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About six million people come into an emergency department every year with chest pain, but not all of them are having a heart attack -- and many are not even at risk or are at very low risk for having one.

Now, a new research study presented at the American College Cardiology Scientific Sessions from the Intermountain Healthcare Heart Institute in Salt Lake City shows that identifying the presence or absence of coronary artery calcium (CAC) in a patients' arteries can help determine their future risk.

"Through these results, we're seeing more clearly that the presence of coronary artery calcium can help us to predict who is more likely to have a cardiac event, not only later in life, but when symptoms are present, in the near future and hopefully, medically intervene in time to stop it," said Viet T. Le, PA-C, principal investigator and researcher at the Intermountain Healthcare Heart Institute in Salt Lake City.

Results of the study were presented at the American College of Cardiology Scientific Sessions in Atlanta on March 16, 2019.

For the study, researchers identified 5,547 patients without a history of coronary artery disease who came to Intermountain Medical Center with chest pain between April 2013 and June 2016.

These patients had undergone PET/CT scans to assess for ischemia, a disruption of normal blood flow through the heart arteries to the muscle tissues of the heart. This scan also looks for the presence of CAC, which are calcium deposits on the walls of the heart's arteries, indicating atherosclerosis, or plaque, the hallmark of heart disease. The researchers then examined patients' medical outcomes for up to the next four years.

Researchers found that patients whose scans revealed CAC were at higher risk of having a heart event within 90 days compared with patients whose PET/CT showed they had no CAC. Researchers also found that patients with CAC were also more likely over the following years to have high-grade obstructive coronary artery disease, revascularization surgery, and/or other major adverse cardiac events than patients who had no coronary artery calcium.

The findings can be used in two different ways, said Le.

First, testing for CAC can help emergency departments quickly identify those patients with chest pain, but are not in acute distress as being at risk for a future heart event from those who may have non-heart related symptoms and should follow up with their primary care physician to identify the true source of the chest pain, which may be as simple as a pulled muscle. These CAC scans are non-invasive, use only as much radiation as a mammogram, and are relatively cheap, especially compared to PET/CT stress tests, Le said.

Second, CAC isn't easily visually identifiable at low or moderate levels in the arteries without a formal scan. Checking patients who are not actively found to be experiencing a heart event but who have suspicious symptoms when they come to the ED can help physicians identify who is at risk for a future event. This allows for early initiation of risk reducing lifestyle changes in those found to have CAC to avoid future events.

"We can have that discussion about improving their lifestyle a little sooner this way because they may not be having an acute event but they're looking down the barrel of one, so let's see if we can move that barrel away," said Le.

Future studies are needed to demonstrate whether a CAC first strategy in these symptomatic patients will better identify those who should have further stress testing as well as improve patient education and early implementation of risk reducing strategies.

LAS VEGAS, NV - The arthroscopic superior capsule reconstruction (SCR) surgical technique offers patients with irreparable rotator cuff tears restored shoulder function and the opportunity to return to sports and physically-demanding work, according to research presented today at the AOSSM/AANA Specialty Day in Las Vegas, Nevada. The study, which examined patient outcomes up to five years after surgery, built upon earlier research which examined short-term patient results.

"We studied 30 patients who were treated with arthroscopic SCR, and consistently saw improvements in outcomes related to shoulder function and the daily lives of those treated," noted lead researcher Teruhisa Mihata, MD, PhD, from Osaka Medical College in Osaka, Japan. "The technique allowed 11 of 12 patients who had previously worked to return full-time at five-year follow-up, and all eight who had participated in sports to return to play."

The study measured both American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores in patients, which improved significantly at both one and five years after surgery. The average ASES scores rose from 29.0 before surgery to 83.0 at one year and 92.3 at five years after surgery, with JOA scores rising from 51.5 before surgery to 85.9 and 91.4, respectively. Active elevation increased from 85 degrees prior to surgery to 151 degrees 5 years after the operation. Out of 30 patients followed for five years, only three (10%) experienced graft tears. Those who demonstrated graft healing also showed no sign of glenohumeral osteoarthritis during the five-year period.

"Our latest research shows continued promise for the arthroscopic SCR technique, particularly to restore a patient's shoulder function and allow them to return to work or sports if they so choose," said Mihata. "We plan to continue studying longer-term outcomes for patients, focusing on continued function and the appearance of osteoarthritis."

LAS VEGAS, NV - Anterior Cruciate Ligament (ACL) reconstruction patients often face bone and muscle loss immediately following the procedure. Researchers presenting their work today at the AOSSM/AANA Specialty Day note that combining blood flow restriction (BFR) therapy with traditional rehabilitation efforts may slow bone loss and reduce return to function time.

