Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre.

BACKGROUND: With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic. METHODS: We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days. RESULTS: Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians. CONCLUSION: In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.

With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic, we analysed telemedicine visits carried out during the pandemic. On the basis of patient charts, we investigated the association between incomplete visits (telemedicine visits requiring in-person follow-up within 3 days) and various factors (age, gender, presenting complaints, whether the treating physician was a resident or staff doctor, and whether the patient and physician had a prior clinical relationship). Patients presenting with lumps and bumps and those seen by resident physicians had higher odds of being asked to come in-person for further evaluation. Overall, though, these required in-person follow-ups were uncommon: less than 10% of telemedicine visits resulted in the patient physically coming to the clinic within 3 days. The findings of our study could help guide patients to appropriate care services.

Overexpression of gamma-glutamyl cyclotransferase 2;1 (CsGGCT2;1) reduces arsenic toxicity and accumulation in Camelina sativa (L.).

KEY MESSAGE: Overexpressing CsGGCT2;1 in Camelina enhances arsenic tolerance, reducing arsenic accumulation by 40-60%. Genetically modified Camelina can potentially thrive on contaminated lands and help safeguard food quality and sustainable food and biofuel production. Environmental arsenic contamination is a serious global issue that adversely affects human health and diminishes the quality of harvested produce. Glutathione (GSH) is known to bind and detoxify arsenic and other toxic metals. A steady level of GSH is maintained within cells via the γ-glutamyl cycle. The γ-glutamyl cyclotransferases (GGCTs) have previously been shown to be involved in GSH degradation and increased tolerance to toxic metals in plants. In this study, we characterized the GGCT2;1 homolog from Camelina sativa for its role in arsenic tolerance and accumulation. Overexpression of CsGGCT2;1 in Camelina under CaMV35S constitutive promoter resulted in strong tolerance to arsenite (AsIII). The overexpression (OE) lines had 2.6-3.5-fold higher shoots and sevenfold to tenfold enhanced root biomass on media supplemented with AsIII, relative to wild-type plants. The CsGGCT2;1 OE lines accumulated 40-60% less arsenic in root and shoot tissues compared to wild-type plants. Further, the OE lines had ~ twofold higher chlorophyll content and 35% lesser levels of malondialdehyde (MDA), an indicator of membrane damage via lipid peroxidation. There was a slight but non-significant increase in 5-oxoproline (5-OP), a product of GSH degradation, in OE lines. However, the transcript levels of Oxoprolinase 1 (OXP1) were upregulated, indicating the accelerated conversion of 5-OP to glutamate, which is further utilized for the resynthesis of GSH to maintain GSH homeostasis. Overall, this research suggests that genetically modified Camelina may have the potential for cultivation on contaminated marginal lands to reduce As accumulation; thereby could help in addressing food safety issues as well as future food and biofuel needs.

Factors affecting perceived credibility of assessment in medical education: A scoping review.

Assessment is more educationally effective when learners engage with assessment processes and perceive the feedback received as credible. With the goal of optimizing the educational value of assessment in medical education, we mapped the primary literature to identify factors that may affect a learner's perceptions of the credibility of assessment and assessment-generated feedback (i.e., scores or narrative comments). For this scoping review, search strategies were developed and executed in five databases. Eligible articles were primary research studies with medical learners (i.e., medical students to post-graduate fellows) as the focal population, discussed assessment of individual learners, and reported on perceived credibility in the context of assessment or assessment-generated feedback. We identified 4705 articles published between 2000 and November 16, 2020. Abstracts were screened by two reviewers; disagreements were adjudicated by a third reviewer. Full-text review resulted in 80 articles included in this synthesis. We identified three sets of intertwined factors that affect learners' perceived credibility of assessment and assessment-generated feedback: (i) elements of an assessment process, (ii) learners' level of training, and (iii) context of medical education. Medical learners make judgments regarding the credibility of assessments and assessment-generated feedback, which are influenced by a variety of individual, process, and contextual factors. Judgments of credibility appear to influence what information will or will not be used to improve later performance. For assessment to be educationally valuable, design and use of assessment-generated feedback should consider how learners interpret, use, or discount assessment-generated feedback.

