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Abstract The number of reforestation projects worldwide is increasing. In many cases funding is obtained through the claimed carbon capture of the trees, presented as immediate and durable, whereas reforested plots need time and maintenance to realise their carbon capture potential. Further, claims usually overlook the environmental costs of natural or anthropogenic disturbances during the forest’s lifetime, and greenhouse gas (GHG) emissions associated with the reforestation are not allowed for. This study uses life cycle assessment to quantify the carbon footprint of setting up a reforestation plot in the Peruvian Amazon. In parallel, we combine a soil carbon model with an above- and below-ground plant carbon model to predict the increase in carbon stocks after planting. We compare our results with the carbon capture claims made by a reforestation platform. Our results show major errors in carbon accounting in reforestation projects if they (1) ignore the time needed for trees to reach their carbon capture potential; (2) ignore the GHG emissions involved in setting up a plot; (3) report the carbon capture potential per tree planted, thereby ignoring limitations at the forest ecosystem level; or (4) under-estimate tree losses due to inevitable human and climatic disturbances. Further, we show that applications of biochar during reforestation can partially compensate for project emissions.

Abstract Background The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. Methods A structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes. Results A total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive. Conclusions Findings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals.

Abstract Background Recruitment for clinical trials and large-scale studies is challenging, especially for patients with complex conditions like chronic pain. Email recruitment has the potential to increase efficiency, to reduce costs, and to improve access for underrepresented patient populations. The objective of this study was to examine the effectiveness, efficiency, and equitability of email versus postal mail recruitment for the Learning to Apply Mindfulness to Pain (LAMP) study, a three-site clinical trial of mindfulness-based interventions for chronic pain. Methods Patients with chronic pain diagnoses were recruited from three United States Department of Veterans Affairs (VA) facilities using the VA electronic health record (EHR). Recruitment materials were sent using either postal mail (n = 7986) or email (n = 19,333). Patients in the email recruitment group were also mailed introductory postcards before any emails. Mailing addresses and email addresses were obtained from the EHR. Effectiveness was measured by the response rate of patients who logged into the secure LAMP study website. Efficiency was measured by the number of days from when the recruitment materials were sent to when patients logged into the LAMP portal as well as the estimated costs of each recruitment approach. To assess equitability, we examined whether email recruitment was less effective for underrepresented populations, based on demographic information from the EHR. Results Effectiveness—unadjusted response rates were greater for email versus postal-mail recruitment (18.9% versus 6.3%), and adjusted response rates were over three times greater for email recruitment (RR = 3.5, 95% CI 3.1–3.8) based on a multivariable analysis controlling for age, gender, race, ethnicity, rurality, and site. Efficiency—email recruitment had a significantly lower mean response time (1 day versus 8 days) and a lower cost. Equity—email recruitment led to higher response rates for all subpopulations, including older, non-White, Hispanic, rural, and female Veterans. Conclusions Email recruitment is an effective, efficient, and equitable way to recruit VA patients to large-scale, chronic pain clinical trials. Trial registration Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

Introduction: Individuals experiencing housing instability face significant health inequities. Addressing housing instability requires an understanding of the factors that contribute to these inequities—a responsibility that has been assumed by community-based organizations. Interviewing individuals from 3 Canadian provinces, the present study aimed to examine the perspectives of individuals from front-line services of the social determinants of health (SDoH) needs of individuals experiencing housing instability. Methods: As part of a larger knowledge translation study, we conducted 8 semi-structured interviews with individuals from front-line services (eg, shelter workers and shelter mental health nurses) in Canada (Nova Scotia, Saskatchewan, and Alberta) and used thematic analysis to identify predominant unmet SDoH needs. Results: Individuals from front-line services discussed the roles of many SDoH that may perpetuate housing instability in their clients. These included: (1) limited social supports; (2) poor access to health services; (3) poor opportunities for income and employment; (4) lack of transportation; (5) gender-based discrimination; (6) race-based discrimination; and (7) limited access to education and limited literacy skills. Conclusion: This study reveals how front-line service providers observe SDoH factors contributing to housing instability and create barriers to accessing support services. They advocate for a multi-system approach to addressing intersecting SDoH factors to validate clients’ experiences and help them achieve stable housing. Additionally, more research and consultation with front-line providers are necessary to understand and overcome systemic barriers to stable housing.