"Providing BFR as part of the rehabilitation efforts following ACL surgery, appears to help preserve the bone, recover muscle loss and improve function quicker, according to our research," said lead author, Bradley Lambert, PhD - Orthopedic Biomechanics Research Laboratory, Department of Orthopedics & Sports Medicine, Houston Methodist Hospital)

Dr. Lambert and his colleagues are presenting new results of a randomized prospective study initiated and directed by Dr. Patrick McCulloch, MD (PI & Chair of Research for the Department) whereby 23 active young patients (Mean age 23) were studied following ACL reconstruction. Participants were divided into two groups. Both groups received the same rehab protocol, however during select exercises the BFR group exercised with an 80% arterial limb occlusion using an automated tourniquet. Bone mineral density, bone mass, and lean muscle mass were measured using DEXA. The addition of BFR therapy to standard rehab exercises was found to prevent muscle mass loss in the whole leg and thigh in the post-operative limb compared to rehab alone. Intriguingly, the addition of BFR was also observed to minimize losses in bone mineral content and preserve bone density in the limb compared to standard rehab alone. These findings coincided with improved functional outcomes observed by Dr. Corbin Hedt, DPT who oversaw the therapy sessions.

"BFR is a suitable additive therapy to ACL rehabilitation for the purposes of minimizing the loss, and enhancing the recovery of muscle, bone, and physical function. While further research is needed to fully illuminate the physiologic mechanisms responsible for our results, these findings likely have wide ranging implications for fields outside of ACL rehab alone such as injury prevention, age-related muscle and bone loss, military rehabilitation, and potentially space flight," said Lambert.

LAS VEGAS, NV -Sixty million kids participate in organized athletics each year with ever increasing amounts of children specializing in one sport before the age of 14 with hopes of a college scholarship or professional career on the line. However, researchers presenting their work at the AOSSM/AANA Specialty Day today reveal that this early intense participation might come at the cost of increased injuries during their athletic careers.

"Our research indicated that athletes who specialized in their varsity sport before the age of 14 were more likely to report a history of injuries and multiple college injuries during the course of their athletic career," said author, Brian M. Cash, MD from the Department of Orthopaedic Surgery at the University of California at Los Angeles.

Cash and his colleagues sent a voluntary survey to 652 athletes who participated in athletics at a single institution. Participants were asked about demographics, scholarship status, reasons for sports specialization, age of specialization, training volume, and injury/surgical history. A total of 202 surveys were available for analysis after some were excluded due to incomplete or incorrect survey completion. Injuries were defined as those which kept an athlete out of participation for more than one week. High training volume was defined as greater than 28 hours per week during pre-high school years. 86.9% vs. 74% of individuals who specialized early reported a history of injury, (64.6% vs. 49.4%) reported multiple injuries and these athletes were held out of sport participation an average of 15.2 vs. 7.0 weeks in those that did not specialize early. However, early specializers were also more likely to receive a college scholarship (92.9 vs 83.1%). Full-scholarship athletes were more likely to report multiple surgical injuries (11.7 vs 3.5%).

In addition, those who trained more than 28 hours per week in their varsity sport before high school were more likely to report multiple injuries (90.0 vs. 56.7%). Individuals with a pre-high school training volume greater than 28 hours/week were not more likely to be recruited (90.0 vs. 89%) or receive a scholarship (80% vs. 74.5%).

"Sports participation is an excellent way for kids to maintain their health and possibly even receive a college scholarship. However, our research further highlights that avoiding sports specialization before the age of 14 and minimizing training time to less than 28 hours per week, may significantly minimize a child's injury chances and promote long-term, athletic college or even elite success," said Cash.

NEWTOWN SQUARE, Penn. (March 15, 2018) - Nitrogen in rain and snow falls to the ground where, in theory, it is used by forest plants and microbes. New research by a scientific collaboration led by the USDA Forest Service shows that more nitrogen from rain and snow is making it to more streams than previously believed and flowing downstream in forests of the United States and Canada. The study, "Unprocessed atmospheric nitrate in waters of the Northern Forest Region in the USA and Canada," was published this week in the journal Environmental Science & Technology and is available at: https://www.nrs.fs.fed.us/pubs/57730

Scientists found that some nitrate, which is a form of nitrogen that plants and microbes can use, occasionally moves too fast for biological uptake, resulting in "unprocessed" nitrate bypassing the otherwise effective filter of forest biology. The study links pollutant emissions from various and sometimes distant sources including industry, energy production, the transportation sector and agriculture to forest health and stream water quality.

"Nitrogen is critical to the biological productivity of the planet, but it becomes an ecological and aquatic pollutant when too much is present," said Stephen Sebestyen, a research hydrologist with the USDA Forest Service's Northern Research Station based in Grand Rapids, Minn., and the study's lead author.

