Culture

New research reveals how frequently being the target of workplace bullying not only leads to health-related problems but can also cause victims to behave badly themselves.

The study, led by the University of East Anglia (UEA) in collaboration with Uninettuno Telematic International University in Italy, found that in some cases this is characterised by a lack of problem solving and high avoidance coping strategies. For example, drinking alcohol when having a problem, experiencing very frequent negative emotions, such as anger, fear and sadness, and high work 'moral disengagement', which refers to the way individuals rationalise their actions and absolve themselves of responsibility for the consequences.

Bullying is one of the major occupational stresses for employees and the effects can compromise their development and health, as well as interfere with the achievement of both personal and professional goals.

It is usually differentiated as work-related and personal-related bullying. The former refers to bullying affecting workload - for example removing responsibility - and work processes, such as attacks on someone's professional status. The latter refers to both indirect - for example exclusion and isolation - and direct negative behaviour, such as physical abuse.

While previous research has shown a link between being the target of bullying and behavioral problems, for the first time this study identified different configurations of victims by considering not only exposure to and types of bullying, but also health problems and bad behaviour.

The study also examined how these groups differ in terms of negative emotions experienced in relation to work, coping strategies, and moral disengagement.

Published in the journal Personality and Individual Differences, the study was led by Dr Roberta Fida, a senior lecturer in work psychology at UEA's Norwich Business School. She said: "Overall, our results show the need to consider not only exposure to and types of bullying but also their associated consequences. In particular, the findings highlight that victimisation is associated not only with health problems but also with a greater likelihood of not behaving in line with the expected social and organisational norms.

"The greater the intensity of bullying and the more the exposure to different types of bullying, the higher the likelihood of engaging in counterproductive workplace behaviour. Furthermore, the results show that health-related symptoms are not always associated with experiences of bullying. Indeed, while those experiencing limited work-related bullying did not report health problems, those who were not bullied but misbehaved did."

The authors say the importance of emotions needs to be considered in HR and management intervention policies. "Despite the evidence recognising the relevance of emotions when dealing with workplace aggression, this is rarely incorporated into guidelines," said Dr Fida. "In addition, it is essential to also promote behavioural regulation strategies to reduce moral disengagement, as well as negative compensating behaviour, such as drinking more alcohol and taking more risks. Its role in allowing 'otherwise good' people to freely engage in conduct they would generally consider wrong is further confirmed in this study."

The researchers asked 1019 Italian employees about their experiences of workplace bullying, counterproductive behaviour and health symptoms. They were also asked about their coping strategies, negative emotions experienced at work and moral disengagement.

Five groups were identified, one of which includes victims who are the target of work-related bullying and frequently exposed to personal-related bullying, who experience high health problems and misbehaviour (4.4% of the sample).

Another group experience work-related bullying but less frequent personal-related bullying, and show lower health problems and misbehaviour (9.6%). Although they generally use problem-solving strategies, they tend to be overwhelmed by the negative emotions they experience and are not able to control them. They also have a tendency to morally disengage.

A third group have limited exposure to work-related bullying and no exposure to personal-related bullying (22.3%). While not experiencing health-related problems they sometimes engage in counterproductive work behaviour.

A fourth group includes those who are not bullied, but have high health-related symptoms and some misbehaviour (23.9%). The last group identified are not exposed to any bullying, have no health symptoms or behavioral problems (39.9%).

Examination of the groups in relation to individual dimensions highlighted the pivotal role of negative emotions and emotional regulation, independently from exposure to workplace bullying. In more severe cases, moral disengagement and compensatory behaviour play an equally important role, suggesting the weakening of individuals' ability to regulate their behaviour.

Johns Hopkins Medicine scientists say that new experiments with mouse eye tissues strongly suggest that a longstanding "textbook concept" about the way a mammal's retina processes light needs a rewrite.

The enduring concept took root more than 30 years ago when researchers doing experiments in frog retinas found that when a single particle of light, known as a photon, is absorbed by light-sensing cells called rods, it starts a cascade of biochemical reactions that involve around 500 molecules called G proteins.

Now, Johns Hopkins vision scientists say that their experiments, described March 12 in Proceedings of the National Academy of Sciences, show that the number of G protein molecules activated in the cascade of reactions is far fewer -- involving only 10-20 of them in the rods of mice.

The new finding matters, say the scientists, because G proteins belong to a very large family of biochemical signaling pathways called G protein-coupled-receptors, which are among the most abundant signaling pathways in biology, says King-Wai Yau, Ph.D., professor of neuroscience and ophthalmology at the Johns Hopkins University School of Medicine.

"These pathways are a major target among pharmaceutical companies, because they control many diverse physiological processes, ranging from those that allow us to see images to those tied to heart disease," says Yau.

"We're beginning to understand our visual system better, and the more we understand a system, the better we are to develop treatments for its malfunction," says Daniel Silverman, Ph.D., postdoctoral fellow in Yau's laboratory.

When a photon of light hits a rod in the retina, it is absorbed by a light-sensing protein, called rhodopsin, which is embedded in membranes within the cell. Rhodopsin then activates G proteins, which, in turn, activate other enzymes. It is the number of G protein molecules activated by one rhodopsin molecule that the new experiments challenge, Yau says. He notes that other scientists had speculated that the number of activated G protein molecules may be much less than the many hundred originally proposed, but the number was difficult to directly measure in intact rods.