Abstract Background Inflammatory bowel disease (IBD) affects over 3 million Americans and has a relapsing and remitting course with up to 30% of patients experiencing exacerbations each year despite the availability of immune targeted therapies. An urgent need exists to develop adjunctive treatment approaches to better manage IBD symptoms and disease activity. Circadian disruption is associated with increased disease activity and may be an important modifiable treatment target for IBD. Morning light treatment, which advances and stabilizes circadian timing, may have the potential to improve IBD symptoms and disease activity, but no studies have explored these potential therapeutic benefits in IBD. Therefore, in this study, we aim to test the effectiveness of morning light treatment for patients with IBD. Methods We will recruit sixty-eight individuals with biopsy-proven IBD and clinical symptoms and randomize them to 4-weeks of morning light treatment or 4-weeks of treatment as usual (TAU), with equivalent study contact. Patient-reported outcomes (IBD-related quality of life, mood, sleep), clinician-rated disease severity, and a biomarker of gastrointestinal inflammation (fecal calprotectin) will be assessed before and after treatment. Our primary objective will be to test the effect of morning light treatment versus TAU on IBD-related quality of life and our secondary objectives will be to test the effects on clinician-rated disease activity, depression, and sleep quality. We will also explore the effect of morning light treatment versus TAU on a biomarker of gastrointestinal inflammation (fecal calprotectin), and the potential moderating effects of steroid use, restless leg syndrome, and biological sex. Discussion Morning light treatment may be an acceptable, feasible, and effective adjunctive treatment for individuals with active IBD suffering from impaired health-related quality of life. Trial registration The study protocol was registered on ClinicalTrials.gov as NCT06094608 on October 23, 2023, before recruitment began on February 1, 2024.

Background: Although studies have documented higher rates of chronic pain among women Veterans compared to men Veterans, there remains a lack of comprehensive information about potential contributors to these disparities. Materials and Methods: This study examined gender differences in chronic pain and its contributors among 419 men and 392 women Veterans, enrolled in a mindfulness trial for chronic pain. We conducted descriptive analyses summarizing distributions of baseline measures, obtained by survey and through the electronic health record. Comparisons between genders were conducted using chi-square tests for categorical variables and t-tests for continuous measures. Results: Compared to men, women Veterans were more likely to have chronic overlapping pain conditions and had higher levels of pain interference and intensity. Women had higher prevalence of psychiatric and sleep disorder diagnoses, greater levels of depression, anxiety, post-traumatic stress disorder, fatigue, sleep disturbance, stress and pain catastrophizing, and lower levels of pain self-efficacy and participation in social roles and activities. However, women were less likely to smoke or have a substance abuse disorder and used more nonpharmacological pain treatment modalities. Conclusion: Among Veterans seeking treatment for chronic pain, women differed from men in their type of pain, had greater pain intensity and interference, and had greater prevalence and higher levels of many known biopsychosocial contributors to pain. Results point to the need for pain treatment that addresses the comprehensive needs of women Veterans. Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

Sugarcane is a high-impact crop used in the majority of global sugar production, with India being the second largest global producer. Understanding the timing and length of sugarcane growth stages is critical to improving the sustainability of sugarcane management. Earth observation (EO) data have been shown to be sensitive to the variation in sugarcane growth, but questions remain as to how to reliably extract sugarcane phenology over wide areas so that this information can be used for effective management. This study develops an automated approach to derive sugarcane growth stages using EO data from Landsat-8 and Sentinel-2 satellite data in the Indian state of Andhra Pradesh. The developed method is then evaluated in the State of Telangana. Normalised difference vegetation index (NDVI) EO data from Landsat-8 and Sentinel-2 were pre-processed to filter out clouds and to harmonise sensor response. Pixel-based cloud filtering was selected over filtering by scene in order to increase the temporal frequency of observations. Harmonising data from two different sensors further increased temporal resolution to 3–6 days (70% of sampled fields). To automate seasonal decomposition, harmonised signals were resampled at 14 days, and low-frequency components, related to seasonal growth, were extracted using a fast Fourier transform. The start and end of each season were extracted from the time series using difference of Gaussian and were compared to assessments based on visual observation for both Unit 1 (R2 = 0.72–0.84) and Unit 2 (R2 = 0.78–0.82). A trapezoidal growth model was then used to derive crop growth stages from satellite-measured phenology for better crop management information. Automated assessments of the start and the end of mid-season growth stages were compared to visual observations in Unit 1 (R2 = 0.56–0.72) and Unit 2 (R2 = 0.36–0.79). Outliers were found to result from cloud cover that was not removed by the initial screening as well as multiple crops or harvesting dates within a single field. These results demonstrate that EO time series can be used to automatically determine the growth stages of sugarcane in India over large areas, without the need for prior knowledge of planting and harvest dates, as a tool for improving sustainable production.