Containing the good idea fairy: A deep dive into Navy firearms restriction policy.

STATEMENT OF PROBLEM: US Navy suicide is an ongoing concern, with more than half of suicide deaths each year related to firearms. Although decreasing firearms access by those who are at risk for suicide has been well-established as a tactic for reducing risk, implementation of firearms restrictions has a significant cultural and occupational impact among service members that may increase the stigma of seeking mental health care. During a recent Deep Dive review of all previous year suicide deaths, subject matter experts from across the US Navy identified significant variability in command utilization of firearms restriction. METHODOLOGY: Based on this finding, a review was conducted to identify best practice for firearms restriction related to suicide risk across the US military services and municipal police departments. FINDINGS: Findings from this review suggested that the Department of the Navy may benefit from adopting consistent standards for disarming and rearming service members at risk for suicide, base decisions on objective suicide risk rather than routine stressors, decrease access primarily when service members are off duty, and engage with service members to decrease core drivers of suicide behavior through command channels. IMPLICATIONS: Implementing these recommendations may be a crucial step in balancing precautions to decrease suicide risk with the stigma of firearms restriction in military settings.

Nanoscale Organization of a Platinum(II) Acetylide Cholesteric Liquid Crystal Molecular Glass for Photonics Applications.

The fabrication, molecular structure, and spectroscopy of a stable cholesteric liquid crystal platinum acetylide glass obtained from trans-Pt(PEt3)2(C≡C-C6H5-C≡N)(C≡C-C6H5-COO-Cholesterol), are described and designated as PE1-CN-Chol. Polarized optical microscopy, differential scanning calorimetry, and wide-angle X-ray scattering experiments show room temperature glassy/crystalline texture with crystal formation upon heating to 165 °C. Further heating results in conversion to cholesteric phase. Cooling to room temperature leads to the formation of a cholesteric liquid crystal glass. Scanning tunneling microscopy of a PE1-CN-Chol monolayer reveals self-assembly at the solid-liquid interface with an array of two molecules arranged in pairs, oriented head-to-head through the CN groups, giving rise to a lamella arrangement. The lamella structure obtained from molecular dynamics calculations shows a clear phase separation between the conjugated platinum acetylide and the hydrophobic cholesterol moiety with the lamellae separation distance being 4.0 nm. Ultrafast transient absorption and flash photolysis spectra of the glass show intersystem crossing to the triplet state occurring within 100 ps following excitation. The triplet decay time of the film compared to aerated and deoxygenated solutions is consistent with oxygen quenching at the film surface but not within the film. The high chromophore concentration, high glass thermal stability, and long triplet lifetime in air show that these materials have potential as nonlinear absorbing materials.

Effects of intramolecular hydrogen bonding and sterically forced non-coplanarity on organic donor/acceptor two-photon-absorbing molecules.

Two photon absorption (2PA) is of great interest across many disciplines and there has been a large effort to increase the two-photon cross section (σ2) via synthetic modification, especially by enhancing intramolecular charge-transfer (ICT). This work takes the previously studied (7-benzothiazol-2-yl-9,9-diethylfluoren-2-yl)diphenylamine (AF240), an asymmetric D-π-A chromophore, and intentionally appends a functional group (-OH, AF240-OH or -OCH3, AF240-OMe) to the 6-position of the fluorenyl π-bridge of the new chromophores. Electrochemical results in both dichloromethane and acetonitrile support stabilization of the highest occupied molecular orbital in the derivatives due to inductive electron donating effects of the hydroxy and methoxy groups. The lowest unoccupied molecular orbital is stabilized via intramolecular hydrogen bonding to the benzothiazole moiety in the case of AF240-OH. As previously observed for AF240, the steady-state emission spectra show significant solvatochromism as they broaden and red shift with increasing solvent polarity. The fluorescence lifetimes and quantum yields show that the non-radiative rate constant is increased for AF240-OH in all solvents, especially in nonpolar media. The results suggest there is forced intramolecular hydrogen bonding to the benzothiazole in nonpolar solvents because the solvent poorly solubilizes the hydroxy group. This increases the non-radiative decay rate constant (knr) via additional vibrational decay pathways. While not as dramatic, the increase in knr in polar solvents supports some deactivation via hydrogen bonding to the solvent. Steric effects are also observed in the methoxy derivative, which inhibits planarization of the benzothiazole with the fluorene, increasing the energy of the excited state. Ultrafast transient absorption spectroscopy in tetrahydrofuran solution supports stabilization of the excited state in a few ps as solvent and structural reorganizations occur. In the case of AF240-OH, no evidence of proton transfer is observed. The decrease in emission energies in the case of AF240-OH support increased ICT driven by higher degree of coplanarity and the quinoidal structure in the excited state. However, a moderate increase in the intrinsic 2PA cross-section is resulted. It is likely because of the two possible and competing solvent-stabilized ICT processes (PICT and TICT) in AF240-OH. Nevertheless, the strategic presence of a hydroxide group capable of intramolecular hydrogen bonding in AF240-OH provides a much broader 2PA sensitivity window than AF240.

