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Background Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic pain (Digital SPA) with end-users and to evaluate its effectiveness and implementation outcomes in Spain. Methods (Phase 1) Focus groups with patients, parents, and clinicians ( n = 5–6 each) will inform about unmet pain care needs and provide a starting point for co-designing the intervention. (Phase 2) Content creation and usability testing will be based on the results of Phase 1, and the theory-driven development will follow the latest available evidence. The intervention will use validated psychological techniques focused on improving functioning by teaching pain coping skills. (Phase 3) Hybrid effectiveness–implementation trial. Participants ( n = 195) will be adolescents aged 12–17 years old with chronic pain and one of their parents. Assessments include physical function, pain, sleep, anxiety, mood, satisfaction and adherence to the treatment, and number of visits to the emergency room. A qualitative framework analysis will be conducted with data from Phase 1. Effects of the intervention will be evaluated using linear multilevel modeling. The Consolidated Framework for Implementation Research (CFIR) and Behavioral Interventions Using Technology (BIT) frameworks will be used to evaluate implementation. Discussion This study is expected to produce a co-created evidence-based digital intervention for pediatric chronic pain and a roadmap for successful implementation. Trial registration number (TRN) and date of registration ClinicalTrials.gov (registered on 26 June 2023: https://clinicaltrials.gov/study/NCT05917626 ). Contributions to the literature The implementation of digital health interventions has two major gaps: (1) adherence to treatment is suboptimal, and (2) the process of making the interventions available to the end-user in a sustainable way is often unsuccessful. In this study, we expect that assessing users’ needs and co-designing an intervention with them will improve adherence. Documenting the implementation process from the project inception and integrating the results into an implementation framework will allow for replication and extension in different contexts. This study will increase the knowledge about implementation in a vulnerable population: adolescents with chronic pain without access to in-person multidisciplinary pain care.

We studied the acclimation modalities of bryophytes to sun and shade under ambient or close-to-ambient conditions, measuring variables usually influenced by photosynthetically active (PAR) and ultraviolet (UV) radiations. Our aim was to elucidate to what extent the responses to changing radiations were influenced by PAR and UV wavelengths. For this aim, we used three taxonomically and structurally different species: the thalloid liverwort Marchantia polymorpha subsp. polymorpha, the leafy liverwort Jungermannia exsertifolia subsp. cordifolia, and the moss Fontinalis antipyretica. In the field, liverworts were more radiation-responsive than the moss, and the thalloid liverwort was more responsive than the leafy liverwort. Sun plants of M. polymorpha showed, in comparison to shade plants, higher sclerophylly, lower Chl a + b contents, higher Chl a/b ratios, higher (antheraxanthin + zeaxanthin)/(violaxanthin + antheraxanthin + zeaxanthin) ratios (xanthophyll index), lower Fv/Fm values, higher contents of methanol-soluble vacuolar UV-absorbing compounds (soluble UVACs), higher values of the ratio between the contents of methanol-insoluble cell wall-bound UVACs (insoluble UVACs) and soluble UVACs, higher contents of soluble luteolin and apigenin derivatives and riccionidin A, and higher contents of insoluble p-coumaric and ferulic acids. Overall, these responses reduced light absorption, alleviated overexcitation, increased photoprotection through non-photochemical energy dissipation, increased UV protection through UV screening and antioxidant capacity, and denoted photoinhibition. J. exsertifolia showed moderate differences between sun and shade plants, while responses of F. antipyretica were rather diffuse. The increase in the xanthophyll index was the most consistent response to sun conditions, occurring in the three species studied. The responses of soluble UVACs were generally clearer than those of insoluble UVACs, probably because insoluble UVACs are relatively immobilized in the cell wall. These modalities of radiation acclimation were reliably summarized by principal components analysis. Using the most radiation-responsive species in the field (M. polymorpha), we found, under close-to-ambient greenhouse conditions, that sclerophylly and Chl a + b content were only influenced by PAR, Fv/Fm, and luteolin and apigenin derivatives were only determined by UV, and xanthophyll index was influenced by both radiation types. Thus, responses of bryophytes to radiation can be better interpreted considering the influence of both PAR and UV radiation.

Ultraviolet (UV) radiation strongly influences grape composition, but only a few studies have focused on how this influence is conserved in the resulting wines. Here we analyzed to what extent the changes induced by exposing Tempranillo grapes to UV radiation from budbreak to harvest were conserved in wine. By using different cut-off filters and lamps, we differentiated the effects of ambient levels of UV-A and UV-B wavelengths, as well as the effects of a realistic UV-B enhancement associated with climate change. Among phenolic compounds, the most consistent responses to UV were those of flavonols (particularly quercetin-, kaempferol-, isorhamnetin- and myricetin-glycosides), which significantly increased in wines whose grapes had been exposed to a synergic combination of UV-A and UV-B radiation. This confirms that flavonols are the phenolic compounds most reliably conserved from UV-exposed grapes to wine, despite the possible influence of the winemaking process. Flavonols are important compounds because they contribute to wine co-pigmentation by stabilizing anthocyanins, and they are interesting antioxidants and nutraceuticals. Hydroxycinnamic acids also increased under the same UV combination or under UV-A alone. Wine VOCs were much less reactive to the UV received by grapes than phenolic compounds, and only esters showed significantly higher values under (mainly) UV-A alone. This was surprising because (1) UV-A has been considered to be less important than UV-B to induce metabolic changes in plants, and (2) esters are produced during winemaking. Esters are relevant due to their contribution to the fruity aroma in wines. In general, the remaining phenolic compounds (stilbenes, flavanols, hydroxybenzoic acids, and anthocyanins) and VOCs (alcohols, hydrocarbons, and fatty acids), together with wine color and antioxidant capacity, showed inconsistent or non-significant responses to UV radiation. These results were summarized by a multivariate analysis. Our study opens up new possibilities to artificially manipulate UV radiation in grapevine cultivation to improve both grape and wine quality.

The liverwort Marchantia polymorpha subsp. ruderalis is an emerging model plant, and some data are available on its responses to ultraviolet (UV) radiation. However, it is unknown if the developmental stage of the thalli modulates the effects of UV radiation on the contents of potentially protecting phenolic compounds. To fill this gap, liverwort samples were exposed or non-exposed to UV radiation for 38 days under controlled conditions, using three developmental stages: gemmae (G), one-month thalli (T1), and two-month thalli (T2). Then, the bulk level of methanol-soluble UV-absorbing compounds and the contents of six flavones (apigenin and luteolin derivatives) were measured. The UV responsiveness decreased with thallus age: G and T1 plants were the most UV-responsive and showed a strong increase in all the variables, with G plants more responsive than T1 plants. In UV-exposed T2 plants, only apigenin derivatives increased and more modestly, probably due to a lower acclimation capacity. Nevertheless, the thalli became progressively tougher due to a decreasing water content, representing a possible structural protection against UV. In UV-exposed plants, the temporal patterns of the accumulation of phenolic compounds were compound-specific. Most compounds decreased with thallus age, but di-glucuronide derivatives showed a bell-shaped pattern, with T1 plants showing the highest contents. A Principal Components Analysis (PCA) ordination of the different samples summarized the results found. The patterns described above should be taken into account to select thalli of an adequate developmental stage for experiments investigating the induction of phenolic compounds by UV radiation.