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"From public land managers to woodlot owners, there is a great deal of interest in forest health and water quality. Our research identifies widespread pollutant effects, which undermines efforts to manage nitrogen pollution."

Sebestyen and 29 co-authors completed one of the largest and longest examinations to trace unprocessed nitrate movement in forests. Scientists from several federal agencies and 12 academic institutions in the United States, Canada, and Japan collected water samples in 13 states and the province of Ontario, ultimately compiling more than 1,800 individual nitrate isotope analyses over the course of 21 years.

"We generally assumed that nitrate pollution would not travel a great distance through a forest because the landscape would serve as an effective filter," Sebestyen said. "This study demonstrates that while we have not been wrong about that, we needed more information to be better informed." Forests overall use most nitrate, unless rainfall and snowmelt runoff during higher flow events lead to brief, but important windows when unprocessed nitrate flows to streams; sometimes at levels that are unexpectedly high.

Too much nitrogen contributes to forest decline and growth of nuisance vegetation in lakes and ponds. Tree species have varying levels of tolerance for nitrogen. Too much nitrogen can change forest composition and provide a foothold for non-native plants. "I'm concerned with how air pollution affects forests and watersheds," said Trent Wickman, an Air Resource Specialist with the USDA Forest Service's Eastern Region and a co-author of the study. "There are a number of federal and state programs that aim to reduce nitrogen air pollution from vehicles and industrial sources. Understanding the fate of nitrogen that originates in the air, but ends up on land, is important to gauge the effectiveness of those pollution reduction programs."

Sebestyen and the study's co-authors suggest that because unprocessed nitrogen is not being filtered by natural vegetation to the extent previously believed, monitoring coupled with this baseline information is needed to give land managers a more nuanced view of forest health issues.

Millions of people work nights, but increasingly scientists are finding that night work is associated with health problems. Now a group of Italian scientists has found that nightshift workers also need to pee more, leading to a deteriorating quality of life for many workers, including care workers. This is also true of younger subjects, who would not normally be expected to report an overactive bladder. This work is reported at the European Association of Urology Congress in Barcelona.

Researchers from the Sant'Andrea Hospital in Rome surveyed 68 men and 68 women between March and October 2018. All were workers in the Italian National Health System, with 66 of the volunteers working nightshifts, on average, 11 hours per nightshift. The 70 day workers worked an average of 9.1 hours/day. The researchers found that the night shift workers reported a significantly higher rate of overactive bladder, and a poorer quality of life when compared with day shift workers. All the workers were under 50 years old.

Using the generally accepted Overactive Bladder Questionnaire*, they found that those on night shift reported an average total score of 31, as against a score of 19 for those working day shifts. They also found that night workers scored a significantly worse quality of life (measured using the OAB QL score and the EORTC QLQ-30 score), with scores of 41 against 31 with day shift workers (see abstract for ranges).

Research leader, Dr Cosimo De Nunzio said: "We know that long-term night work is stressful, and is associated with increased levels of health problems. This work shows that constant night workers may have a higher urinary frequency as well as a decline in their own quality of life. Furthermore, we have measured these changes in health workers, who are themselves responsible for looking after the well-being of patients. If they feel bad themselves, then this will inevitably lead to poorer patient care. The same is probably true in many other occupations. One of the most concerning things about this work is everyone in our sample was under 50. We normally expect bladder problems with older people, but here we have younger people expressing a deteriorating quality of life".

Background

In many countries, night shift work is increasing to cope with the demands of the 24-hour economy. In the UK one worker in 8 works night shift (2017 figures; that's 3.2 million, a 250,000 increase in the previous 5 years), with one in 6 black workers working night shift. In the USA, nearly 9 million people work night shifts. In general, night shift workers are concentrated in poorer manual or service jobs, such as security, transport, cleaning, maintenance, etc. Night work has been shown to put stresses on health, with night workers showing greater levels of depression, cardiovascular disease, and certain cancers***.

Commenting, Professor Jean-Nicolas Cornu (Rouen, France ) said: "Increased urinary frequency is an issue for millions of people worldwide. In nightshift workers, the present work highlights the importance of this issue regarding quality of life. Whether the changes described in this study depend on confounding factors (modification of drinking habits, caffeine intake, etc.) and/or modification of urinary production by the kidney cannot be assessed. A lot of work remains needed to understand what happens in those cases."

This is an independent comment; Professor Jean-Nicolas Cornu was not involved in this work

The researchers note that this is a modest sample size, so the work needs to be reproduced in a larger study, with a longer-term follow up.

