Objectives/Goals: Attention deficit hyperactivity disorder (ADHD) affects 5.9% of youth worldwide and is associated with mental health disorders. In adults, HeartMath biofeedback improves ADHD, emotional regulation, and anxiety. Breathing practices promote similar outcomes. Our goal was to examine the synergistic effect of these therapies in children with ADHD. Methods/Study Population: A 10-week, 2-arm randomized controlled clinical trial was conducted in a rural health care clinic to examine the safety, feasibility, preliminary efficacy, and self-reported child and parent perceptions of a biofeedback plus breathing practices intervention (Healing Minds) in a pediatric population (n=12; M=5; F=7; 11.6 ±3.6 years). Children were randomized to waiting list placebo (P) or treatment (T) intervention [Weekly biofeedback (HeartMath) and breathing exercises (Qi gong, belly, box, and alternate nostril) by trained medical staff]. Symptoms and severity of ADHD (Vanderbilt; Conners), Screen for Child Anxiety-Related Disorders, Child & Adolescent Trauma Screen (CATS), CATS-Caregiver, Child & Youth Resilience Measure, and perceptions by interview were assessed at baseline, 5 and 11 weeks. Results/Anticipated Results: Twelve children were enrolled (6=T; 6=P) into the clinical trial. Nine completed the study [T (N=4); P (N=5)]. One moderate, unrelated adverse event was reported. Treatment attendance rates varied [90% (2), 70% (1), 60% (1), and 30% (1)]. Children self-reported reduced panic attacks, improved sleep, and feelings of self-control. Parents perceived a calmer home with fewer meltdowns, less overwhelming events, and expressed satisfaction with biofeedback, Qi gong, and belly breathing, but not box and alternate nostril breathing. Questionnaires were perceived as burdensome, and placebo waiting list delays were unacceptable to parents. School-related scheduling challenges and missing assessment data limited study implementation. Small sample sizes limited statistical power and the evaluation of outcomes. Discussion/Significance of Impact: Healing Minds shows promise as a beneficial adjunct to clinical care in rural children with ADHD. The program was shown to be safe and feasible. Children and parents self-reported beneficial effects. Future studies should include a patient-centered study design, focused breathing techniques, fewer assessments, and improved school coordination.

In 250 men (21·4 (sd 2·9) years; BMI 24·2 (sd 3·0) kg·m–2) commencing arduous military training during winter, we investigated the effect of 12 weeks of vitamin D supplementation on lower body (pelvic girdle, sacrum, coccyx and lower limb) overuse musculoskeletal injury risk in a randomised, placebo-controlled trial. Participants received either simulated sunlight (1·3 × standard erythemal dose in T-shirt and shorts, three times per week for 4 weeks and then once per week for 8 weeks), oral vitamin D3 (1000 IU · d–1 for 4 weeks and then 400 IU · d–1 for 8 weeks) or placebo for each intervention. Serum vitamin D metabolites and bone metabolism biomarkers were measured at baseline, week 5 and week 12. At baseline, 29 % of participants were vitamin D sufficient (25-hydroxyvitamin D ≥ 50 nmol·L–1). Vitamin D supplementation achieved vitamin D sufficiency in 95 % of participants after 4 weeks. During 6 months of training and subsequent 3 years of military service, 100 lower body overuse musculoskeletal injuries were diagnosed by clinicians. Frailty models indicated no difference in injury risk between vitamin D and placebo during military training (HRplacebo:vitamin D = 1·23 (95 % CI 0·57, 2·66), P = 0·597) or military service (HRplacebo:vitamin D = 0·94 (95 % CI 0·60, 1·46), P = 0·782). Both safe simulated sunlight and oral vitamin D3 were effective in achieving and maintaining vitamin D sufficiency in almost all. There was no clear evidence that vitamin D affects the risk of lower body overuse musculoskeletal injury during 6 months of military training or subsequent 3 years of military service.

In general, research demonstrates that deprivation, education, health, and well-being are determinants of volunteering, and that volunteering can play an important role in building stronger communities and provides many benefits for individual health and well-being. This study concentrates on the effects of physical and mental health and well-being as predictors when the aspect of socio-economic impact has been minimised. It utilises a unique data set from a UK Housing Association community with generally high levels of deprivation. Data were analysed using bivariate probit regression. In contrast to previous findings, physical health and mental health were not significantly related to volunteering. The key finding was that mental well-being was significantly related to informal volunteering.