To do that, Yau and his colleagues devised two ways to measure the response to a single activated G protein in intact rods.

First, the scientists used mice engineered to express a mutant form of rhodopsin that interacts very poorly with the G protein so that most of the time no G protein is activated. But when rhodopsin was successful in interacting with G protein molecules, only one G protein was activated.

Second, the scientists looked at a derivative of normal rhodopsin called opsin, which is generated after rhodopsin is exposed to light. Opsin itself does not absorb light, but it can signal G proteins occasionally and very weakly. Opsin's signal is so weak that it can activate, at most, one G protein molecule, says Yau.

To make quantitative measurements, Silverman and former graduate student Wendy W.S. Yue used a tight-fitting glass pipette thinner than a human hair filled with saline solution and placed the glass pipette around a single rod, which sprouts from the retina of mice like a blade of grass. Then, Silverman and Yue recorded an electrical current from the rod that essentially reflects the signal coming from the rhodopsin/opsin-G protein cascade.

By using mathematical tools to analyze the electrical signal, Yue and Silverman found that the electrical signal triggered by a single G protein molecule was only one-twelfth to one-fourteenth the size of estimates of signals coming from a single rhodopsin molecule. Thus, they estimated that one rhodopsin activates approximately 10-20 G protein molecules.

Yau had previously found that, in a similar signaling cascade that facilitates the sense of smell in mice, one activated receptor molecule has a very low probability of activating one G protein molecule. By comparison, the finding that such signaling systems in vision trigger 10-20 molecules may reflect the visual system's unique need to detect light in very dim light conditions, without having to group together information from multiple rods, which would sacrifice spatial resolution.

The average Dane will gain a health benefit from substituting part of the red and processed meat in their diet with fish, according to calculations from the National Food Institute, Technical University of Denmark. Men over 50 and women of childbearing age in particular would benefit from such a change in diet.

In a PhD study at the National Food Institute, Sofie Theresa Thomsen has developed a method to calculate the total health impact of replacing one food with another in the diet. The method has been used to assess the health impact that would be achieved by replacing red and processed meat with fish, so the intake reaches the recommended weekly intake of 350 grams of fish.

Fish is an important source of healthy fatty acids and vitamin D, but may also contain potentially harmful substances such as methylmercury. Red and processed meat contributes to the intake of saturated fat in the Danish diet and is associated with the development of different types of cancer, but red meat is also an important source of e.g. dietary iron. Replacing red and processed meat with fish in the Danish diet can therefore have a health impact on human health.

Seven thousand healthy years of life to be gained annually

Risk-benefit assessments weigh up the beneficial and adverse health effects by estimating how many healthy years of life a population gains because of health improvements, or lose due to reduced quality of life or by dying earlier than expected.

This is exactly what Sofie Theresa Thomsen has done in her calculations.

"They show that the Danish population as a whole can gain up to 7,000 healthy years of life annually, if all adult Danes eat fish in the recommended quantities while at the same time reducing their meat intake. This estimate covers among others the prevention of approximately 170 deaths from coronary heart disease per year," she says.

However, the health benefit depends on the type of fish people put on their plates, as well as the age and sex of the persons whose diet is being altered.

Go easy on the tuna

The greatest health benefit comes from eating only fatty fish (such as herring and mackerel) or a mixture of fatty and lean fish (such as plaice and pollock), while a smaller health gain is achieved by eating only lean fish. This is because fatty fish contain larger amounts of beneficial fatty acids.

On the other hand, the calculations show a significant health loss if tuna is the only type of fish in the diet, because tuna is both low in beneficial fatty acids and can have high concentrations of methylmercury. The health loss is calculated as particularly high among women of childbearing age, as intake of fish with a high concentration of methylmercury can damage unborn children's brain development.

Furthermore, the study shows that it is possible to reduce the proportion of Danes who have an insufficient intake of vitamin D significantly by replacing some of the red and processed meat with a mixture of fatty and lean fish. The study also points out that the proportion of Danes with an insufficient intake of dietary iron will not increase despite the lowered meat intake.

Greatest effect among men over 50 and childbearing women

The study shows large variations in the overall health impact when the red and processed meat gives way to fish. Everyone over the age of 50--but the men in particular--as well as women of childbearing age will reap the greatest health benefits from eating 350 grams of fish weekly, of which 200 grams are fatty fish.

For men, this is because the group as a whole is at higher risk than other population groups of developing cardiovascular disease. The risk is reduced by replacing part of the red meat with fish that contain fatty acids, which can prevent cardiovascular disease.

"In women of childbearing age the health benefit is particularly large because the intake of fish containing healthy fish oils will not only benefit the women themselves. The health-promoting properties of fish will also have a beneficial effect in the development of their unborn children, which is taken into account in the overall calculations," Sofie Theresa Thomsen explains.

Useful when developed intervention strategies and dietary advice

The methods developed in the PhD study are useful e.g. when examining the health effects of various interventions designed to promote healthy eating habits or when developing official dietary guidelines.

Current vaccination policies may not be sufficient to achieve and maintain measles elimination and prevent future resurgence in Australia, Ireland, Italy, the UK and the US, according to a study published in the open access journal BMC Medicine.

To successfully achieve and maintain measles elimination in these countries in the medium to long term, further country-specific immunisation efforts may be needed in addition to current strategies. Measles elimination has been defined as the absence of endemic measles transmission in a region or other defined geographic area for twelve months or longer.