The interaction of metals and biological materials is of interest for reasons such as metal recovery, toxicity and production of high-value products such as gold and platinum nanoparticles. Understanding the way in which metals interact with the biomass surface and intracellular components provides insights into the biosorption and bioaccumulation processes and increases the potential for process optimisation. Three technologies are available for the qualitative visualisation of metal - biomass interactions in South Africa, namely, micro-PIXE, transmission electron microscopy and scanning electron microscopy coupled with energy-dispersive analysis of X-rays. Each technique provides unique information and has specific shortcomings which should be taken into account when selecting the appropriate technology. This paper focuses on evaluating the various techniques.

Zileuton is a leukotriene inhibitor used to treat asthma. As a BCS class II drug it exhibits challenges with solubility which likely impact its absorption. As patient gender significantly impacts the pharmacokinetics of many drugs, this study aimed to investigate potential gender-based pharmacokinetic differences after oral zileuton administration in rats. Male and female Sprague Dawley rats received single oral gavage doses of pure zileuton as an active pharmaceutical ingredient (30 mg/kg body weight (bw)), physical mixture (PM; at 30 mg/kg bw of the formulation contains zileuton, kollidon VA64 fine, dowfax2A1 and trehalose), and nanocrystalline formulation of zileuton (NfZ; at 30 mg/kg bw of the formulation). Plasma, tissue, and urine concentrations were quantified using high performance liquid chromatography (HPLC). Noncompartmental pharmacokinetic analysis showed higher zileuton levels in the plasma of female versus male rats across all evaluated forms of zileuton (API, PM, and NfZ). Female rats demonstrated higher peak plasma concentrations (Cmax) and increased area under the plasma concentration-time curve (AUC) relative to males, regardless of formulation. These findings reveal substantial gender disparities in the pharmacokinetics of zileuton in the rat model. This study emphasizes the critical need to evaluate gender differences during preclinical drug development to enable gender-based precision dosing strategies for equivalent efficacy/safety outcomes in male and female patients. Additional studies are warranted to investigate underlying mechanisms of such pharmacokinetic gender divergences.

Space exploration requires consideration of the dietary requirements of astronauts. Not only do nutritional requirements differ in space versus Earth, but limitations to payload combined with the length of space missions means that astronauts will need to produce as much food as possible in situ. Lettuce (Lactuca sativa) possesses many traits that make it suitable for space farming. Its small size, quick life cycle, large harvestable fraction and previous successful cultivation aboard the International Space Station (ISS) means that it represents a model plant for space cultivation. Here we discuss the suitability and requirements of lettuce as a dietary source on space missions. Using simplex linear programming, we identify the ration sizes of existing lettuce varieties to optimise nutrient delivery to both men and women on Earth and in Space. Whilst, unsurprisingly, a diet consisting only of lettuce cannot provide full nutrient requirements, there are differences in ration size and composition depending upon gender and location, indicating the importance of group composition when designing farming systems. We then review different routes to the biofortification of lettuce based on current literature and perform the modelling approach to determine portion sizes of theoretical ‘maximally fortified lettuce’, whose nutritional content was predicted based on the combined biofortification strategies. Finally, we conclude with the application of these approaches towards future space farming of a variety of crop species.

First metatarsal comminuted fractures are rare and debilitating injuries. They can lead to a host of complications including infection, deformity, malalignment, transfer pressure, and early onset first metatarsophalangeal joint arthritis. They are not well reported in the literature and rarely involve the first metatarsal head. We present a case report of a 17 year-old patient who sustained an open comminuted fracture of the first metatarsal head after dropping a weight on his foot. This was treated with staged procedures, resulting in open reduction and reconstruction of the metatarsal head with placement of external fixator device. He went on to full bony union with resolution of pain, full return to activity, and salvage of the first metatarsophalangeal joint. This is an uncommon case that can lead to disastrous outcomes. The goal of this paper is to outline the steps for surgical reconstruction of the first metatarsal head in order to achieve a functional first ray while avoiding a first metatarsophalangeal joint arthrodesis in a young, active patient.

BackgroundPost-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms.AimExamine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial.MethodsParticipants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms.ResultsAdjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-valuesConclusionThese findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.