PHILADELPHIA (March 15, 2019) -- In the decade since the federal government's electronic health record (EHR) initiatives first became law, nearly all U.S. hospitals have adopted some form of EHR technology. Now, focus is on how a comprehensive EHR can enhance outcomes. Yet, little is known about the sociotechnical factors that can shape the relationship between advanced EHR adoption and quality of care.

In a first-of-its-kind study, Penn Nursing's Center for Health Outcomes & Policy Research (CHOPR) has examined nurse satisfaction with EHR systems and the concurrent effects of EHR adoption level and the hospital work environment on usability and quality outcomes. Data from more than 12,000 nurses at 353 hospitals in four states show that the work environment is associated with all EHR usability outcomes, with nurses in hospitals with better environments being less likely than nurses in less favorable environments to report dissatisfaction with EHR systems.

Overall, 25 percent of nurses reported dissatisfaction with their current record systems while similarly high percentages reported usability issues. Over half of the surveyed nurses reported that EHRs interfered with patient care, while nearly one-third reported that they did not help them to do their work efficiently. Differences in usability reports were vastly different by the quality of the work environment. Nearly forty percent of nurses working in hospitals with poor work environments reported dissatisfaction with the record system compared with less than twenty percent of nurses working in hospitals with better environments. Also of note, nearly half of nurses working in poor environments reported that the EHR system did not help them to work efficiently, compared with one-quarter of nurses in better environments.

"Our study indicated that hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care," says lead-investigator Ann Kutney-Lee, PhD, RN, FAAN, Adjunct Associate Professor of Nursing, and a Senior Fellow at both CHOPR and the Leonard Davis Institute of Health Economics. "Our data showed that the effect of EHR adoption level on outcomes was moderated and sometimes rendered insignificant after including the work environment. This moderation suggests that the work environment may play a more important role in the delivery of safe patient care than the type of EHR system."

Strength training over a short time period can reduce fat stores in the liver and improve blood glucose control in obese mice, according to a study published in the Journal of Endocrinology. The study reports that strength training over a short time-period, less than would be enough to change body fat composition in humans, was sufficient to reduce the accumulation of liver fat and improve regulation of blood glucose in obese mice, even without overall loss of body weight. These findings suggest that strength training may be a fast and effective strategy for reducing the risk of fatty liver disease and diabetes in obese people.

Obesity is a growing, global health epidemic that needs more effective intervention strategies to avoid debilitating complications including fatty liver disease and diabetes. Approximately 94% of obese people are diagnosed with non-alcoholic fatty liver disease, which leads to inflammation in this vital organ and impairs its ability to regulate blood glucose. This increases the risk of type 2 diabetes and its associated serious complications, including nerve and kidney damage. Although increased physical activity is a widely accepted method of improving health and aiding weight loss, the relative benefits of different types, durations and intensities of physical activities are still under much debate. A wealth of research has focussed on the benefits of energy-burning aerobic exercise, with the potential benefits of muscle-building strength and resistance training often neglected.

In this study, Leandro Pereira de Moura and colleagues at the School of Applied Sciences at the University of Campinas in Brazil, investigated the effects of strength-based exercise on liver fat accumulation, blood glucose regulation and markers of inflammation in obese mice. Obese mice performed strength training over a short time-period, the equivalent of which in humans would not be enough to change their body fat composition. After this short-term training the mice had less fatty livers, reduced levels of inflammatory markers and their blood glucose regulation was improved, despite no change in their overall body weight.

Dr Pereira de Moura comments, "The fact that these improvements in metabolism occurred over a short time, even though the overall amount of body fat was unchanged, suggest that strength training can have positive effects on health and directly affect liver function and metabolism. so may be a more effective, non-drug and low-cost strategy for improving health in obesity."

Dr Pereira de Moura cautions: "Although these findings show a clear benefit in obese mice, to mimic strength training in animals is difficult. More investigation is required in both animals and people to really understand how liver metabolism is affected by strength training. It should be noted that these health benefits would be even more effective if accompanied by reduction of body fat. However, based on these findings obese individuals could be directed to increase their activity through strength training but they should always first consult their primary care physician."

Dr Pereira de Moura and colleagues now plan to investigate the mechanisms underlying these findings, to identify how they may be maximised and to help devise real guidance for obese individuals. They are currently conducting studies that examine the impact of different exercise protocols, such as aerobic exercise or aerobic exercise combined with strength training, on fatty liver accumulation. It is possible that by better understanding how strength training improves liver function, new targets for drug intervention that may prevent or reduce the risk of fatty liver disease and type 2 diabetes in obesity may be identified.