A team of researchers at the Bruno Kessler Foundation and Bocconi University, Italy used a computer model to simulate the evolution of measles immunity between 2018 and 2050 in seven countries; Australia, Ireland, Italy, Singapore, South Korea, the UK and the US. The authors focused their analysis on countries with a routine two-dose measles vaccination programme and a high primary school involvement rate, but with different demographics and vaccination histories. The aim was to evaluate the effect of possible adjustments to existing immunisation strategies, and to estimate the proportion of people who may remain susceptible to measles in high-income countries over time.

The authors' projections up until 2050 suggest that if current vaccination policies remain unchanged, the proportion of the population susceptible to measles would only remain below 7.5% in Singapore and South Korea, two countries which had high vaccination coverage in the past. Previous research estimated that the proportion of the population that does not have immunity (maximum susceptibility) needs to be 7.5% or less for measles to be eliminated.

In 2018, the proportion of the population susceptible to measles infection in the countries under study ranged from 3.7% in the UK to 9.3% in Italy (the only country where the proportion was found to be higher than 7.5%). In Australia, Ireland, the UK and the US, vaccination from routine programmes would need to continuously cover more than 95% of the population to keep the proportion of susceptible individuals below 7.5% until 2050.

Dr. Filippo Trentini, the first author said: "In recent years, we've witnessed a resurgence of measles cases even in countries where, according to World Health Organisation guidelines, elimination should already have been achieved. This resurgence is due to suboptimal vaccination coverage levels. In Italy, where measles incidents rates were among the highest, the government has made measles vaccination compulsory for children before they enter primary school. We investigated the potential of this and other policies to reinforce immunisation rates in seven high-income countries."

Co-author Dr. Stefano Merler added: "Our results suggest that most of the countries we have studied would strongly benefit from the introduction of compulsory vaccination at school entry in addition to current immunisation programmes. In particular, we found that this strategy would allow the UK, Ireland and the US to reach stable herd immunity levels in the next decades, which means that a sufficiently high proportion of individuals are immune to the disease to avoid future outbreaks. To be effective, mandatory vaccination at school entry would need to cover more than 40% of the population."

In Italy, the fraction of susceptible individuals by 2050 is projected to be 10%, even if coverage for routine vaccination reaches 100%, and additional vaccination strategies targeting both children at school entry and adults may be needed to achieve elimination.

South American fur seal pups with high levels of hookworm infection spend more time in the water, but that's not necessarily a good thing, report Morris Animal Foundation-funded researchers at the University of Georgia.

The team hypothesized the higher infection rates are due to a climate change chain reaction that forces pups' mothers to devote more time to searching for food, rather than providing the pups maternal care that can thwart parasites. The team recently published their study in the journal Ecology and Evolution.

"This was a surprising finding, but it helps us understand the full relationship these parasites have with their hosts, directly and indirectly," said Dr. Mauricio Seguel, a veterinary researcher at the University of Georgia. "More importantly, though, studies like this answer smaller parts of a bigger question: How much do our activities as humans impact animals?"

Hookworm infection is a significant health risk in South American fur seal populations. A separate Morris Animal Foundation-funded study, led by Dr. Seguel, determined more than 20 percent of fur seal pups die from parasitic infections every year.

"It is important to understand these complex associations between animal behavior and disease that can reveal effects of climate change on ocean health" said Dr. Janet Patterson-Kane, Morris Animal Foundation Chief Scientific Officer. "This study shows pups with higher parasite loads and more time in the water as two outcomes of decreased maternal care, but there is more to the story and we are dedicated to discovering what that is."

Dr. Sequel's team studied pups at a fur seal colony on Guafo Island in southwestern Chile, where all pups show some degree of hookworm infection. For four months, researchers captured pups that were 1 to 2 days old and marked them for tracking. The team observed each pup's behavior for at least eight weeks, recording the number of times and in what ways the pups engaged in water activities.

The researchers also took regular blood and fecal samples to measure the level of hookworm infection in each animal. They discovered that pups with higher parasite burdens were far more active in the water than pups with lower levels; playing and swimming, rather than resting by or avoiding it.

Further analysis revealed the animals with higher infection rates spent less time with their mothers. The team believes this could be because warmer ocean temperatures make fish scarcer. Younger, less experienced females then must spend more time searching for food and less time with their offspring. Those pups, in turn, aren't able to feed from their mothers and spend more time in the water; and have weaker immune systems that are less able to clear the parasites.

It is unknown what the implications are for the long-term survival and reproductive success of fur seal populations, given increasing ocean temperatures, higher parasite load, and the extended periods of time mothers spend away from their pups as finding food becomes more challenging. Dr. Seguel's work, with funding from Morris Animal Foundation, is critical to a better understanding of these populations and their ongoing health.

In future studies, Dr. Seguel and his team hope to learn more about fur seal pup swimming behavior and how less or more time in the water positively or negatively impacts pup health.

Strict policies traditionally embraced by Asian nations to discourage illicit drug use are beginning to change, with a few nations adopting alternative approaches while other nations are taking an even harder line against drugs, according to a new RAND Corporation report.

Thailand is on the forefront of Southeast Asian nations that are reconsidering longstanding policies, moving to adopt greater harm reduction, approving the use of medical cannabis and easing restrictions on the traditional use of the substance kratom.

Meanwhile, some other nations -- most visibly represented by the Philippines -- are adopting even harsher policies on illicit drugs, including violent repression of drug distribution and use.

