parents, teachers and peers. Consequently, people with BVI frequently consider PE a missed opportunity for lifelong PA. As transitioning from general to special schooling deems the only alternative to continue their education, questions arise in how far and in which ways specialized schools manage to accommodate their needs in PE. To address these gaps in literature, we investigated BVI students' perceived opportunities and barriers to participation in PE within a specialized school setting and their imaginations for possible (digital) improvements and solutions.Materials and methodsWithin the framework of Inclusive and Youth Participatory Action Research, we adopted the Mosaic Approach to investigate a sample of 19 students aged 14–20 at lower and upper secondary level in a specialized school in Austria. Data material included audio-recordings of interviews, student-guided school tours, photographs of significant places and objects and field protocols. The analysis was conducted with Interpretative Phenomenological Analysis.Results and conclusionThrough the analysis, we identified three themes. The data material firstly revealed the complex intricacies of how PE teachers can act as facilitators and gatekeepers to autonomous PA. Secondly, material norms function not only as barriers to participation even in a specialized school setting, but also constitute the basis for social hierarchies between students with various degrees of visual impairment. Thirdly, students imagined manifold digital solutions to enhance participation derived from their perceived barriers. The findings contribute to amplifying BVI individuals' voices and provide revealing insights in how participation in PA is enabled and prohibited for students with BVI which can not only help to improve specialized but also inclusive settings.

Accurate observation of two or more particles within a very narrow time window has always been a challenge in modern physics. It creates the possibility of correlation experiments, such as the ground-breaking Hanbury Brown–Twiss experiment, leading to new physical insights. For low-energy electrons, one possibility is to use a Microchannel plate with subsequent delay lines for the readout of the incident particle hits, a setup called a Delay Line Detector. The spatial and temporal coordinates of more than one particle can be fully reconstructed outside a region called the dead radius. For interesting events, where two electrons are close in space and time, the determination of the individual positions of the electrons requires elaborate peak finding algorithms. While classical methods work well with single particle hits, they fail to identify and reconstruct events caused by multiple nearby particles. To address this challenge, we present a new spatiotemporal machine learning model to identify and reconstruct the position and time of such multi-hit particle signals. This model achieves a much better resolution for nearby particle hits compared to the classical approach, removing some of the artifacts and reducing the dead radius a factor of eight. We show that machine learning models can be effective in improving the spatiotemporal performance of delay line detectors.

Mediterranean islands suffer from a lack of freshwater due to persistent and recursive droughts, limited groundwater availability and mass tourism. In Ibiza (Spain), private estates disconnected from the water distribution network consume about 21% of the total freshwater demand on the island. We conducted a study to evaluate the potential of ground-runoff harvesting (GRH) as a sustainable and inexpensive solution to increase freshwater availability in isolated households in Ibiza. The study involved an innovative modular tank of 40 m3 buried in the garden of a private property. The tank intercepted runoff forming in a 12,300 m2 hilly micro-catchment. We found that an extreme rainfall event with an intensity of 65 mm/h was able to create sufficient runoff to fill up the tank in one hour. A curve-number-based rainfall-runoff model was used to simulate the experimental results and to obtain a first-cut estimation of the potential of GRH at the scale of the island. The analysis indicates that, if installed in all forest areas in Ibiza with a similar slope to the study area, a volume of 1.31×106 m3 of freshwater could be harvested per year on the island just from extreme precipitation events. Such a volume of water is equivalent to about 5% of the island’s total freshwater budget. The study concludes that GRH is a highly valuable, yet still unexploited opportunity to save large freshwater volumes in dry-climate areas like Ibiza. GRH should be promoted across Mediterranean islands, and it can be easily incorporated within local water regulations.

Resumen El artículo analiza el rol que jugó el Observatorio Astronómico Nacional en la expansión territorial de Chile a fines del siglo XIX, a través de la relación que sostuvo con tres exploraciones geográficas asociadas a este proceso. Se propone que el Observatorio cumplió un papel central para estas exploraciones geográficas, ayudando a obtener coordenadas geográficas precisas en pos de producir mapas exactos de los territorios anexados al norte y sur de Chile. Los resultados permiten afirmar que el Observatorio Astronómico Nacional fue una institución que prestó servicios estratégicos durante la expansión territorial y, a su vez, que la geografía fue parte importante de sus trabajos científicos institucionales.