Accountability is a much studied subject in the social sciences and is known for its complexity, context dependence, and ambiguity. By conducting a comprehensive literature review and analysis across nonprofit, public, and private sector literatures, this article identifies the causes of ambiguities present in many accountability frameworks and describes the trend toward understanding accountability as a constructed concept combining both instrumental and interpretive elements. The relationship between legitimacy and accountability is considered. The authors develop a holistic accountability framework that facilitates defining and implementing accountability in complex, multi-stakeholder environments, by providing a means to operationalize commonly encountered but ambiguous accountability goals through a social process of deliberative dialogue. The authors conclude by summarizing limitations of the approach and describing future research needed.

The recommended method of control for glyphosate-resistant (GR) Italian ryegrass in Mississippi is to apply residual herbicides in the fall; however, these treatments may negatively affect rice performance. This study was conducted to evaluate rice performance following fall-applied treatments of residual herbicides + flumioxazin at different rates. Pooled over with and without flumioxazin and herbicide rates, clomazone and dimethenamid-P caused <10% injury 28 d after emergence. Acetochlor delayed rice maturity by 2 d to clomazone, dimethenamid-P, and flumioxazin. Rice density was reduced ≥4 plants m−2 following fall-applied acetochlor and dimethenamid-P compared to nontreated plants. Rough rice yields were reduced by ≥670 kg ha−1 with fall-applied acetochlor alone and dimethenamid-P compared to nontreated plants. Acetochlor should not be used as a fall-applied treatment in areas where rice is scheduled to grow the following season. Given current label restrictions and rice injury caused by acetochlor and dimethenamid-P, clomazone remains the only viable option for controlling GR Italian ryegrass where rice is scheduled to be planted the following spring.

Current evidence underscores a need to transform how we do clinical research, shifting from academic-driven priorities to co-led community partnership focused programs, accessible and relevant career pathway programs that expand opportunities for career development, and design of trainings and practices to develop cultural competence among research teams. Failures of equitable research translation contribute to health disparities. Drivers of this failed translation include lack of diversity in both researchers and participants, lack of alignment between research institutions and the communities they serve, and lack of attention to structural sources of inequity and drivers of mistrust for science and research. The Duke University Research Equity and Diversity Initiative (READI) is a program designed to better align clinical research programs with community health priorities through community engagement. Organized around three specific aims, READI-supported programs targeting increased workforce diversity, workforce training in community engagement and cultural competence, inclusive research engagement principles, and development of trustworthy partnerships.

Objectives/Goals: Research supports the use of music to improve the care and well-being of adults living with dementia; however, the practice and implementation of music in elder care communities is not regulated. The goal of this qualitative study was to survey elder care communities in Northeast Kansas to determine the use of music with people living with dementia. Methods/Study Population: We interviewed staff (n = 10) at five elder care communities in the Kansas City Metro area and observed musical activities and artifacts in shared living spaces within each community. Interview questions included details of the frequency and purpose of using music, who determined which music to use, and any effects, positive or negative, the interviewee believed to be associated with the use of music. Musical events, visiting musicians or music therapists leading group sing-alongs were observed at two communities, and music-related activities led by staff were observed at two others. Results/Anticipated Results: Music was used in some way at each of the five communities. Each location had recorded music available to residents in the shared living spaces, and most had a piano in the main lounge area. During the sing-along and music-related activities, residents were observed singing along to songs from memory, engaging with one another and the group leader and smiling. Staff employed by each community varied in their level of musical training and experience, from none to a full-time music therapist in residence. Staff interviewed said they believed music was helpful to aid memory recall, reduce anxiety, and to engage interest. Interestingly, a music therapist at one site also described how music during mealtimes created too much of a distraction for residents and interfered with dietary care. Discussion/Significance of Impact: It is clear from both the staff interviews and direct observations of musical activities that music is important to consider for people living with dementia in care communities. Guidelines for implementation and minimum standards would be helpful to ensure all care community residents can experience benefits highlighted by staff in this study.