"Asian nations have long espoused the goal of a drug-free society, imposing harsh criminal penalties and even the death penalty on those involved with illicit drugs," said Bryce Pardo, lead author of the report and a policy analyst at RAND, a nonprofit research organization. "So it is surprising to see some Asian nations begin to go in a different direction and consider more-progressive policies."

The RAND report also dissects China's role as a focal point in the global supply of fentanyl, a powerful synthetic opioid that is responsible for a growing number of fatal drug overdoses in the U.S.

The report outlines the rapid rise of the drug industry in China, where there are now more than 5,000 pharmaceutical manufacturers and hundreds of thousands of chemical companies. While the industry is a leading source of many legitimate chemicals and pharmaceutical ingredients, its growth has made it easier for some companies to avoid regulations.

China's central government has promised to crack down on fentanyl manufacturers, but enforcement of such policies is typically done at the provincial level, where there is little infrastructure in place to regulate the drug and chemical industries.

"China's leaders recognize that they have a problem and appear committed to seeking solutions," Pardo said. "But it is unlikely that they can contain the illicit production and distribution of fentanyl in the short term because enforcement mechanisms are lacking. Producers are quick to adapt, impeding Chinese law enforcement's ability to stem the flow to global markets."

Thailand's shift from harsh drug policies toward evidence-based treatment and reduced punishment appears to be motivated by the heavy burden previous policies have had on its prison system and an alarming increase in disease transmission related to needle-sharing.

In 2016, about 70 percent of Thailand's 320,000 prisoners were incarcerated for drug offences, including many for consumption-related violations. The nation has begun to move toward voluntary outpatient treatment and has experimented with needle-exchange programs to address disease transmission.

The report notes that the illicit production and use of opioids and amphetamine-type substances are the greatest concern across Asia. There also are reports of rising trafficking and use of new psychoactive substances and ketamine.

But one challenge facing Asian nations is a shortage of reliable information about drug use, which is key to assessing the size of the problem and judging the influence of policies.

"As in many countries, there is tremendous imprecision in the data available on the prevalence of drug use in Asia and the amount of money spent on these substances," said Beau Kilmer, a co-author of the report and co-director of the RAND Drug Policy Research Center. "Policy shifts are occurring and these data gaps will make it difficult to evaluate the consequences of these changes in the near and longer term."

May 15, 2019 - We all know plants need nutrients, especially nitrogen and phosphorus. To give crops a boost, they are often put on fields as fertilizer. But we never talk about where the nutrients themselves come from.

Phosphorus, for example, is taken from the Earth, and in just 100-250 years, we could be facing a terrible shortage. That is, unless scientists can find ways to recycle it.

Scientists at Tel Hai College and MIGAL Institute in Israel are working on a way to make phosphorus fertilizer from an unlikely source -- dairy wastewater.

Additionally, they are taking the element from the wastewater with another unlikely character. They are using the leftovers that comes from making clean drinking water, which contain the element aluminum.

"The material left after purification, called aluminum water treatment residue, is normally taken to a landfill to be buried," says Michael "Iggy" Litaor, who led this work. "We changed this material by mixing it with dairy wastewater rich with phosphorus and organic matter. We then found it can be just as good as common fertilizers."

The benefits of the practice could go beyond recycling the element. Putting too much of the commercially available fertilizers on fields can hurt the quality of water nearby.

"Phosphorus is an important nutrient needed by most crops," Litaor explains. "However, it is a non-renewable resource. If we continue with the current rate of use, what we have may be depleted in 100 to 250 years. There are also side-effects of too much fertilizer. Hence, scientists around the world are searching for simple and affordable ways to recycle the element without lowering crop yield."

In their study, Litaor and his team mixed the aluminum water treatment residue with dairy wastewater. Dairy wastewater comes from washing cow udders before milking and from cooling cows during hot summer days. It is high in phosphorus because of detergents used while cleaning the sheds that house the cows as well as runoff from cows' urine.

What allows the mixture to become fertilizer is the magic of chemistry. Reactions occur between the phosphorus, aluminum, and organic matter that result in it being a possible fertilizer.

Litaor and his team then put the potential fertilizer on lettuce to see how well it worked. They found it did just as well as common fertilizers.

"This experiment clearly showed that we can use aluminum refuse to recapture phosphorus from dairy wastewater and use it as fertilizer," he says. "We showed that the water treatment residue can take phosphorus from the wastewater and put it in soil that doesn't have much phosphorus. This may offset somewhat the mining of this non-renewable resource."

If this method of making fertilizer were to become widely practiced, Litaor sees the possibility of building plants next to dairies with lots of cattle. This would give a large supply of phosphorus. A company could bring in the leftovers from water treatment systems to produce fertilizer. It could be used by large farms or sold to others.

He says the next step in this research is to look at the use of water treatment leftovers that contain iron, because many soils also lack this element. The scientists must also show that no unwanted material such as hormones and antibiotics are in the fertilizer.

"I also want to find an investor who will support us taking this idea to the marketplace," he adds. "After many years of research on phosphorus in wetlands, streams, and rivers, I decided to look for an efficient means to recycle the element using wastes we were already producing."

ANN ARBOR, Mich. - Thousands of emergency medicine physicians gather this week at the Society for Academic Emergency Medicine Annual Meeting in Las Vegas, Nevada. According to SAEM, it is the largest forum for the presentation of original education and research in academic emergency medicine.