Homeostatic plasticity in human extrastriate cortex following a simulated peripheral scotoma.

Neuroimaging and patient work over the past decade have indicated that, following retinal deafferentation, the human visual cortex undergoes a large-scale and enduring reorganization of its topography such that the classical retinotopic organization of deafferented visual cortex remaps to represent non-classical regions of visual space. Such long-term visual reorganization is proposed to occur through changes in the functional balance of deafferented visual circuits that engage more lasting changes through activity-dependent neuroplasticity. Here, we investigated the short-term changes in functional balance (short-term plasticity; homeostatic plasticity) that occur within deafferented human visual cortices. We recorded electroencephalogram (EEG) while observers were conditioned for 6 s with a simulated retinal scotoma (artificial scotoma) positioned 8.0° in the periphery. Visual evoked potentials (VEPs) evoked by the onset of sinusoidal visual probes that varied in their tilt were used to examine changes in cortical excitability within and around cortical representations of the simulated scotoma. Psychophysical orientation functions obtained from discrimination of visual probe tilt were used to examine alterations in the stimulus selectivity within the scotoma representations. Consistent with a mechanism of homeostatic disinhibition, an early extrastriate component of the VEP (the early phase P1) exhibited increased amplitude following the condition with a simulated scotoma relative to a stimulus-matched control condition. This increased visual cortical response was associated with a reduction in the slope of the psychophysical orientation function, suggesting a broader tuning of neural populations within scotoma representations. Together, these findings support a mechanism of disinhibition in promoting visual plasticity and topographical reorganization.

Steric hindrance inhibits excited-state relaxation and lowers the extent of intramolecular charge transfer in two-photon absorbing dyes.

The two-photon absorbing dye AF240 [1, (7-benzothiazol-2-yl-9,9-diethylfluoren-2-yl)diphenylamine] is modified by adding bulky alkyl groups to the diphenylamino moiety. Three new compounds are synthesized which have ethyl groups in both ortho positions of each phenyl ring (2), t-butyl groups in one ortho position of each phenyl ring (3), and t-butyl groups in the para position of each phenyl ring (4). The dyes are examined in several aprotic solvents with varying polarity to observe the effects of the sterically hindering bulky groups on the ground and excited-state photophysical properties. While the ground state shows minimal solvent dependence, there is significant dependence on the fluorescence quantum yield and lifetime, as well as the excited-state energy levels. This effect is caused by the formation of an intramolecular charge-transfer (ICT) state, which is observed in the solvents more polar than n-hexane and supported by TD-DFT calculations. Electronic effects of ortho or para alkyl substitution should be similar, yet drastic differences are observed. A red shift in the fluorescence maximum is observed in 4 relative to 1, yet a blue shift occurs in 2 and 3 because the substituents at the sterically sensitive ortho-positions inhibit excited-state geometric relaxation and result in less ICT character than 1. Coupled with theoretical calculations, the data support a planar ICT (PICT) excited state where the diphenylamino nitrogen in an sp(2)-like geometry is integral with the plane containing the fluorene and benzothiazole moieties. Ultrafast transient absorption experiments show that ICT occurs rapidly (<150 fs) followed by geometric and solvent relaxation in ∼ 1-4 ps to form the PICT or solvent-stabilized ICT (SSICT) state. This relaxation is not observed in non-polar n-hexane because the solvent dependent ICT state energy lies higher than the locally-excited (LE) state. Finally, formation of a triplet state (T1) is only efficiently observed in n-hexane for all four dyes.