Objectives/Goals: This study demonstrates the utility of the CBID biodesign process for identifying and prioritizing high-impact neurosurgical needs. The research emphasizes the process’s role in developing innovative medical technologies that align with the healthcare ecosystem’s demands and stakeholder priorities. Methods/Study Population: The CBID Spiral Innovation Model, integrating clinical, technical, business, and strategic considerations across clinical challenges in neurosurgery was employed over a 15-week period at a tertiary care center. The process involved three phases: (1) needs identification through 8 weeks of clinical immersion, (2) 7–8 weeks of stakeholder engagement via informational interviews, surveys, and conferences, and (3) iterative refinement based on evidence generation and market value. Stakeholders included over 70 clinicians (neurosurgeons, neurocritical care specialists, neurologists, etc.) across 15 institutions as well as more than 10 payers and hospital administrators. Data collection encompassed direct observation, structured interviews, and comprehensive literature review. Results/Anticipated Results: The initial list of 300+ identified neurosurgical needs was reduced to 271 after clinician and market input. High-level market and clinical evidence assessments further reduced this to 74 needs. Finally, through iterative evaluation of evidence generation, market opportunity, and stakeholder feedback, five critical unmet needs in stroke, traumatic brain injury, hydrocephalus, and epilepsy were identified for technological innovation. These needs met the criteria for clinical importance, economic viability, and market accessibility. The findings highlight the effectiveness of the biodesign process in creating a roadmap for innovation that is both clinically relevant and commercially viable. Discussion/Significance of Impact: This study underscores the effectiveness of structured need-finding and prioritization within neurosurgery. Integrating stakeholder perspectives and rigorous analysis, it provides a replicable framework for medical innovation to accelerate the development of impactful solutions across medicine.

Objectives/Goals: Increased follicle-stimulating hormone (FSH) is linked to declines in ovarian and metabolic function in older women. Obesity is both a manifestation and a driver of aging pathologies. In animal models, FSH and insulin resistance (IR) were reduced after 6 mos. of a nutritional therapeutic (GLYLO). Our goal was to translate preclinical evidence to humans. Methods/Study Population: An integrated, precision medicine approach identified a unique phenotype of aging-related debility relative to older females. A non-comparer pilot study was conducted to translate GLYLO preclinical findings to postmenopausal women with obesity (n = 85; >55 years; body mass index [BMI]  = 35.0±4.35; range: 30.3–42.8). Participants meeting the inclusion and exclusion criteria (n = 13) were enrolled and received two capsules of GLYLO (vitamins and natural products) daily for 6 mos. Assessments for FSH, estradiol (E2), IR (homeostatic model [HOMA-IR]), total cholesterol (TC), low- (LDL), high-density lipoproteins (HDL), safety biomarkers (e.g., red cell distribution width [RDW%], mean corpuscular volume [MCV]), and depression (Center for Epidemiologic Studies Depression Scale) were conducted prior to and after 6 mos. Results/Anticipated Results: Mixed-effect models with intent-to-treat analysis were applied to compare outcomes prior to (n = 13) and following (n = 7) the intervention. Significant reductions in FSH were observed (-13.1 [2.47] ∆/SD; p = 0.002)) following the 6-month intervention. Interestingly, BMI, E2 (p = 0.412), HOMA-IR (p = 0.885), TC (p = 0.363), and LDL (p = 0.145) were unchanged, while HDL decreased significantly (-9.7 [3.82] ∆/SD; p = 0.044). Other biomarkers, RDW% (-0.2 [0.05] ∆/SD; p = 0.009) and MCV (-2.3 [0.33] ∆/SD; p = 0004), were significantly reduced. All other safety parameters were not altered. Six participants reported mild to moderate adverse events (acid indigestion) and were lost to follow-up. Depression scores significantly increased (+4.0 [0.75] ∆/SD; p = 0.002)). Results were similar with and without intent to treat analysis. Discussion/Significance of Impact: Decreased FSH, but not IR, was observed following six months of GLYLO in postmenopausal women with obesity. Significant alterations in HDL, depression, RDW%, and MCV warrant further investigation. Findings are limited by the small sample size and loss to follow-up. Randomized, controlled trials are needed to confirm these results.

The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBTi), but access is limited. Telehealth- or internet-delivered CBTi are alternative ways to increase access. To date, these intervention modalities have never been compared within a single study. Further, few studies have examined (a) predictors of response to the different modalities, (b) whether successfully treating insomnia can result in improvement of health-related biomarkers, and (c) mechanisms of change in CBTi. This protocol was designed to compare the three CBTi modalities to each other and a waitlist control for adults aged 50–65 years (N = 100). Participants are randomly assigned to one of four study arms: in-person- (n = 30), telehealth- (n = 30) internet-delivered (n = 30) CBTi, or 12-week waitlist control (n = 10). Outcomes include self-reported insomnia symptom severity, polysomnography, circadian rhythms of activity and core body temperature, blood- and sweat-based biomarkers, cognitive functioning and magnetic resonance imaging.