The emergency medicine team at Michigan Medicine is well represented at the conference. Here are some highlights:

Keynote address: Firearm injury

This year's keynote address was presented by Rebecca Cunningham, M.D., a professor of emergency medicine at Michigan Medicine and director of the Centers for Disease Control and Prevention-funded University of Michigan Injury Prevention Center.

Cunningham, along with Garen Wintemute, M.D., M.P.H., presented Firearm Injury: Facts, Myths, and a Public Health Path Forward.

"Firearm violence is a major public health problem," says Cunningham, associate vice president for research-health sciences at U-M. "In fact, firearm injuries are the second leading cause of death among children one to 18 years old and the leading cause of death among children 14 to 17 years old."

In April 2018, she received a $5 million grant from the National Institutes of Health to create the Firearm-safety Among children & Teens Consortium (FACTS). In November 2018, FACTS launched a new website with free access to data on the issue of gun violence, as well as training for health care providers and others.

The keynote address focused on gun safety, a term Cunningham hopes more people will start using.

"People always use the term gun control when talking about gun safety, but that's not what I'm talking about here," Cunningham says. "We're talking about an injury prevention issue. We want to prevent injury, while respecting Second Amendment rights."

Cunningham and Wintemute provided an overview of firearm violence, data on how firearm injuries compare to other forms of injury and death in patient populations, and ways for their fellow physicians to begin researching and screening for gun violence in their own clinical settings.

"Through research and science we were able to reduce the amount of children and teens dying in motor vehicle accidents, even though there are more cars on the road today," Cunningham says. "I believe we can apply the same scientific principles to firearm violence and reduce the number of children dying from guns."

Plenary session: Reducing over-testing in the emergency department

The meeting's plenary session includes the top six abstracts selected by the SAEM19 Program Committee.

One of this year's plenary session abstracts was research presented by Keith Kocher, M.D., M.P.H., an assistant professor of emergency medicine at Michigan Medicine.

The abstract, titled Emergency Care Quality Imaging Benchmarks in a Statewide Collaborative: Estimated Excess and Associated Spending, included other Michigan Medicine experts Benjamin Bassin, M.D., Michaelina Bolton, M.D., James Pribble, M.D., Nicole Sroufe, M.D., Bradley Uren, M.D., and Michele Nypaver, M.D.

In the study, the research team highlights opportunities to safely reduce over-testing in emergency departments using data from the Michigan Emergency Department Improvement Collaborative (MEDIC), a physician-led statewide quality network connecting a diverse set of unaffiliated emergency departments with the goal of improving quality and reducing low-value emergency care throughout the state of Michigan. Estimates of excess imaging were calculated based on Achievable Benchmark of Care, a method for determining quality improvement targets across a population.

"The emergency department is an essential care setting, treating over 145 million annual visits in the United States across a wide range of patient populations," says Kocher, a member of the University of Michigan Institute for Healthcare Policy and Innovation. "Therefore, the emergency department setting represents the ideal venue to implement practice improvement efforts to ensure high-quality care, informed by the best available evidence."

Across the collaborative, the team found substantial variation in amounts of performed imaging and the potential to avoid 1,519 head computed tomography (CT) scans for minor head injury, 3,308 chest x-rays for children with asthma, bronchiolitis or croup, and 4,254 CT scans for suspected pulmonary embolism in 2017 alone.

"The estimated spending on these excess tests ranged from $3.59 to $5.02 million," Kocher says. "We show that there is the opportunity to avoid low-value imaging in the emergency department and in turn, create significant health care savings."

Awards

In addition to giving the keynote address, Cunningham received this year's SAEM Excellence in Research Award.

According to SAEM, the award honors a SAEM member who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge. Recipients are chosen based on their research accomplishments, training and mentorship of other investigators, and recognition, such as peer review journal positions, awards they have received and more.

"I am humbled and honored to receive this award from the Society for Academic Emergency Medicine," says Cunningham, who will become interim vice president for research at U-M on June 1. "As an emergency medicine physician and academic researcher, my goals have consistently aligned with those of SAEM: we both strive to improve care for acutely ill and injured patients by advancing research and education.

"I look forward to partnering with organizations like SAEM as we continue our work to translate research that has the greatest impact on emergency care."

Patrick Carter, M.D., an assistant professor of emergency medicine at Michigan Medicine, was one of the recipients of this year's SAEM Young Investigator Award.

According to SAEM, the award recognizes those SAEM members who have demonstrated commitment and achievement in research during the early stage of their academic career. Recipients are chosen based on several criteria, but mainly their academic and research accomplishments, including grant awards.

SonoGames

Robert Huang, M.D., the associate director of clinical ultrasound and clinical ultrasound fellowship director at Michigan Medicine, is one of the lead organizers of SonoGames, an ultrasound educational event that takes place on the last day of the Annual Meeting.

According to SAEM, SonoGames is a national ultrasound competition in which residents demonstrate their skills and knowledge of point-of-care ultrasound in an exciting and educational format. They compete in front of hundreds of spectators in hopes of bringing home the SonoCup to their residency program.

"Typically about 80 teams from 80 different residency programs compete and faculty come to support and watch," Huang says. "We will have our own team of residents, Mitch Odom, Christ Hebert and Vivian Lam, competing this year."

The Houston Astros' José Altuve steps up to the plate on a 3-2 count, studies the pitcher and the situation, gets the go-ahead from third base, tracks the ball's release, swings ... and gets a single up the middle. Just another trip to the plate for the three-time American League batting champion.