Strong triplet excited-state absorption in a phenanthrolinyl iridium(III) complex with benzothiazolylfluorenyl-substituted ligands.

Femtosecond transient difference absorption (fs TA) measurements, together with a series of open-aperture Z scans at picosecond and nanosecond pulse widths and a variety of pulse energies, were performed on a 1,10-phenanthrolinyl iridium(III) complex bearing ligands containing a benzothiazolylfluorenyl motif. An analysis of decay data from the fs TA experiment yields a value of 1.24±0.26 ns for the singlet excited-state lifetime τ(S) of the complex. By fitting the Z scans to a five-level dynamic model incorporating the independently measured value of τ(S) and previously reported values of the complex's triplet quantum yield (0.13) and triplet excited-state lifetime (230 ns), we obtain values of 3.5×10(-17) cm(2) (singlet) and 5.0×10(-16) cm(2) (triplet) for the excited-state absorption cross-sections of the complex in toluene solution at 532 nm; the latter value represents one of the largest triplet excited-state absorption cross-sections ever reported at this wavelength. The ratio of the triplet excited-state cross-section to the ground-state absorption cross-section exceeds 3800.

Reduced Silver Nanoparticle Phytotoxicity in Crambe abyssinica with Enhanced Glutathione Production by Overexpressing Bacterial γ-Glutamylcysteine Synthase.

Silver nanoparticles (Ag NPs) are widely used in consumer products, and their release has raised serious concerns about the risk of their exposure to the environment and to human health. However, biochemical mechanisms by which plants counteract NP toxicity are largely unknown. We have previously engineered Crambe abyssinica plants expressing the bacterial γ-glutamylecysteine synthase (γ-ECS) for enhancing glutathione (GSH) levels. In this study, we investigated if enhanced levels of GSH and its derivatives can protect plants from Ag NPs and AgNO3 (Ag(+) ions). Our results showed that transgenic lines, when exposed to Ag NPs and Ag(+) ions, were significantly more tolerant, attaining a 28%-46% higher biomass and 34-49% more chlorophyll content, as well as maintaining 35-46% higher transpiration rates as compared to those of wild type (WT) plants. Transgenic γ-ECS lines showed 2-6-fold Ag accumulation in shoot tissue and slightly lower or no difference in root tissue relative to levels in WT plants. The levels of malondialdehyde (MDA) in γ-ECS lines were also 27.3-32.5% lower than those in WT Crambe. These results indicate that GSH and related peptides protect plants from Ag nanotoxicity. To our knowledge, this is the first direct report of Ag NP detoxification by GSH in transgenic plants, and these results will be highly useful in developing strategies to counteract the phytotoxicty of metal-based nanoparticles in crop plants.

Engagement and partnership with consumers and communities in the co-design and conduct of Research: Lessons from the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial.

BACKGROUND: Engagement and partnership with consumers and communities throughout research processes produces high quality research meeting community needs and promoting translation of research into improved policy and practice. Partnership is critical in research involving Aboriginal and/or Torres Strait Islander people (First Nations Peoples) to ensure cultural safety. We present lessons from the design, implementation and progress of the National Health and Medical Research Council funded INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis (INFERR) clinical trial. MAIN BODY: The trial was designed to understand the benefits and harms of iron therapy in First Nations Australians on haemodialysis with anaemia and hyperferritinaemia. The lack of evidence for treatment was discussed with patients who were potential participants. A key element ensuring safe conduct of the INFERR trial was the establishment of the Indigenous Reference Groups (IRGs) comprising of dialysis patients based in the Top End of Australia and Central Australia. Two IRGs were needed based on advice from First Nations communities and researchers/academics on the project regarding local cultural differences and approaches to trial conduct. The IRGs underpin culturally safe trial conduct by providing input into study materials and translating study findings into effective messages and policies for First Nations dialysis patients. Throughout the trial conduct, the IRGs' role has developed to provide key mechanisms for advice and guidance regarding research conduct both in this study and more broadly. Support provided to the IRGs by trial First Nations Research Officers and independent First Nations researchers/academics who simplify research concepts is critical. The IRGs have developed feedback documents and processes to participants, stakeholders, and the renal units. They guarantee culturally safe advice for embedding findings from the trial into clinical practice guidelines ensuring evidence-based approaches in managing anaemia in haemodialysis patients with hyperferritinaemia. CONCLUSION: Active consumer and community partnership is critical in research conduct to ensure research impact. Strong partnership with consumers in the INFERR clinical trial has demonstrated that First Nations Consumers will engage in research they understand, that addresses health priorities for them and where they feel respected, listened to, and empowered to achieve change.