Repatriation of human remains and associated funerary objects under NAGPRA and the increased use of culturally informed curation practices for sacred, religious, and ceremonial objects are important steps toward restoring control over cultural patrimony to Native Nations in the United States. Many museums holding Indigenous belongings have begun a collaborative care approach involving Indigenous community voices and improving access to collections. However, this framework has not been applied to many animal remains curated in American archaeology museums, which remain broadly beyond the care or administrative purview of Native people. Because many Indigenous worldviews do not hold a clear separation between the human and animal spheres, common practices applied to animal remains are not congruent with the idea of respectful or culturally informed care. Here we outline steps to shift the treatment of animals through the application of Indigenous knowledge to museum collections.

While clinical research intends to improve health outcomes for all, access to research participation is often limited and inequitable. Geographic proximity is a recognized barrier, thus, systemic infrastructure solutions through federal programs including General Clinical Research Centers and Clinical and Translational Science Awards have sought to improve accessibility. Even with such support, academic medical centers often have limited clinical research-dedicated space apart from shared exam rooms in difficult-to-navigate hospitals or clinics. In 2019, the Duke University School of Medicine looked beyond its medical center campus to identify free-standing sites within Durham communities for participant study visits. Catalyzed by the COVID-19 pandemic, Duke Research at Pickett, a 22 000-square-foot building with a laboratory, 30 exam rooms, and on-site parking, opened in October 2020 to support vaccine and treatment trials. Upon the lifting of many COVID-19 restrictions, and in partnership with the Research Equity and Diversity Initiative (READI) Community Advisory Council, the building was transformed to encourage community gatherings, education, and training programs. To date, Duke Research at Pickett has hosted 2692 participants in 78 research trials and 14 community-engaged activities.

Horses began to feature prominently in funerary contexts in southern Siberia in the mid-second millennium BC, yet little is known about the use of these animals prior to the emergence of vibrant horse-riding groups in the first millennium BC. Here, the authors present the results of excavations at the late-ninth-century BC tomb of Tunnug 1 in Tuva, where the deposition of the remains of at least 18 horses and one human is reminiscent of sacrificial spectral riders described in fifth-century Scythian funerary rituals by Herodotus. The discovery of items of tack further reveals connections to the earliest horse cultures of Mongolia.

Chromium(VI) in the environment is of particular concern because it is toxic to both plants and animals, even at low concentrations. As a redox-sensitive element, the fate and toxicity of chromium is controlled by soil reduction-oxidation (redox) reactions. In-situ remediation of chromium combines reduction of Cr(VI) to Cr(III) and immobilization of chromium on mineral surfaces. In this study, Fe-rich smectite, montmorillonite, illite, vermiculite, and kaolinite were examined to determine reactivity in sorption-reduction of Cr(VI). The clays were compared to forms that were reduced by sodium dithionite. Clays containing Fe(II) efficiently removed soluble Cr(VI) from solution. Chromium K-edge X-ray absorption near edge structure (XANES) suggested that clays containing Fe(II) reduced Cr(VI) to Cr(III), immobilizing Cr at the clay/water interface. Adsorption of Cr(VI) by the Fe(II)-containing clay was a prerequisite for the coupled sorption-reduction reaction. Sodium dithionite added directly to aqueous suspensions of non-reduced clays reduced Cr(VI) to Cr(III), but did not immobilize Cr on clay surfaces. The capacity of clays to reduce Cr(VI) is correlated with the ferrous iron content of the clays. For dithionite-reduced smectite, the exchangeable cation influenced the sorption reaction, and thus it also influenced the coupled sorption-reduction reaction of Cr(VI). The pH of the aqueous system affected both the amount of Cr(VI) reduced to Cr(III) and the partition of Cr(III) between aqueous and adsorbed species. A plot of pH vs. amount (adsorption envelope) adsorbed for the coupled sorption-reduction reaction of Cr by reduced smectite exhibited a similar pattern to that of typical anion-sorption.