There is a growing awareness that diversity, health equity, and inclusion play a significant role in improving patient outcomes and advancing knowledge. The Pediatric Heart Network launched an initiative to incorporate diversity, health equity, and inclusion into its 2021 Scholar Award Funding Opportunity Announcement. This manuscript describes the process of incorporating diversity, health equity, and inclusion into the Pediatric Heart Network Scholar Award and the lessons learned. Recommendations for future Pediatric Heart Network grant application cycles are made which could be replicated by other funding agencies.

Efficient evidence generation to assess the clinical and economic impact of medical therapies is critical amid rising healthcare costs and aging populations. However, drug development and clinical trials remain far too expensive and inefficient for all stakeholders. On October 25–26, 2023, the Duke Clinical Research Institute brought together leaders from academia, industry, government agencies, patient advocacy, and nonprofit organizations to explore how different entities and influencers in drug development and healthcare can realign incentive structures to efficiently accelerate evidence generation that addresses the highest public health needs. Prominent themes surfaced, including competing research priorities and incentives, inadequate representation of patient population in clinical trials, opportunities to better leverage existing technology and infrastructure in trial design, and a need for heightened transparency and accountability in research practices. The group determined that together these elements contribute to an inefficient and costly clinical research enterprise, amplifying disparities in population health and sustaining gaps in evidence that impede advancements in equitable healthcare delivery and outcomes. The goal of addressing the identified challenges is to ultimately make clinical trials faster, more inclusive, and more efficient across diverse communities and settings.

Among the most widely distributed species globally, common reed (Phragmites australis (Cav.) Trin. ex Steud.) has generated extensive interest in invasive plant science and management because its introduced strains are highly invasive and often form monocultures that alter ecosystem properties. In desert wetlands in Las Vegas, Nevada, USA, where management goals included reducing hazardous P. australis fuels and increasing native plant diversity, we assessed variation in P. australis cover, the degree of native plant colonization, and soil seed banks after P. australis management treatments (cutting, glyphosate-imazapyr herbicide) and wildfires across gradients in soil properties. Based on change in P. australis cover during six measurement events over 24 months, 24 study sites formed three groups: 1) decreasing cover, where initially high P. australis cover (60-85%) decreased to < 5% following multiple cutting or herbicide treatments; 2) sustaining low cover, where wildfire or clearing was associated with initially low P. australis cover which remained low (< 30%) after multiple herbicide applications; and 3) sustaining high cover (45-100% initially and remaining 30-100%), including sites unmanaged or treated/burned only once. High soil salinity correlated with low post-management P. australis cover. No native plants were detected in the sustaining high P. australis cover group, despite natives occurring in the seed bank. Where management reduced P. australis cover, minimal native plant colonization did occur. Secondary invasion by other non-native plants was nearly absent. Our results suggest that if P. australis can be initially cleared, multiple herbicide applications can persistently keep cover low, especially on drier, saline soils. Slow native plant colonization suggests that a phased approach may be useful to initially reduce P. australis cover, keep it low via repeated treatments, and actively revegetate sites with native species tailored to the moisture-salinity gradient across P. australis-invaded habitats.

People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.

Herbicides that persist in the forest litter and soil following their use for managing invasive plant species may negatively affect restoration efforts as well as minimise re-invasion via their residual phytotoxic activity. This study determined the impact of an herbicide mixture comprising triclopyr, dicamba, picloram and aminopyralid (‘TDPA’) for the control of dense infestations of a woody invader, Pinus contorta, on the germination of re-invading P. contorta and three New Zealand native species (Chionochloa rubra, Fucospora cliffortioides, and Leptospermum scoparium) used in restoration. Given the essential role of ectomycorrhizal fungi in facilitating pine re-invasion, the impact of residual herbicides present in mineral soil on the ectomycorrhizal infection of P. contorta seedling roots was also examined. Germination trials were conducted using intact forest litter-soil cores collected at 27, 112 and 480 days (after herbicide spraying) from sprayed and adjacent unsprayed dense P. contorta infestations. At the same time, mineral soil was also collected for the ectomycorrhizal infection study. Post-spray herbicide residue bound in the litter significantly decreased germination rate, root and shoot growth and survival, and also caused malformation of P. contorta seedlings. Similar results were recorded for native species germination, however, overall viability of native seed was poor resulting in low germination rates. There was no difference in levels of ectomycorrhizal infection rates of P. contorta between treatments. Results indicate residual levels of TDPA herbicide in forest floor litter negatively affect P. contorta re-invasion, native recruitment and active restoration management. Ectomycorrhizal fungi, however, are unaffected by this herbicide mixture and therefore remain a risk to facilitating re-invasion as residual herbicide declines.