Herpes viruses reactivate in more than half of crew aboard Space Shuttle and International Space Station missions, according to NASA research published in Frontiers in Microbiology. While only a small proportion develop symptoms, virus reactivation rates increase with spaceflight duration and could present a significant health risk on missions to Mars and beyond.

NASA's rapid viral detection systems and ongoing treatment research are beginning to safeguard astronauts - and immunocompromised patients on Earth, too.

Herpes viruses reactivate in immunocompromised astronauts

"NASA astronauts endure weeks or even months exposed to microgravity and cosmic radiation - not to mention the extreme G forces of take-off and re-entry," says senior author Dr. Satish K. Mehta of KBR Wyle at the Johnson Space Center. "This physical challenge is compounded by more familiar stressors like social separation, confinement and an altered sleep-wake cycle."

To study the physiological impact of spaceflight, Mehta and colleagues analyze saliva, blood and urine samples collected from astronauts before, during and after spaceflight.

"During spaceflight there is a rise in secretion of stress hormones like cortisol and adrenaline, which are known to suppress the immune system. In keeping with this, we find that astronaut's immune cells - particularly those that normally suppress and eliminate viruses - become less effective during spaceflight and sometimes for up to 60 days after."

In the midst of this stress-induced amnesty on viral killing, dormant viruses reactivate and resurface.

"To date, 47 out of 89 (53%) astronauts on short space shuttle flights, and 14 out of 23 (61%) on longer ISS missions shed herpes viruses in their saliva or urine samples," reports Mehta. "These frequencies - as well as the quantity - of viral shedding are markedly higher than in samples from before or after flight, or from matched healthy controls."

Overall, four of the eight known human herpes viruses were detected. These include the varieties responsible for oral and genital herpes (HSV), chickenpox and shingles (VZV) - which remain lifelong in our nerve cells - as well as CMV and EBV, which take permanent but uneventful residence in our immune cells during childhood. CMV and EBV, are two viruses associated with causing different strains of mononucleosis or the "kissing disease".

Deep-space exploration could depend on effective prevention and treatment

So far, this viral shedding is typically asymptomatic.

"Only six astronauts developed any symptoms due to viral reactivation," says Mehta. "All were minor."

However, continued virus shedding post flight could endanger immunocompromised or uninfected contacts on Earth, like newborns.

"Infectious VZV and CMV were shed in body fluids up to 30 days following return from the International Space Station."

What's more, as we prepare for human deep-space missions beyond the moon and Mars, the risk that herpes virus reactivation poses to astronauts and their contacts could become more crucial.

"The magnitude, frequency and duration of viral shedding all increase with length of spaceflight."

Developing countermeasures to viral reactivation is essential to the success of these deep-space missions, argues Mehta.

"The ideal countermeasure is vaccination for astronauts - but this is so far available only against VZV."

"Trials of other herpes virus vaccines show little promise, so our present focus is on developing targeted treatment regimens for individuals suffering the consequences of viral reactivation.

"This research has tremendous clinical relevance for patients on Earth too. Already, our spaceflight-developed technologies for rapid viral detection in saliva have been employed in clinics and hospitals around the world."

An interface system that uses augmented reality technology could help individuals with profound motor impairments operate a humanoid robot to feed themselves and perform routine personal care tasks such as scratching an itch and applying skin lotion. The web-based interface displays a "robot's eye view" of surroundings to help users interact with the world through the machine.

The system, described March 15 in the journal PLOS ONE, could help make sophisticated robots more useful to people who do not have experience operating complex robotic systems. Study participants interacted with the robot interface using standard assistive computer access technologies -- such as eye trackers and head trackers -- that they were already using to control their personal computers.

The paper reported on two studies showing how such "robotic body surrogates" - which can perform tasks similar to those of humans - could improve the quality of life for users. The work could provide a foundation for developing faster and more capable assistive robots.

"Our results suggest that people with profound motor deficits can improve their quality of life using robotic body surrogates," said Phillip Grice, a recent Georgia Institute of Technology Ph.D. graduate who is first author of the paper. "We have taken the first step toward making it possible for someone to purchase an appropriate type of robot, have it in their home and derive real benefit from it."

Grice and Professor Charlie Kemp from the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University used a PR2 mobile manipulator manufactured by Willow Garage for the two studies. The wheeled robot has 20 degrees of freedom, with two arms and a "head," giving it the ability to manipulate objects such as water bottles, washcloths, hairbrushes and even an electric shaver.

"Our goal is to give people with limited use of their own bodies access to robotic bodies so they can interact with the world in new ways," said Kemp.

In their first study, Grice and Kemp made the PR2 available across the internet to a group of 15 participants with severe motor impairments. The participants learned to control the robot remotely, using their own assistive equipment to operate a mouse cursor to perform a personal care task. Eighty percent of the participants were able to manipulate the robot to pick up a water bottle and bring it to the mouth of a mannequin.