AbstractPeatlands are a globally important carbon store, but peatland ecosystems from high latitudes to the tropics are highly degraded due to increasingly intensive anthropogenic activity, making them significant greenhouse gas (GHG) sources. Peatland restoration and conservation have been proposed as a nature-based solution to climate change, by restoring the function of peatlands as a net carbon sink, but this may have implications for many local communities who rely on income from activities associated with transformed peatlands, particularly those drained for agriculture. However, without changing the way that humans interact with and exploit peatlands in most regions, peatlands will continue to degrade and be lost. We propose that there are ultimately three potential trajectories for peatland management: business as usual, whereby peatland carbon sink capacity continues to be eroded, responsible agricultural management (with the potential to mitigate emissions, but unlikely to restore peatlands as a net carbon sink), and restoration and conservation. We term this the three-peat challenge, and propose it as a means to view the benefits of restoring peatlands for the environment, as well as the implications of such transitions for communities who rely on ecosystem services (particularly provisioning) from degraded peatlands, and the consequences arising from a lack of action. Ultimately, decisions regarding which trajectories peatlands in given localities will follow torequire principles of equitable decision-making, and support to ensure just transitions, particularly for communities who rely on peatland ecosystems to support their livelihoods.

Agroforestry integrates woody vegetation with crop and/or livestock production to benefit from the ecological and economic interactions. The objective of this paper is to systematically determine the spatial distribution of agroforestry in the EU, and changes in the areas and types of agroforestry from 2009 to 2018. This was achieved using the Land Use/Cover Area Statistical (LUCAS) dataset. Agroforestry was categorised into silvopastoral, silvoarable, agrosilvopastoral, grazed permanent crops, intercropped permanent crops and kitchen gardens systems. In our categorisation of ‘agroforestry’, sites combing trees and shrubs with understorey grass or forage were required to show evidence of grazing. In 2018, the total area of agroforestry in the EU28 was 114,621 km2 equivalent to 6.4% of the utilised agricultural area (UAA), and a majority located in the Mediterranean bioregion. Silvopastoral was the most widespread system, representing 81% of the total agroforestry area (5% of UAA), with almost a third of that area present in Spain. An initial analysis of the LUCAS data suggested that the area of agroforestry increased from 2009 to 2012, before declining from 2012 to 2018. However our subsequent analysis suggests that the area of agroforestry in 2009 was underestimated due to a mis-categorisation of some grazing areas. After making corrections, we calculated that the area of agroforestry (using the above definitions) in the EU23 (a full-time sequence for the EU28 is unavailable) declined by 47% between 2009 and 2018. This decline is primarily due to a reduction in outdoor grazing, perhaps driven by reduced livestock numbers and/or permanent livestock housing. The only agroforestry system showing an increase was kitchen gardens (7%). The paper highlights the usefulness of the LUCAS dataset for studying the extent of agroforestry in Europe, but also potential limitations in terms of the consistency of the location of data points and the categorisation of grazing. The paper also argues that although the area of within-field agroforestry may be declining, the drive towards net zero greenhouse gas emissions may be re-establishing the link between increased tree cover and food production at a farm-level.

Abstract Introduction Despite significant improvements in longevity and quality of life associated with antiretroviral therapy, individuals with HIV still suffer from a higher burden of sleep and circadian disruption and inflammatory‐based diseases than individuals without HIV. While melatonin is a hormone that has a role in sleep and circadian regulation and has anti‐inflammatory properties, the overnight concentration of the urinary melatonin metabolite has not yet been reported in people with HIV. Methods The aim of this study was to compare the overnight urinary melatonin metabolite levels in women aged 35–70 years with HIV (n = 151) to a well‐matched comparison group of women without HIV (n = 147). All women wore a wrist actigraphy monitor and completed daily diaries documenting sleep timing and use of medications and drugs or alcohol for 10 days. Participants collected their overnight urine near the end of the monitoring period. Results Melatonin levels did not differ between women with or without HIV, but more than 40% of women had low levels of melatonin. Higher body mass index predicted lower levels of melatonin, and lower levels of melatonin were associated with lower sleep efficiency as assessed with wrist actigraphy. Conclusion These data lay the foundation for exploration of the longitudinal consequences of endogenous melatonin levels for inflammatory‐based diseases in aging women with and without HIV. Future studies should consider the use of supplemental melatonin to improve sleep in women with lower levels of melatonin.