In this paper, we present the importance of actively involving consumers in the planning, implementation and conduct of research using the example of a clinical trial among Aboriginal and/or Torres Strait Australians (First Nations Australians) who have kidney disease and are currently receiving haemodialysis. The study assesses how safe and effective it is for people on dialysis to receive iron given through the vein during dialysis when they have anaemia and high levels of a blood test called ferritin, a test used routinely to measure iron levels. Two consumer reference groups of First Nations patients on dialysis, one based in the Top End of Australia and the other based in Central Australia, are supported by First Nations Research Officers and Research Academics to make sure that the research is performed in a way that involves, respects and values First Nations participation, culture, and knowledge. Active consumer and community partnership in this study has supported robust research governance processes which we believe are crucial for knowledge translation to have a positive impact for patients.

Ornithine: the overlooked molecule in the regulation of polyamine metabolism.

We overexpressed a mouse ornithine decarboxylase gene under the control of a constitutive and an estradiol-inducible promoter in Arabidopsis thaliana to increase our understanding of the regulation of polyamine metabolism. Of particular interest was the role of the substrate ornithine not only in the regulation of polyamine biosynthesis, but also in the accumulation of related amino acids in response to short-term induction of this enzyme. We hypothesized that the inducible expression of the transgene would mimic the natural responses of plants to changing conditions, e.g. under stress conditions and during rapid growth. Our results reveal that ornithine, even though present in relatively small quantities (compared with other amino acids of the glutamate-arginine-proline pathway), may not only be the key regulator of polyamine biosynthesis in Arabidopsis, but it may also regulate the entire subset of pathways for glutamate to arginine and to proline. Indirectly, it could also regulate putrescine catabolism, therefore contributing to the γ-aminobutyric acid content of the cells. Furthermore, the induction of mouse ornithine decarboxylase resulted in up- and down-regulation of several amino acids in the transgenic plants. It was learned that the turnover of putrescine in both the wild type and the transgenic plants occurs rapidly, with a half-life of 6-8 h.

Patterns of physical, chemical, and metabolic characteristics of sugar maple leaves with depth in the crown and in response to nitrogen and phosphorus addition.

Few previous studies have described the patterns of leaf characteristics in response to nutrient availability and depth in the crown. Sugar maple has been studied for both sensitivity to light, as a shade-tolerant species, and sensitivity to soil nutrient availability, as a species in decline due to acid rain. To explore leaf characteristics from the top to bottom of the canopy, we collected leaves along a vertical gradient within mature sugar maple crowns in a full-factorial nitrogen (N) by phosphorus (P) addition experiment in three forest stands in central New Hampshire, USA. Thirty-two of the 44 leaf characteristics had significant relationships with depth in the crown, with the effect of depth in the crown strongest for leaf area, photosynthetic pigments and polyamines. Nitrogen addition had a strong impact on the concentration of foliar N, chlorophyll, carotenoids, alanine and glutamate. For several other elements and amino acids, N addition changed patterns with depth in the crown. Phosphorus addition increased foliar P and boron (B); it also caused a steeper increase of P and B with depth in the crown. Since most of these leaf characteristics play a direct or indirect role in photosynthesis, metabolic regulation or cell division, studies that ignore the vertical gradient may not accurately represent whole-canopy performance.

Is foliar tissue drying and grinding required for reliable and reproducible extraction of total inorganic nutrients? A comparative study of three tissue preparation methods.