Could a robot get a hit in the same situation? Not likely.

Altuve has honed natural reflexes, years of experience, knowledge of the pitcher's tendencies, and an understanding of the trajectories of various pitches. What he sees, hears, and feels seamlessly combines with his brain and muscle memory to time the swing that produces the hit. The robot, on the other hand, needs to use a linkage system to slowly coordinate data from its sensors with its motor capabilities. And it can't remember a thing. Strike three!

But there may be hope for the robot. A paper by University of Maryland researchers just published in the journal Science Robotics introduces a new way of combining perception and motor commands using the so-called hyperdimensional computing theory, which could fundamentally alter and improve the basic artificial intelligence (AI) task of sensorimotor representation -- how agents like robots translate what they sense into what they do.

"Learning Sensorimotor Control with Neuromorphic Sensors: Toward Hyperdimensional Active Perception" was written by computer science Ph.D. students Anton Mitrokhin and Peter Sutor, Jr.; Cornelia Fermüller, an associate research scientist with the University of Maryland Institute for Advanced Computer Studies; and Computer Science Professor Yiannis Aloimonos. Mitrokhin and Sutor are advised by Aloimonos.

Integration is the most important challenge facing the robotics field. A robot's sensors and the actuators that move it are separate systems, linked together by a central learning mechanism that infers a needed action given sensor data, or vice versa.

The cumbersome three-part AI system--each part speaking its own language -- is a slow way to get robots to accomplish sensorimotor tasks. The next step in robotics will be to integrate a robot's perceptions with its motor capabilities. This fusion, known as "active perception," would provide a more efficient and faster way for the robot to complete tasks.

In the authors' new computing theory, a robot's operating system would be based on hyperdimensional binary vectors (HBVs), which exist in a sparse and extremely high-dimensional space. HBVs can represent disparate discrete things -- for example, a single image, a concept, a sound or an instruction; sequences made up of discrete things; and groupings of discrete things and sequences. They can account for all these types of information in a meaningfully constructed way, binding each modality together in long vectors of 1s and 0s with equal dimension. In this system, action possibilities, sensory input and other information occupy the same space, are in the same language, and are fused, creating a kind of memory for the robot.

The Science Robotics paper marks the first time that perception and action have been integrated.

A hyperdimensional framework can turn any sequence of "instants" into new HBVs, and group existing HBVs together, all in the same vector length. This is a natural way to create semantically significant and informed "memories." The encoding of more and more information in turn leads to "history" vectors and the ability to remember. Signals become vectors, indexing translates to memory, and learning happens through clustering.

The robot's memories of what it has sensed and done in the past could lead it to expect future perception and influence its future actions. This active perception would enable the robot to become more autonomous and better able to complete tasks.

"An active perceiver knows why it wishes to sense, then chooses what to perceive, and determines how, when and where to achieve the perception," says Aloimonos. "It selects and fixates on scenes, moments in time, and episodes. Then it aligns its mechanisms, sensors, and other components to act on what it wants to see, and selects viewpoints from which to best capture what it intends."

"Our hyperdimensional framework can address each of these goals."

Applications of the Maryland research could extend far beyond robotics. The ultimate goal is to be able to do AI itself in a fundamentally different way: from concepts to signals to language. Hyperdimensional computing could provide a faster and more efficient alternative model to the iterative neural net and deep learning AI methods currently used in computing applications such as data mining, visual recognition and translating images to text.

"Neural network-based AI methods are big and slow, because they are not able to remember," says Mitrokhin. "Our hyperdimensional theory method can create memories, which will require a lot less computation, and should make such tasks much faster and more efficient."

MINNEAPOLIS - Vertigo is a form of severe dizziness that can result in a loss of balance, a feeling of falling, trouble walking or standing, or nausea. There is more than one type of vertigo, each with a different cause, and sometimes requiring different treatment. Now a proof-of-concept study has found that special goggles that measure eye movements during an episode of vertigo may help more accurately diagnose which type of vertigo a person has. The study is published in the May 15, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Vertigo can be a disabling condition, so an accurate diagnosis is important to effectively treat and stop the vertigo as soon as possible," said study author Miriam S. Welgampola, MD, PhD, of the University of Sydney in Australia and a member of the American Academy of Neurology. "Observing a person's eye movements during an episode can help make the diagnosis, but people don't always have an episode when they are at the doctor's office."

For the study, researchers gave participants a pair of video-oculography goggles that record the uncontrolled eye movements that accompany vertigo.

The study involved 117 people who had been previously diagnosed with one of three conditions that cause vertigo. Of the group, 43 people had Meniere's disease, an inner ear disorder that can affect hearing and balance, 67 had vestibular migraine that can cause vertigo but may not cause a headache, and seven had benign paroxysmal positional vertigo, one of the most common causes of vertigo, where a person's head movements trigger the episodes.

Researchers taught each participant how to use the goggles to record video of their eye movements at home whenever they had a vertigo episode. Eye movements that accompany vertigo are repetitive and uncontrolled, and the eyes can move side to side, up and down or around in circles.

For the majority of people with Meniere's disease who had fast horizontal eye movements, the goggles were able to diagnose the type of vertigo accurately with a sensitivity of 95 percent and a specificity of 82 percent. Sensitivity is the percentage of actual positives that are correctly identified as positive. Specificity is the percentage of negatives that are correctly identified. By comparison, audio tests for Meniere's disease have both a sensitivity and specificity of 91 percent.