Abstract Background Both short sleep duration and circadian rhythm misalignment are risk factors for metabolic dysfunction, but the underlying mechanisms are unknown. The goal of this study is to examine how sleep duration and circadian alignment predict changes in cardiometabolic risk factors over a 12-month period, and test cognitive function and hedonic eating tendencies as potential mechanisms. Methods We will recruit a sample of 120 working aged adults with BMI 25–35 kg/m2 (overweight to class I obesity). The protocol includes 5 visits over a 12-month period. Study visits include wrist actigraphy to measure sleep behaviors, 24-h diet recalls, dim light melatonin collection, a computerized neurobehavioral assessment, eating in the absence of hunger task, and frequently sampled IV glucose tolerance test. Discussion The results of the TIME study will advance the understanding of how both short sleep duration and circadian misalignment contribute to behavioral aspects of obesity and metabolic dysfunction. Trial registration ClinicalTrials.Gov, NCT04759755 , registered retrospectively February 13, 2021.

Abstract To meet the increasing global demand for food, feed, fibre and other plant‐derived products, a steep increase in crop productivity is a scientifically and technically challenging imperative. The CropBooster‐P project, a response to the H2020 call ‘Future proofing our plants’, is developing a roadmap for plant research to improve crops critical for the future of European agriculture by increasing crop yield, nutritional quality, value for non‐food applications and sustainability. However, if we want to efficiently improve crop production in Europe and prioritize methods for crop trait improvement in the coming years, we need to take into account future socio‐economic, technological and global developments, including numerous policy and socio‐economic challenges and constraints. Based on a wide range of possible global trends and key uncertainties, we developed four extreme future learning scenarios that depict complementary future developments. Here, we elaborate on how the scenarios could inform and direct future plant research, and we aim to highlight the crop improvement approaches that could be the most promising or appropriate within each of these four future world scenarios. Moreover, we discuss some key plant technology options that would need to be developed further to meet the needs of multiple future learning scenarios, such as improving methods for breeding and genetic engineering. In addition, other diverse platforms of food production may offer unrealized potential, such as underutilized terrestrial and aquatic species as alternative sources of nutrition and biomass production. We demonstrate that although several methods or traits could facilitate a more efficient crop production system in some of the scenarios, others may offer great potential in all four of the future learning scenarios. Altogether, this indicates that depending on which future we are heading toward, distinct plant research fields should be given priority if we are to meet our food, feed and non‐food biomass production needs in the coming decades.

Crop canopy architecture is a central component of yield. The arrangement of leaves in three-dimensional space defines the efficiency of absorption of radiation and its conversion into dry matter at the canopy level. The description of architecture is normally associated with light since the optimal distribution of light is associated with that of other essential components such as nitrogen and pigments. However, architecture has been influenced by a number of other unrelated processes through breeding and selection that may have acted independently or even against light use efficiency. This review attempts to provide a broad view and interpretation of canopy architectural properties and the factors affecting crop architecture starting with evolution, domestication, climatic conditions and cultivation patterns, predominantly focusing on field grown agricultural crops. Using examples of modelling with a virtual canopy, we will discuss how architectural traits affect light interception and photosynthesis. Finally, we will discuss the future of architectural research: the concept of the ideal plant type (the ideotype) and which features we can expect to see, as well as the social constraints that may govern future crop architecture.

Acclimation of photosynthesis to light intensity (photoacclimation) takes days to achieve and so naturally fluctuating light presents a potential challenge where leaves may be exposed to light conditions that are beyond their window of acclimation. Experiments generally have focused on unchanging light with a relatively fixed combination of photosynthetic attributes to confer higher efficiency in those conditions. Here a controlled LED experiment and mathematical modelling was used to assess the acclimation potential of contrasting Arabidopsis thaliana genotypes following transfer to a controlled fluctuating light environment, designed to present frequencies and amplitudes more relevant to natural conditions. We hypothesize that acclimation of light harvesting, photosynthetic capacity and dark respiration are controlled independently. Two different ecotypes were selected, Wassilewskija-4 (Ws), Landsberg erecta (Ler) and a GPT2 knock out mutant on the Ws background (gpt2-), based on their differing abilities to undergo dynamic acclimation i.e. at the sub-cellular or chloroplastic scale. Results from gas exchange and chlorophyll content indicate that plants can independently regulate different components that could optimize photosynthesis in both high and low light; targeting light harvesting in low light and photosynthetic capacity in high light. Empirical modelling indicates that the pattern of ‘entrainment’ of photosynthetic capacity by past light history is genotype-specific. These data show flexibility of photoacclimation and variation useful for plant improvement.