"Compared to able-bodied persons, the capabilities of the robot are limited," Grice said. "But the participants were able to perform tasks effectively and showed improvement on a clinical evaluation that measured their ability to manipulate objects compared to what they would have been able to do without the robot."

In the second study, the researchers provided the PR2 and interface system to Henry Evans, a California man who has been helping Georgia Tech researchers study and improve assistive robotic systems since 2011. Evans, who has very limited control of his body, tested the robot in his home for seven days and not only completed tasks, but also devised novel uses combining the operation of both robot arms at the same time - using one arm to control a washcloth and the other to use a brush.

"The system was very liberating to me, in that it enabled me to independently manipulate my environment for the first time since my stroke," said Evans. "With respect to other people, I was thrilled to see Phil get overwhelmingly positive results when he objectively tested the system with 15 other people."

The researchers were pleased that Evans developed new uses for the robot, combining motion of the two arms in ways they had not expected.

"When we gave Henry free access to the robot for a week, he found new opportunities for using it that we had not anticipated," said Grice. "This is important because a lot of the assistive technology available today is designed for very specific purposes. What Henry has shown is that this system is powerful in providing assistance and empowering users. The opportunities for this are potentially very broad."

The interface allowed Evans to care for himself in bed over an extended period of time. "The most helpful aspect of the interface system was that I could operate the robot completely independently, with only small head movements using an extremely intuitive graphical user interface," Evans said.

The web-based interface shows users what the world looks like from cameras located in the robot's head. Clickable controls overlaid on the view allow the users to move the robot around in a home or other environment and control the robot's hands and arms. When users move the robot's head, for instance, the screen displays the mouse cursor as a pair of eyeballs to show where the robot will look when the user clicks. Clicking on a disc surrounding the robotic hands allows users to select a motion. While driving the robot around a room, lines following the cursor on the interface indicate the direction it will travel.

Building the interface around the actions of a simple single-button mouse allows people with a range of disabilities to use the interface without lengthy training sessions.

"Having an interface that individuals with a wide range of physical impairments can operate means we can provide access to a broad range of people, a form of universal design," Grice noted. "Because of its capability, this is a very complex system, so the challenge we had to overcome was to make it accessible to individuals who have very limited control of their own bodies."

While the results of the study demonstrated what the researchers had set out to do, Kemp agrees that improvements can be made. The existing system is slow, and mistakes made by users can create significant setbacks. Still, he said, "People could use this technology today and really benefit from it."

The cost and size of the PR2 would need to be significantly reduced for the system to be commercially viable, Evans suggested. Kemp says these studies point the way to a new type of assistive technology.

"It seems plausible to me based on this study that robotic body surrogates could provide significant benefits to users," Kemp added.

CINCINNATI -- A pilot study of 45 middle school kids shows that more than a third of those screened had abnormal levels of blood sugar or high cholesterol. Two had blood sugar levels (HbA1c) in the diabetes range.

The study supports routine screening for diabetes and abnormal lipids, but most are not routinely screened, even though the American Academy of Pediatrics and other major medical organizations recommend it.

"We were shocked with the diabetes screening results," says Robert Siegel, MD, director of the Center for Better Health and Nutrition at Cincinnati Children's. "Most studies show that around 20 percent of kids will have abnormalities, so we weren't too surprised by the results of the lipid screening. Our message is to get screened, eat right, and get out and play."

Dr. Siegel and his colleagues at the Cincinnati Children's Heart Institute screened seventh and eighth grade students at Norwood Middle School in Ohio. Norwood is a city of nearly 20,000 people in southwestern Ohio. The children ranged from 12 to 14 years old. Seventy one percent were white, 16 percent black and 9 percent Hispanic.

Forty-two percent of those screened were either overweight or obese. Fifteen of 43 students (two declined to have their blood drawn) had a lipid screening or HbA1c out of the normal range. Two had a cholesterol level greater than 200 mg/dl.

Two students had HbA1C levels greater than 6.5, meaning that they had diabetes. Neither had yet experienced symptoms but were referred to a pediatric endocrinologist for evaluation.

"More research is needed to understand why or why not parents want their children screened and whether they prefer it be done at a doctor's office or at school," says Dr. Siegel. "With our study, we demonstrate that if the middle school setting is used for cardiovascular screening, if it is feasible to do so, and the yield is high."

Vehicles could be affordably produced for a wide variety of specialized purposes using a sophisticated wheel unit developed by researchers at the University of Waterloo.

The self-contained unit combines a wheel and an electric motor with braking, suspension, steering and a control system in a single module designed to be bolted to any vehicle frame.