In response to abiotic and biotic stress or experimental treatment(s), foliar concentrations of inorganic nutrients and metabolites often change in concert to maintain a homeostatic balance within the cell's environment thus allowing normal functions to carry on. Therefore, whenever possible, changes in cellular chemistry, metabolism, and gene expressions should be simultaneously evaluated using a common pool of tissue. This will help advance the knowledge needed to fill the gaps in our understanding of how these variables function together to maintain cellular homeostasis. Currently, foliar samples of trees for total inorganic nutrients and metabolic analyses are often collected at different times and are stored and processed in different ways before analyses. The objective of the present study was to evaluate whether a pool of wet (previously frozen) intact tissue that is used for metabolic and molecular work would also be suitable for analyses of foliar total inorganic nutrients. We compared quantities of nutrients extracted from wet-intact, dried-intact, and dried-ground tissues taken from a common pool of previously frozen foliage of black oak (Quercus velutina L.), sugar maple (Acer saccharum Marshall), red spruce (Picea rubens Sarg.), and white pine (Pinus strobus L.). With a few exceptions in the case of hardwoods where concentrations of total Ca, Mg, K, and P extracted from wet-intact tissue were significantly higher than dry tissue, data pooled across all collection times suggest that the extracted nutrient concentrations were comparable among the three tissue preparation methods and all for species. Based on the data presented here, it may be concluded that drying and grinding of foliage may not be necessary for nutrient analyses thus making it possible to use the same pool of tissue for total inorganic nutrients and metabolic and/or genomic analyses. To our knowledge, this is the first report on such a comparison.

Limitations of Canadian COVID-19 data reporting to the general public.

Canadian coronavirus (COVID-19) case statistics reported by governmental bodies and news outlets are central to inform the public and to guide health policy. We searched Canadian governmental and news outlets websites to determine how COVID-19 case statistics were reported to the general public, whether they were reported with appropriate denominators, data sources, and accounted for age, sex, and race or ethnicity. Canadian COVID-19 data reporting practices were found to have limited utility due to varying case definitions, heterogeneous and dynamic testing criteria, lack of appropriate standardization accounting for dynamics, sizes, and characteristics of the populations being tested. Population-wide representative COVID-19 testing should be implemented to enable accurate estimation of the scale and dynamics of the epidemiological situation. Comprehensive COVID-19 data on underrepresented and marginalized populations should be collected and reported in an effort to develop equitable health policies.

National Radon Action Plans in Europe and Need of Effectiveness Indicators: An Overview of HERCA Activities.

Protection of the population and of workers from exposure to radon is a unique challenge in radiation protection. Many coordinated actions and a variety of expertise are needed. Initially, a National Radon Action Plan (NRAP) has been developed and implemented by some countries, while it is currently recommended by international organizations (e.g., World Health Organization) and required by international regulations, such as the European Council Directive 2013/59/Euratom and the International Basic Safety Standards on Radiation Protection and Safety of Radiation Sources, cosponsored by eight international organizations. Within this framework, the Heads of the European Radiological Protection Competent Authorities (HERCA) have organized activities aimed at sharing experiences to contribute toward the development and implementation of effective NRAPs. Two workshops were held in 2014 and 2015, the latter on radon in workplaces. As a follow-up to these, an online event took place in March 2021, and a second specific workshop on NRAP is planned for June 2022. These workshops were attended by experts from the competent authorities of European countries, relevant national and international organizations. The experience of several countries and the outcomes from these workshops have highlighted the need for adequate indicators of the effectiveness and progress of the actions of NRAPs, which could also be useful to implement the principle of optimization and the graded approach in NRAPs. In this paper, the activities of HERCA to support the development and implementation of effective NRAPs are described and some examples of effectiveness indicators are reported, including those already included in the NRAP of some European countries.

Effects of nutrient addition on leaf chemistry, morphology, and photosynthetic capacity of three bog shrubs.