A Jones fracture is classified as a break that occurs at the proximal diaphyseal and metaphyseal junction of the fifth metatarsal. Higher rates of nonunion are reported with nonsurgical management of this fracture, therefore surgical intervention is recommended. In this case series, we present several unique patients who sustained a Jones fracture, but had bony ossicles or deformity that were complicating factors to surgical treatment. On radiographic evaluation, these bony abnormalities included an os vesalianum, a hypertrophic peroneal tubercle, and severe metatarsus adductus. All of the patients underwent surgical intervention with intramedullary screw placement for fixation across the fracture. Surgical planning to avoid these bony ossicles and adapt to deformities was successful in all cases. We present these three cases to illustrate surgical tips on how to successfully manage Jones fractures when bony abnormalities are present.

Abstract The growing world population and global increases in the standard of living both result in an increasing demand for food, feed and other plant‐derived products. In the coming years, plant‐based research will be among the major drivers ensuring food security and the expansion of the bio‐based economy. Crop productivity is determined by several factors, including the available physical and agricultural resources, crop management, and the resource use efficiency, quality and intrinsic yield potential of the chosen crop. This review focuses on intrinsic yield potential, since understanding its determinants and their biological basis will allow to maximize the plant's potential in food and energy production. Yield potential is determined by a variety of complex traits that integrate strictly regulated processes and their underlying gene regulatory networks. Due to this inherent complexity, numerous potential targets have been identified that could be exploited to increase crop yield. These encompass diverse metabolic and physical processes at the cellular, organ and canopy level. We present an overview of some of the distinct biological processes considered to be crucial for yield determination that could further be exploited to improve future crop productivity.

Micro electro-mechanical systems (MEMS) combining sensing and microfluidics functionalities, as are common in Lab-on-Chip (LoC) devices, are increasingly based on polymers. Benefits of polymers include tunable material properties, the possibility of surface functionalization, compatibility with many micro and nano patterning techniques, and optical transparency. Often, additional materials, such as metals, ceramics, or silicon, are needed for functional or auxiliary purposes, e.g., as electrodes. Hybrid patterning and integration of material composites require an increasing range of fabrication approaches, which must often be newly developed or at least adapted and optimized. Here, a microfabrication process concept is developed that allows one to implement attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and electrochemistry on an LoC device. It is designed to spatially resolve chemical sensitivity and selectivity, which are instrumental for the detection of chemical distributions, e.g., during on-flow chemical and biological reaction chemistry. The processing sequence involves (i) direct-write and soft-contact UV lithography in SUEX dry resist and replication in polydimethylsiloxane (PDMS) elastomers as the fluidic structure; (ii) surface functionalization of PDMS with oxygen plasma, 3-aminopropyl-triethoxysilane (APTES), and a UV-curable glue (NOA 73) for bonding the fluidic structure to the substrate; (iii) double-sided patterning of silicon nitride-coated silicon wafers serving as the ATR-FTIR-active internal reflection element (IRE) on one side and the electrode-covered substrate for microfluidics on the back side with lift-off and sputter-based patterning of gold electrodes; and (iv) a custom-designed active vacuum positioning and alignment setup. Fluidic channels of 100 μm height and 600 μm width in 5 mm thick PDMS were fabricated on 2” and 4” demonstrators. Electrochemistry on-chip functionality was demonstrated by cyclic voltammetry (CV) of redox reactions involving iron cyanides in different oxidation states. Further, ATR-FTIR measurements of laminar co-flows of H2O and D2O demonstrated the chemical mapping capabilities of the modular fabrication concept of the LoC devices.

BackgroundMental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. ObjectiveThe primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. MethodsThis pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. ResultsParticipants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. ConclusionsRather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. Trial RegistrationClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771 International Registered Report Identifier (IRRID)DERR1-10.2196/37712