It would free manufacturers from making huge investments to develop those components from scratch and enable the economical production of specialized vehicles in even small quantities.

"The idea is modularity and plug-and-play control capability," said Amir Khajepour, a mechanical and mechatronics engineering professor at Waterloo. "Our wheel unit, in a sense, is a full vehicle with only one wheel. All that's missing is a body."

Automotive researchers first applied the concept to electric, two-seater urban cars, which promise to ease congestion and reduce pollution, but make up only a tiny fraction of sales because of high prices, space limitations and safety concerns.

Mass-produced wheel units would significantly reduce production costs while also creating space for passengers that would otherwise be devoted to mechanical components such as steering columns.

To improve the stability of the tall, narrow cars, researchers also designed and prototyped the units - which weigh about 40 kilograms and have about 25 horsepower - to enable active wheel cambering, or tilting.

"Companies will be able to produce a smaller car that is cheaper, too," said Khajepour, director of the Mechatronic Vehicle Systems Lab. "Right now, we are not there. You have to pay more to get a smaller car, to get less."

The next step in the research involves scaling up the wheel unit, technically called a corner module, for large utility and commercial vehicles.

That would pave the way for more cost-effective production of low-volume, specialized vehicles with customized bodies in fields including mining, forestry and rescue operations.

"It's an economy of scale problem," Khajepour said. "Corner modules would allow us, without enormous development costs, to make vehicles that are specific for each application, for each function, by concentrating only on the design of the body and the user interface."

Bullying is a harmful antisocial behavior present in schools all over the world. Involvement in bullying, as either perpetrators or victims, have serious short-term and long-term consequences for all the members of the school community, family and society in general, causing future problems related to depression and difficulty with social relationships. Moreover, studies on bullying link it to drug use and even offending.

Bullying among teens is a serious problem that needs to be urgently addressed. Even though the number of studies about bullying has increased, there are still gaps in knowledge related to its long-term within person stability and the change , which is known as a longitudinal perspective on youth development .

The evolution of bullying and its manifestation through specific behaviors as adolescents grow older was the focus of this international team, which includes researchers from the University of Cordoba Izabela Zych and Vicente J. Llorent, together with Manuel P. Eisner, David P. Farrington and Maria M. Ttofi from the University of Cambridge and Denis Ribeaud from the University of Zurich. This team identified specific bullying behaviors in each age group and how adolescents continue to be involved in bullying or, on the other hand, find a way out at some point before adulthood. Recent findings of this study were published in Child Development, in which evolution of bullying is explained, finding that it becomes less physical with age. In this sense, physical harm is a common bullying behavior at young ages, while more subtle forms, such as insults and social exclusion, are maintained throughout adolescence.

This study is based on nearly 1000 adolescents, who responded to a questionnaire on bullying perpetration and victimization at age 11, 13, 15 and 17. What is new about this study is that the same group of participants was followed up from age 11 to age 17, that is, for six years, in order to see the evolution of bullying.

This study shows that there are different bullying roles. These roles are: perpetrators, victims and bully/victims (who are both perpetrators and victims). Nearly 15% of the almost 1000 participants in the sample had been involved in one of these bullying roles during all their adolescent years, that is at age 11, 13, 15 and 17. Moreover, it was found that most participant who were not involved in bullying at 11 were never affected by this problem, or that they were involved only once during their adolescent years.

On the other hand, it is common that children involved in bullying at age 11 continue to be involved in bullying for several years afterwards. Victims generally continue to be victims or transition to uninvolved, whereas perpetrators generally continue to be perpetrators or transition to uninvolved. Bully/victims tend to transition to different bullying roles, but they rarely end up escaping from bullying and they usually remain involved for years. As adolescents grow older, a noticeable decrease in the percentage of bully/victims was also detected.

This research performed by the international team made it possible to understand the evolution of bullying. This could be key in detecting bullying given that physical bullying is easier to notice, while noticing subtle ways of bullying requires specific skills and training. This study opens up new horizons in research on risk and protection factors for bullying, that in the near future could also focus on the consequences of being involved in long-term or sporadic bullying.

Knowledge about the stability and change in the evolution of bullying can open up new horizons in research on prevention and early intervention in order to help children not to get involved or to escape from bullying.

TALLAHASSEE, Fla. -- It's not uncommon for young adults to pitch in and help out with the care of younger siblings. But it turns out that sometimes birds choose to become avian au pairs rather than raise their own brood.

After a five-year experiment, researchers from Florida State University and the Tallahassee-based Tall Timbers Research Station found that when fewer mates were available for brown-headed nuthatches, these small pine-forest birds opted to stay home and help their parents or other adults raise their offspring.