The patterns of eye movements were more mixed for those with vestibular migraine. However, up and down, repetitive, uncontrolled eye movements had a high specificity of 93 percent, but a low sensitivity of 24 percent.

For those with benign paroxysmal positional vertigo, the sensitivity was 100 percent and the specificity was 78 percent.

"While further studies are needed in larger groups, providing people with a pair of goggles that they can easily use at home to record eye movement has the potential to help with vertigo diagnosis not only by a neurologist in a clinic, but also by physicians in an emergency room and physicians diagnosing patients remotely as well," said Welgampola.

Limitations of the study include that some participants did not feel well enough to wear the goggles when experiencing vertigo. Additionally, others did not wear them when they thought their vertigo was too mild. Also, some medications taken for vertigo may have influenced eye movement.

More studies are needed in larger groups of people.

Blood tests that track the amount of tumor DNA can - after only one month of drug therapy - detect how well treatment is working in patients with skin cancer, a new study finds.

Led by researchers from NYU School of Medicine and Perlmutter Cancer Center, the study takes advantage of the nature of cancer cells, which die and are replaced by new cells continuously as part of aggressive cancer growth. Tumor cells burst as they die, spilling their DNA into the bloodstream, where it can be measured by tests, enabling improved diagnosis and better targeting of treatment based on each individual tumor's DNA.

For the new study, researchers traced circulating tumor DNA or ctDNA for the cancer gene BRAF, a gene that plays a key role in many melanomas, the most deadly form of skin cancer. In the United States, more than 7,200 individuals are expected to die from metastatic melanoma in 2019, with BRAF mutations playing a role in nearly half of such diagnoses, according to the Skin Cancer Foundation.

"Our study offers firm evidence that tracking this genetic information may be helpful in identifying patients whose cancers shrink and who survive longer as a result of a particular drug regimen," says senior study investigator David Polsky, MD, PhD, the Alfred W. Kopf, MD, Professor of Dermatologic Oncology at NYU Langone Health.

For the study, being presented at the 2019 American Society of Clinical Oncology annual meeting on June 1 in Chicago, researchers analyzed blood samples from 345 male and female patients with stage III or IV melanoma, which had already spread from the skin to other organs, and who had BRAF mutations.

These patients could not be treated surgically and were part of a larger group of patients participating in a clinical trial of the drugs dabrafenib and trametinib, designed to target BRAF-mutated cancers.

Among the study’s key findings was that the tumor’s BRAF mutation could be detected by the new blood test in 93 percent of the patients before treatment started. In addition, the research team found that BRAF ctDNA levels were no longer detectable after one month of therapy in the 40 percent of patients who had a positive clinical outcome after targeted therapy (as measured by an average survival time of 28 months). By contrast, the 60 percent of patients who did not respond as well still had detectable ctDNA levels, and survived for an average of just 14 months.

Polsky and his colleagues say this test appears to be more revealing than the current standard test, which measures lactate dehydrogenase (LDH), an enzyme often elevated by melanoma, because fluctuations in LDH often do not accurately predict treatment success or failure.

The typical method of identifying disease progression for these melanoma patients is through CT scans every three months, but Polsky says the blood test in the current study, noted as the largest BRAF detection rate in patients' blood to date, suggests it may be helpful to doctors because these tests can be done more frequently and efficiently, and results could be available within a few days.

"If further testing proves successful, monitoring blood samples for BRAF could give us an early indication of whether or not we need to adjust a patient's treatment plan," says Polsky, dermatologist and director of the pigmented lesion service at NYU Langone.

Researchers next plan to test the efficacy of monitoring patient blood samples over longer periods of time, such as several months. They also hope to open a clinical trial to determine whether treatment decisions based on these test results improves patient survival.

A University of Bristol academic has succeeded where countless cryptographers, linguistics scholars and computer programs have failed - by cracking the code of the 'world's most mysterious text', the Voynich manuscript.

Although the purpose and meaning of the manuscript had eluded scholars for over a century, it took Research Associate Dr. Gerard Cheshire two weeks, using a combination of lateral thinking and ingenuity, to identify the language and writing system of the famously inscrutable document.

In his peer-reviewed paper, The Language and Writing System of MS408 (Voynich) Explained, published in the journal Romance Studies, Cheshire describes how he successfully deciphered the manuscript's codex and, at the same time, revealed the only known example of proto-Romance language.

"I experienced a series of 'eureka' moments whilst deciphering the code, followed by a sense of disbelief and excitement when I realised the magnitude of the achievement, both in terms of its linguistic importance and the revelations about the origin and content of the manuscript.

"What it reveals is even more amazing than the myths and fantasies it has generated. For example, the manuscript was compiled by Dominican nuns as a source of reference for Maria of Castile, Queen of Aragon, who happens to have been great aunt to Catherine of Aragon.

"It is also no exaggeration to say this work represents one of the most important developments to date in Romance linguistics. The manuscript is written in proto-Romance - ancestral to today's Romance languages including Portuguese, Spanish, French, Italian, Romanian, Catalan and Galician. The language used was ubiquitous in the Mediterranean during the Medieval period, but it was seldom written in official or important documents because Latin was the language of royalty, church and government. As a result, proto-Romance was lost from the record, until now."