BackgroundEmerging research suggests that food intake timing, eating behavior and food preference are associated with aspects of the circadian system function but the role that the circadian system may play in binge eating (BE) behavior in humans remains unclear.ObjectiveTo systematically evaluate the evidence for circadian system involvement in BE behavior.MethodsSystematic searches of PubMed, EMBASE, and Scopus were performed for reports published from inception until May 2020 (PROSPERO Registration CRD42020186325). Searches were conducted by combining Medical Subject Headings related to the circadian system, BE behavior, and/or interventions. Observational and interventional studies in humans with BE behavior published in peer-review journals in the English language were included. Studies were assessed using quality and risk of bias tools (AXIS, ROB 2.0, or ROBINS).ResultsThe search produced 660 articles, 51 of which were included in this review. Of these articles, 46 were observational studies and 5 were interventional trials. Evidence from these studies suggests that individuals with BE behavior tend to have more food intake, more binge cravings, and more BE episodes later in the day. Hormonal and day/night locomotor activity rhythm disturbances may be associated with BE behavior. Furthermore, late diurnal preference (“eveningness”) was associated with BE behavior and chronobiological interventions that shift the circadian clock earlier (e.g., morning bright light therapy) were found to possibly decrease BE behavior. Substantive clinical overlap exists between BE and night eating behavior. However, there is a significant knowledge gap regarding their potential relationship with the circadian system. Limitations include the lack of studies that use best-established techniques to assess the chronobiology of BE behavior, heterogeneity of participants, diagnostic criteria, and study design, which preclude a meta-analytic approach.ConclusionCurrent evidence, although limited, suggests that the circadian system may play a role in the etiology of BE behavior. Further mechanistic studies are needed to fully characterize a potential role of the circadian system in BE behavior. A chronobiological approach to studying BE behavior may lead to identification of its neurobiological components and development of novel therapeutic interventions.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186325], identifier [CRD42020186325].

The purpose of this research was to fill the identified gap on financial data of Sida hermaphrodita (L.) Rusby (Sida) and Silphium perfoliatum L. (Silphium), two perennial bioenergy crops that potentially provide a more sustainable alternative/complement to other bioenergy crops. Using discounted cash flow analysis, the Net Present Values of Sida and Silphium were compared to a rotation of other arable crops including maize, and the two energy crops of short rotation coppice and Miscanthus. The analysis was completed using the SidaTim analysis tool for the UK, Italy, Germany and Poland, producing a total of four independent models. The results showed that with no subsidies, cultivating Sida was unattractive in all four countries relative to other crop options. However, Silphium, was an economically viable option in each country. Both Sida and Silphium can offer greater environmental benefits than other arable crops, and the profitability of each crop would be further enhanced if additional payments for such public services were made to farmers, and if there were secure markets for the sale of the biomass. This study is the first comparative economic analysis in West and Central Europe of the two novel energy crops in comparison to more common energy crops and an arable rotation.

Abstract Introduction Pragmatic clinical trials (PCTs) can overcome implementation challenges for bringing evidence‐based therapies to people living with pain and co‐occurring conditions, providing actionable information for patients, providers, health systems, and policy makers. All studies, including those conducted within health systems that have a history of advancing equitable care, should make efforts to address justice and equity. Methods Drawing from collective experience within pragmatic pain clinical trials networks, and synthesizing relevant literature, our multidisciplinary working group examined challenges related to integrating justice and equity into pragmatic pain management research conducted in large, integrated health systems. Our analysis draws from military and veteran health system contexts but offers strategies to consider throughout the lifecycle of pragmatic research more widely. Results We found that PCTs present a unique opportunity to address major influences on health inequities by occupying a space between research, healthcare delivery, and the complexities of everyday life. We highlight key challenges that require attention to support complementary advancement of justice and equity via pragmatic research, offering several strategies that can be pursued. Conclusions Efforts are needed to engage diverse stakeholders broadly and creatively in PCTs, such as through dedicated health equity working groups and other collaborative relationships with stakeholders, to support robust and inclusive approaches to research design and implementation across study settings. These considerations, while essential to pain management research, offer important opportunities toward achieving more equitable healthcare and health systems to benefit people living with pain and co‐occurring conditions.

Background Chronic sleep disruption can have significant negative health effects and prior studies suggest that people with HIV (PWH) have disproportionately higher rates of sleep problems. Methods We evaluated baseline sleep of sedentary, older adults (50–75 years) with (n = 28) and without HIV (n = 29) recruited into a 24-week exercise study. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI); objective sleep parameters were assessed using wrist-worn actigraphy. Regression models were used to investigate changes in outcomes. Results Fifty-seven participants completed the intervention. At baseline, PWH had significantly lower sleep efficiency (88.7 [95% CI 86, 91]%) compared to controls (91.8 [95% CI 91, 93]%; p = 0.02); other sleep measures indicated poorer sleep among PWH but did not reach statistical significance (p ≥ 0.12). Overall, sleep outcomes did not significantly change with the exercise intervention (all p > 0.05). In adjusted analyses, PWH demonstrated a decrease in total sleep time (–22.1 [–43.7, –0.05] p = 0.045) and sleep efficiency (–1.3 [–2.5, –.01], p = 0.03) during the 24 weeks of exercise; these differences were attenuated and no longer significant after adjusting for exercise intensity. At the completion of the intervention, compared to controls, PWH had significantly poorer sleep by PSQI score (2.2 [0.6, 3.8]; p = 0.006) and sleep efficiency (–2.8 [–5.4,–0.2]%; p = 0.04). Conclusions In this study, sleep disturbance was more prevalent in sedentary older PWH compared to uninfected controls. An exercise intervention had minimal effect on sleep impairments among PWH nor controls. Among older adults, interventions beyond cardiovascular and resistance exercise may be needed to significantly alter subjective and objective sleep outcomes.