Metabolic and inflammatory dysfunction is prevalent in middle-aged people with major mood disorders, but less is known about young people. We investigated the trajectories of sensitive metabolic (Homeostatic Model Assessment for Insulin Resistance [HOMA2-IR]) and inflammatory markers (C-reactive protein [CRP]) in 155 young people (26.9 ± 5.6 years) accessing mental health services. We examined demographic and clinical correlates, longitudinal trajectories and relationships with specific illness subtypes. Additionally, we compared the HOMA2-IR with fasting blood glucose (FBG) for sensitivity. We observed a significant increase in HOMA2-IR and CRP over time with higher baseline levels predicting greater increases, although the rate of increase diminished in those with higher baseline levels. Body mass index predicted increases in HOMA2-IR (p < 0.001), but not CRP (p = 0.135). Multinomial logistic regression revealed that higher HOMA2-IR levels were associated with 2.3-fold increased odds of the “circadian-bipolar spectrum” subtype (p = 0.033), while higher CRP levels were associated with a reduced risk of the “neurodevelopmental psychosis” subtype (p = 0.033). Standard FBG measures were insensitive in detecting early metabolic dysregulation in young people with depression. The study supports the use of more sensitive markers of metabolic dysfunction to address the longitudinal relationships between immune-metabolic dysregulation and mood disorders in young people.

Coastal wetlands are hotspots of carbon sequestration, and their conservation and restoration can help to mitigate climate change. However, there remains uncertainty on when and where coastal wetland restoration can most effectively act as natural climate solutions (NCS). Here, we synthesize current understanding to illustrate the requirements for coastal wetland restoration to benefit climate, and discuss potential paths forward that address key uncertainties impeding implementation. To be effective as NCS, coastal wetland restoration projects will accrue climate cooling benefits that would not occur without management action (additionality), will be implementable (feasibility) and will persist over management-relevant timeframes (permanence). Several issues add uncertainty to understanding if these minimum requirements are met. First, coastal wetlands serve as both a landscape source and sink of carbon for other habitats, increasing uncertainty in additionality. Second, coastal wetlands can potentially migrate outside of project footprints as they respond to sea-level rise, increasing uncertainty in permanence. To address these first two issues, a system-wide approach may be necessary, rather than basing cooling benefits only on changes that occur within project boundaries. Third, the need for NCS to function over management-relevant decadal timescales means methane responses may be necessary to include in coastal wetland restoration planning and monitoring. Finally, there is uncertainty on how much data are required to justify restoration action. We summarize the minimum data required to make a binary decision on whether there is a net cooling benefit from a management action, noting that these data are more readily available than the data required to quantify the magnitude of cooling benefits for carbon crediting purposes. By reducing uncertainty, coastal wetland restoration can be implemented at the scale required to significantly contribute to addressing the current climate crisis.

Rift propagation, rather than basal melt, drives the destabilization and disintegration of the Thwaites Eastern Ice Shelf. Since 2016, rifts have episodically advanced throughout the central ice-shelf area, with rapid propagation events occurring during austral spring. The ice shelf's speed has increased by ~70% during this period, transitioning from a rate of 1.65 m d−1 in 2019 to 2.85 m d−1 by early 2023 in the central area. The increase in longitudinal strain rates near the grounding zone has led to full-thickness rifts and melange-filled gaps since 2020. A recent sea-ice break out has accelerated retreat at the western calving front, effectively separating the ice shelf from what remained of its northwestern pinning point. Meanwhile, a distributed set of phase-sensitive radar measurements indicates that the basal melting rate is generally small, likely due to a widespread robust ocean stratification beneath the ice–ocean interface that suppresses basal melt despite the presence of substantial oceanic heat at depth. These observations in combination with damage modeling show that, while ocean forcing is responsible for triggering the current West Antarctic ice retreat, the Thwaites Eastern Ice Shelf is experiencing dynamic feedbacks over decadal timescales that are driving ice-shelf disintegration, now independent of basal melt.

Resistive tearing instabilities are common in fluids that are highly electrically conductive and carry strong currents. We determine the effect of stable stratification on the tearing instability under the Boussinesq approximation. Our results generalise previous work that considered only specific parameter regimes, and we show that the length scale of the fastest-growing mode depends non-monotonically on the stratification strength. We confirm our analytical results by solving the linearised equations numerically, and we discuss whether the instability could operate in the solar tachocline.