Cheshire explains in linguistic terms what makes the manuscript so unusual:

"It uses an extinct language. Its alphabet is a combination of unfamiliar and more familiar symbols. It includes no dedicated punctuation marks, although some letters have symbol variants to indicate punctuation or phonetic accents. All of the letters are in lower case and there are no double consonants. It includes diphthong, triphthongs, quadriphthongs and even quintiphthongs for the abbreviation of phonetic components. It also includes some words and abbreviations in Latin."

The next step is to use this knowledge to translate the entire manuscript and compile a lexicon, which Cheshire acknowledges will take some time and funding, as it comprises more than 200 pages.

"Now the language and writing system have been explained, the pages of the manuscript have been laid open for scholars to explore and reveal, for the first time, its true linguistic and informative content."

An innovative use of instruments that measure the ocean near Antarctica has helped Australian scientists to get a clearer picture of how the ocean is melting the Antarctic ice sheet.

Until now, most measurements in Antarctica were made during summer, leaving winter conditions, when the sea freezes over with ice, largely unknown.

But scientists from IMAS and the CSIRO, supported by ACE CRC, the ARC-funded Antarctic Gateway Partnership and the Centre for Southern Hemisphere Oceans Research (CSHOR), developed a novel mission that allowed year-round measurements to be collected near the Totten Glacier, a fast-melting glacier in East Antarctica.

They used instruments known as ARGO floats that are typically designed to drift with ocean currents and measure ocean temperature and salinity profiles.

For this mission, however, the floats were designed to "park" on the sea floor between profiles so they stayed in the region and did not drift away, and vital data collected during ice-covered winter months were stored and uploaded via satellite later in ice-free conditions.

The study published in the journal JGR Oceans revealed for the first time that deep water driving melting at the base of the Totten Glacier is warmer and in a thicker layer during winter and autumn than during spring and summer.

Lead author Alessandro Silvano, from IMAS, said this means the Totten Glacier might melt more rapidly in winter than summer, and that summer measurements might under-estimate the flow of warm water to the ice shelf.

"We had a nervous wait during the first winter, wondering if the floats would survive the icy winter conditions after being parked on the rough sea floor for long periods," he said.

"When spring arrived and the sea ice started to melt we were very excited to see that the floats returned and transmitted the winter data.

"We immediately noticed that the ocean was warmer in autumn and winter than found in our previous summer measurements.
"The new measurements confirm that this part of East Antarctica is exposed to warm ocean waters that can drive rapid melt, with the potential to make a large contribution to future sea level rise.

"The floats also provided new measurements of ocean depth in the region, revealing a deep trough that allows warm water to approach the glacier year-round," Mr Silvano said.

CSIRO co-author Dr Steve Rintoul from CSHOR said the new measurements of ocean depth, temperature and salinity will help improve models used to predict the Antarctic's contribution to sea level rise.

"Crashing sensitive oceanographic instruments into the sea floor isn't generally recommended," he said.

"But these results show that profiling floats can be used in novel ways to measure the ocean near Antarctica, a critical blind-spot in the global ocean observing system.

"Much work remains to be done and more measurements are needed to assess the vulnerability of the ice shelf to changes in the ocean, including in the ocean beneath the floating Totten Glacier.

"New technologies, like the autonomous underwater vehicle (AUV) recently acquired by the University of Tasmania, will be needed to fill this gap," Dr Rintoul said.

Vanderbilt University paleontologists are looking into the evolutionary origins of the whistles and squeaks that dolphins and porpoises make - part of the rare echolocation ability that allows them to effectively navigate their dark environment.

The team, one of the first in the world to examine the ability's origins, used a small CT scanner to look inside a 30-million-year-old ear bone fossil from a specimen resembling Olympicetus avitus. This member of the toothed whale family, in a branch that died out before modern dolphins and porpoises appeared, lived in what is now the state of Washington. The CT scan revealed cochlear coiling with more turns than in animals with echolocation, indicating hearing more similar to the cloven-hoofed, terrestrial mammals dolphins came from than the sleek sea creatures they are today.

"The simple theory is that there was one origin for echolocation in dolphins, and we'd find it in their 30-million-year-old ancestor," said Rachel A. Racicot, who completed the research as a visiting scholar at Vanderbilt. "Now, we believe it didn't evolve just once in this lineage, but more than once and in more than one lineage - at least in xenorophids, which are extinct, and somewhere along the line to the Odontoceti crown group that still survives."

Because echolocation is useful for navigating dark waters, natural selection likely came into play with its development in the branch that survived, she said. The findings appear May 15 in The Royal Society journal Biology Letters.

Racicot will join Vanderbilt's Earth and Environmental Sciences Department after spending a year working in Germany. Her co-author, Assistant Professor of Earth and Environmental Sciences Simon A.F. Darroch, installed the CT scanner, which works the same way as those used in medicine and allows for internal examination of fossils without damaging them.

Learning echolocation's origins also can help preserve modern creatures that use it, Darroch said, by understanding how they're perceiving sound from ship engines, oil drills and other machinery. Confusion over those sounds may be causing mass stranding events, and solving the mystery could lead to methods of discouraging species such as the vaquita, a small porpoise on the brink of extinction in the Gulf of California, away from boats and nets.

"If we develop correlates for the shapes of the inner ear and how that corresponds to hearing frequencies, we can extrapolate those methods without capturing animals and bombarding them with sounds that don't work," Darroch said.

First, according to Racicot and Darroch, paleontologists will have to find and scan a much larger sampling of all the toothed whale group's ancestors and those of rare modern species.