BackgroundExposure to trauma can result in various mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although psychotherapies and pharmacotherapies exist for the treatment of these disorders, many individuals fail to receive treatment and among those who do, many remain symptomatic. Therefore, it is critical to continue developing new interventions for traumatic stress that target underlying mechanisms of pathology and offer a safe and acceptable alternative to current treatments. Morning light treatment has good potential as a novel non-invasive, low risk treatment for traumatic stress. Evidence suggests that morning light may improve traumatic stress by reducing reactivity in the amygdala, a brain region implicated in the pathophysiology of PTSD and anatomically linked to circadian photoreceptors in the eye.MethodsIn this study, we aim to establish a significant dose-response relationship between duration of morning light treatment and reduction in amygdala reactivity among individuals with traumatic stress symptoms (NCT# 04117347). Using a transdiagnostic approach, sixty-six individuals with a history of a DSM-5 criterion A trauma and traumatic stress symptoms will be recruited to participate in a 5-week study. Participants will be randomized across three treatment arms based on morning light treatment duration: 15-minutes, 30-minutes, or 60-minutes of light treatment per day for four weeks. To evaluate amygdala activity, participants will undergo fMRI at pre-treatment, mid-treatment, and post-treatment. Participants will also complete clinical assessments and self-report measures of PTSD, depression, and anxiety at pre-treatment, mid-treatment, and post-treatment.DiscussionMorning light therapy may be an acceptable, feasible, and effective treatment for individuals suffering from traumatic stress. Identifying mechanistically relevant targets, and the doses needed to impact them, are critical steps in developing this new treatment approach for the sequelae of traumatic stress.

Suicide is a major public health problem and previous studies in major depression and anxiety show problematic sleep is a risk factor for suicidal ideation (SI). However, less is known about sleep and SI in social anxiety disorder (SAD), despite the pervasiveness of SAD. Therefore, the current study comprised participants with major depressive disorder (MDD) (without comorbid SAD) (n = 26) and participants with SAD (without comorbid MDD) (n = 41). Wrist actigraphy was used to estimate sleep duration, wake after sleep onset, and sleep efficiency; sleep quality was evaluated with self-report. Self-report was also used to examine SI. These measures were submitted to independent t-tests and multiple regression analysis. t-test results revealed sleep and SI did not differ between MDD and SAD groups. Multiple regression results showed shorter sleep duration and worse sleep quality related to greater SI when taking symptom severity and age into account. Post-hoc partial correlational analysis showed these sleep–SI relationships remained significant after controlling for symptom severity and age. Preliminary findings indicate sleep and SI may be transdiagnostic features of MDD and SAD. Evidence of distinct sleep–SI relationships are consistent with previous reports showing that sleep difficulties contribute to SI. Altogether, improving sleep duration and sleep quality may reduce the risk of SI.

Rumination and worry are forms of repetitive negative thinking (RNT) commonly associated with internalizing psychopathologies, although less is known about RNT in trauma-exposed individuals with internalizing psychopathologies. Separate lines of research show RNT also plays a role in problematic sleep, which is frequently experienced after trauma exposure. To address gaps in the literature, the current study examines the impact of sleep and symptoms on RNT in trauma-exposed participants. A transdiagnostic sample of 46 unmedicated treatment-seeking trauma-exposed participants completed standard measures of rumination and worry, as well as clinical measures that assessed posttraumatic stress, depression, and anxiety severity. Actigraphic sleep variables were sleep duration, wake after sleep onset (WASO), and sleep efficiency. Sleep and clinical measures were submitted to multiple regression analyses with rumination and worry as dependent variables. The regression results showed that rumination was significantly explained by WASO and posttraumatic stress symptom (PTSS) severity, and the omnibus test was significant. Depression, anxiety, and other estimates of sleep were not significant. No significant results emerged for worry. Preliminary findings suggest that PTSS and WASO, an index of fragmented sleep, may contribute to rumination, but not worry, in trauma-exposed individuals. Longitudinal studies are needed to determine potential causal relationships.

Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.