Digital technologies have permeated most aspects of modern life. In particular, the intersection of digitalization and physical activity has seen significant developments. Such digital technologies have become constitutive of adolescents’ life, being a main source of information and a strong influence for their knowledge and behavior in physical activities. These developments have raised significant questions among educational stakeholders worldwide, providing the basis for digital education at all school levels. One of the core goals for the future is preparing the next generation to be able to use digital technologies within physical activities competently, while at the same time taking a constructive and critical perspective on the potentials and risks. The subject of physical education (PE) plays a major role in this intersection. Since it is the central role of a curriculum to act as a systematic framework for the course of learning, it is of particular interest to what extent issues of digitalization appear in PE curricula. Against this backdrop, this paper examines how digitalization is interpreted for official curriculum texts in and across current PE curricula in three German-speaking countries. A qualitative comparative document analysis has been applied. The findings demonstrate differences in what is valued in terms of digitalization and PE. Digital media appear with a predominantly functional character where media are primarily used as tools, for example, for movement analyzes aiming at improving sports skills. In addition, the critical reflection regarding the medial effects of, for example, fitness trends or body ideals embedded in media is only rarely addressed. The paper concludes that future curriculum reforms should address digitalization and PE in a more comprehensive way to empower students critically navigating through sport and movement in the digital realm.

This Special Issue focuses on technology and how people are making sense of this related to body, movement, exercise and health through a sport pedagogical lens.

The aim of this article is to explain multimodal coherence-making as a transcribing practice and how this can be used to teach multimodal, narrative, and media competences in different genres. In multimodal arrangements, language makes images readable in specific ways and images make language understandable in different ways. This results in an abductive understanding process that can be used in teaching and learning contexts. This idea of meaning-making is based on the social semiotic approach of style. According to the understanding of semiotic meta functions, this approach considers style as the practice of selecting, forming, and composing semiotic resources. These stylistic practices realize a subjective appropriation of discursive and habitual patterns, which are carried out within the semiotic and technological dispositions (affordances) of the situationally used media infrastructures. In this sense, digital storytelling is a multimodal style practice with digital tools. Multimodal storytelling in educational contexts means that teachers and learners are prompted to bring the communicative functions of text, image, video, and audio into narrative coherence. Based on a journalistic Instagram story, this article reconstructs the media-practical, multimodal, and narrative skills that are prototypically necessary. Based on this analysis, these competencies are operationalized to make them usable for new teaching/learning arrangements using digital storytelling.

BackgroundRepeat hospitalizations, complications, and psychosocial burdens are common in patients with left ventricular assist devices (LVAD). Specialist palliative care (sPC) involvement supports patients during decision-making until end-of-life. In the United States, guidelines recommend early specialist palliative care (esPC) involvement prior to implantation. Yet, data about sPC and esPC involvement in Europe are scarce.Materials and MethodsThis is a retrospective descriptive study of deceased LVAD patients who had received sPC during their LVAD-related admissions to two university hospitals in Duesseldorf, Germany and Basel, Switzerland from 2010 to 2021. The main objectives were to assess: To which extent have LVAD patients received sPC, how early is sPC involved? What are the characteristics of those, how did sPC take place and what are key challenges in end-of-life care?ResultsIn total, 288 patients were implanted with a LVAD, including 31 who received sPC (11%). Twenty-two deceased LVAD patients (19 male) with sPC were included. Mean patient age at the time of implantation was 67 (range 49–79) years. Thirteen patients (59%) received LVAD as destination therapy, eight patients (36%) were implanted as bridge to transplantation (BTT), and one as an emergency LVAD after cardiogenic shock (5%). None of the eight BTT patients received a heart transplantation before dying. Most (n = 13) patients lived with their family and mean Eastern Cooperative Oncology Group (ECOG) performance status was three. Mean time between LVAD implantation and first sPC contact was 1.71 years, with a range of first sPC contact from 49 days prior to implantation to more than 6 years after. Two patients received esPC before implantation. In Duesseldorf, mean time between first sPC contact and in-hospital death was 10.2 (1–42) days. In Basel, patients died 16 (0.7–44) months after first sPC contact, only one died on the external sPC unit. Based on thorough examination of two case reports, we describe key challenges of sPC in LVAD patients including the necessity for sPC expertise, ethical and communicative issues as well as the available resources in this setting.ConclusionDespite unequivocal recommendations for sPC in LVAD patients, the integration of sPC for these patients is yet not well established.

El artículo analiza una controversia pública sobre el estado de los principales instrumentos del Observatorio Astronó­mico Nacional de Chile a fines del siglo XIX, las labores de reparación y mantención de estos y la producción científica de la institución. En la controversia participaron una amplia gama de actores, entre los que se encuentran miembros del Congreso Nacional, ministros de Estado, astrónomos, mecánicos y arquitectos. Este caso permite examinar la estrecha vinculación entre la esfera política y la tecnocientífica, evidenciándose en la administración, financiamiento, evaluación y fiscalización del quehacer del obser­vatorio astronómico. Acá podemos observar cómo el cuestionamiento sobre la calidad científica, como el estado de los instrumen­tos de la institución, enfrentó no solo los juicios, sino la autoridad de quienes los emitían. Por otro lado, esta controversia permi­te observar cómo la necesidad de crear tecnologías asociadas y adaptar los instrumentos astronómicos dio un protagonismo a mecánicos, ingenieros y arquitectos, actores muchas veces invisibles en comparación con los astrónomos.