Plants in nutrient-poor environments typically have low foliar nitrogen (N) concentrations, long-lived tissues with leaf traits designed to use nutrients efficiently, and low rates of photosynthesis. We postulated that increasing N availability due to atmospheric deposition would increase photosynthetic capacity, foliar N, and specific leaf area (SLA) of bog shrubs. We measured photosynthesis, foliar chemistry and leaf morphology in three ericaceous shrubs (Vaccinium myrtilloides, Ledum groenlandicum and Chamaedaphne calyculata) in a long-term fertilization experiment at Mer Bleue bog, Ontario, Canada, with a background deposition of 0.8 g N m(-2) a(-1). While biomass and chlorophyll concentrations increased in the highest nutrient treatment for C. calyculata, we found no change in the rates of light-saturated photosynthesis (A(max)), carboxylation (V(cmax)), or SLA with nutrient (N with and without PK) addition, with the exception of a weak positive correlation between foliar N and A(max) for C. calyculata, and higher V(cmax) in L. groenlandicum with low nutrient addition. We found negative correlations between photosynthetic N use efficiency (PNUE) and foliar N, accompanied by a species-specific increase in one or more amino acids, which may be a sign of excess N availability and/or a mechanism to reduce ammonium (NH(4)) toxicity. We also observed a decrease in foliar soluble Ca and Mg concentrations, essential minerals for plant growth, but no change in polyamines, indicators of physiological stress under conditions of high N accumulation. These results suggest that plants adapted to low-nutrient environments do not shift their resource allocation to photosynthetic processes, even after reaching N sufficiency, but instead store the excess N in organic compounds for future use. In the long term, bog species may not be able to take advantage of elevated nutrients, resulting in them being replaced by species that are better adapted to a higher nutrient environment.

Endometrial Biopsy: Indications and Technique.

Abnormal uterine bleeding is a frequent medical concern for premenopausal and postmenopausal patients. Endometrial biopsy is a safe, cost-effective option offered in the office setting. Although endometrial biopsy may result in insufficient tissue or false-negative results, data suggest that endometrial biopsy is 90% sensitive for endometrial cancer and 82% sensitive for atypical hyperplasia, with specificity of 100% for postmenopausal patients and similar results in premenopausal patients. Topical cervical analgesia and oral nonsteroidal anti-inflammatory drugs decrease a patient's discomfort during endometrial biopsy. Aftercare instructions and how patients want to receive results should be reviewed in advance of performing the endometrial biopsy.

Intrauterine Device Insertion and Removal.

Intrauterine devices (IUDs) are safe, highly effective, reversible contraception and come in 2 varieties in the United States: nonhormonal (copper) or levonorgestrel hormonal (LNG) IUDs. There are few absolute contraindications, making them appropriate birth control for most patients. Patients are more likely to select an IUD when counseled about IUD removal and factors that are important to them. IUD insertion and removal are uncomplicated office procedures that can be offered by primary care providers.

Frontal midline theta differentiates separate cognitive control strategies while still generalizing the need for cognitive control.

Cognitive control processes encompass many distinct components, including response inhibition (stopping a prepotent response), proactive control (using prior information to enact control), reactive control (last-minute changing of a prepotent response), and conflict monitoring (choosing between two competing responses). While frontal midline theta activity is theorized to be a general marker of the need for cognitive control, a stringent test of this hypothesis would require a quantitative, within-subject comparison of the neural activation patterns indexing many different cognitive control strategies, an experiment lacking in the current literature. We recorded EEG from 176 participants as they performed tasks that tested inhibitory control (Go/Nogo Task), proactive and reactive control (AX-Continuous Performance Task), and resolving response conflict (Global/Local Task-modified Flanker Task). As activity in the theta (4-8 Hz) frequency band is thought to be a common signature of cognitive control, we assessed frontal midline theta activation underlying each cognitive control strategy. In all strategies, we found higher frontal midline theta power for trials that required more cognitive control (target conditions) versus control conditions. Additionally, reactive control and inhibitory control had higher theta power than proactive control and response conflict, and proactive control had higher theta power than response conflict. Using decoding analyses, we were able to successfully decode control from target trials using classifiers trained exclusively on each of the other strategies, thus firmly demonstrating that theta representations of cognitive control generalize across multiple cognitive control strategies. Our results confirm that frontal midline theta-band activity is a common mechanism for initiating and executing cognitive control, but theta power also differentiates between cognitive control mechanisms. As theta activation reliably differs depending on the cognitive control strategy employed, future work will need to focus on the differential role of theta in differing cognitive control strategies.