The study is published in the journal Behavioral Ecology.

Associate Professor of Biological Science Emily DuVal and Jim Cox, a vertebrate ecologist from Tall Timbers and a courtesy faculty member at FSU, had long been interested in how these tiny birds showed cooperation -- that is often having non-breeding young adults hang out and help raise chicks. After all, bypassing the chance to reproduce is not typically how nature works.

Researchers have often thought that a shortage of males might be one reason for this behavior. To test this idea, they manipulated the ratio of adult males and females throughout Tall Timbers to see exactly how that might affect breeding and cooperation.

Aided by graduate student Jessica Cusick, Cox and DuVal swapped the chicks among 72 nests to create two areas that had an overabundance of either male or all female nuthatches. They also left some areas in between untouched. After two years of observation, they had a year with no manipulation and then reversed the treatments for each area and drove the ratio of males and females in the opposite direction.

"We're trying to understand cooperation from perspective of mate limitations," DuVal said. "Cooperative breeding is a complex social interaction. The idea that you could change such a complex social behavior with a relatively simple manipulation was something we wanted to explore."

The team found that in these areas where the potential mating population was skewed by the manipulation, more of these birds opted to become helpers rather than live on their own or disperse to the buffer zone where there may be more potential mates.

The helper bird engages in activities such as feeding the young or helping feed the mother while she is nesting. The helper might also help defend the nest.

Typically, male birds are more likely to function as a helper in raising chicks, but in the population affected by the manipulation, researchers found an uptick in cooperation by both sexes.

"We saw a slight increase in female helpers," said Cox, who is the study's first author. "It didn't look like a good year for finding mates when young females emerged from their nests and encountered lots of other females nearby. Instead, they stayed and helped out the birds who did mate."

This was the first large-scale, experimental evidence that the sex ratio of males and females could affect cooperative breeding, the researchers said.

Not all birds breed cooperatively, but it is commonly found among crows and jays. Birds with such complex social behavior are often long-lived, and this work built on nearly a decade of careful population monitoring by Cox and his Tall Timbers Research Station team to identify nests and breeding pairs.

The researchers also found that many of the nests took on additional helpers. While there is usually only one bird acting as a helper each year, in this case, some nests had three.

Female hormones, particularly estrogen, do not seem to explain why women tend to have higher survival rates than men following severe trauma, an 11-year study using data from 815,843 Swedish patients suggests. The findings are published in the open access Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

Robert Larsen of Linkoping University, Sweden, the corresponding author, said: "A general female survival advantage is well known; women tend to outlive men by several years. The survival advantage has also been shown in models of trauma and sepsis in animals, but the underlying mechanisms that may explain these advantages remain unclear. Better understanding of these mechanisms may provide clues that could help improve trauma care outcomes. Here, we wanted to find out if estrogen, the female sex hormone, is involved in the female survival advantage in trauma."

The researchers found that women appear to have an overall survival advantage - that is lower mortality - compared to men, in the 30 days following hospital admission for the three most lethal forms of injury - from falls, road traffic accidents, and assault. Yet, no major differences were observed in this pattern across the three age categories that the authors used as surrogate markers for sex hormone levels: 0-14 years, 15-50 years, and older than 50 years (pre-menarche, reproductive, and post-menopausal status).

Survival advantage in women did not differ between age groups and it was not more pronounced in the age group where female sex hormones are expected to be higher (15-50 years), that is mortality within that group wasn't significantly lower than in the other age groups. The findings thus do not seem to confirm the authors' hypothesis that estrogen is protective and the main contributing factor for female survival following trauma.

Robert Larsen, the corresponding author, said: "We were convinced that the survival advantage was due to estrogen, but if the hormonal component was of major importance, an added survival advantage during the hormone-producing years of life would have been expected. However, if anything, we observed that survival advantage for females actually increased with age. This further supports the idea that other mechanisms than levels of female sexual hormones explain differences in survival in men and women."

The authors examined data on 815,843 hospital admissions from falls, road traffic accidents, or assault, collected from 2001 to 2011, included in the National Patient Registry in Sweden and the Cause of Death Registry. Out of the total number of patients whose data was included in this study, 54% were female. The authors caution that as age ranges were used as proxies for hormonal status, this may have led to some misclassification of hormone levels.

Another recent study by Pape et al. also published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine found an increased likelihood for intensive care unit admission in men compared to women in a cohort of 6,865 trauma patients admitted to the emergency department of three trauma centers in the Netherlands between January 2006 and December 2014. The authors also found a survival advantage for female patients aged 16 to 44 years. Yet, although the effect of gender in severely injured patients has been investigated for years, the exact physiological mechanisms that confer this survival advantage remain unclear.