Brain

WASHINGTON - Fewer than 60% of young women diagnosed with sexually transmitted infections (STIs) in the emergency department fill prescriptions for antimicrobial therapy to treat these conditions, according to a research letter published online May 28, 2019, by JAMA Pediatrics.

Adolescents make up nearly half of the people diagnosed with sexually transmitted infections each year. According to the Centers for Disease Control and Prevention, untreated sexually transmitted diseases in women can cause pelvic inflammatory disease (PID), an infection of the reproductive organs that can complicate getting pregnant in the future.

"We were astonished to find that teenagers' rates of filling STI prescriptions were so low," says Monika K. Goyal, M.D., MSCE, assistant chief of Children's Division of Emergency Medicine and Trauma Services and the study's senior author. "Our findings demonstrate the imperative need to identify innovative methods to improve treatment adherence for this high-risk population."

The retrospective cohort study, conducted at two emergency departments affiliated with a large, urban, tertiary care children's hospital, enrolled adolescents aged 13 to 19 who were prescribed antimicrobial treatment from Jan. 1, 2016, to Dec. 31, 2017, after being diagnosed with PID or testing positive for chlamydia.

Of 696 emergency department visits for diagnosed STIs, 208 teenagers received outpatient prescriptions for antimicrobial treatments. Only 54.1% of those prescriptions were filled.

"Teenagers may face a number of hurdles when it comes to STI treatment, including out-of-pocket cost, access to transportation and confidentiality concerns," Dr. Goyal adds.

Future studies will attempt to identify barriers to filling prescriptions in order to inform development of targeted interventions based in the emergency department that promote adherence to STI treatment.

A global study shows people born very preterm or with very low birthweight have a high risk of lung disease and are not reaching their full airway capacity by early adulthood.

The research found those born before 32 weeks of pregnancy or with a birthweight of less than 1501g are four times more likely to have airflow in worrying clinical ranges in early adulthood than those born on time.

The international study*, published in the latest edition of The Lancet Respiratory Medicine, was led by the Murdoch Children's Research Institute, the Royal Woman's Hospital and the University of Melbourne, with collaborators from Norway, Finland, the UK, and The Netherlands.

The research sourced data from 11 studies involving 935 participants who were born very preterm or with very low birthweight and 722 who were born at full term. All were aged between 16 and 33.

Lead researcher Professor Lex Doyle said many people born very preterm or with very low birthweight will develop chronic obstructive pulmonary disease (COPD), which blocks airflow and makes it difficult to breathe.

Professor Doyle said the likelihood was even higher if they had bronchopulmonary dysplasia - a form of lung injury that affects newborn babies, - or were exposed to tobacco smoke or other pollutants.

"The reductions in their airflow capacity in adolescence and early adulthood were substantial and a significantly higher proportion had expiratory flow rates (exhaling speed) in concerning clinical ranges compared with those born on time," he said.

Professor Doyle said babies born very preterm or with very low birthweight often required help with breathing problems after birth, such as assisted ventilation or oxygen treatment, and many would develop bronchopulmonary dysplasia.

"They go onto have reduced airflow through childhood compared with children born on time or of normal birthweight," he said.

However, it wasn't clear until now whether they were reaching the expected peak of lung growth in their early 20s.

"As they are now surviving in large numbers with modern obstetric and neonatal care, it's important to study their breathing ability in adulthood."

Professor Doyle said general practitioners or specialist physicians should be aware that their adult patients born very preterm or with very low birthweight, particularly those who had bronchopulmonary dysplasia, were more likely to present with respiratory problems than those born at term.

"Physicians should obtain a perinatal history, including gestational age at birth, birthweight, and bronchopulmonary dysplasia, when assessing adults with airway disease," he said.

1. Physician burnout costs the U.S. health care system approximately $4.6 billion a year
Investing in strategies to reduce physician burnout may have significant economic benefits
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1422
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1191
URLs go live when the embargo lifts

Physician burnout is a substantial economic burden, costing the U.S. health care system approximately $4.6 billion a year. Investing in strategies to reduce burnout may have economic benefits. Findings are published in Annals of Internal Medicine.

Physician burnout is a significant issue that has the potential to dramatically increase the cost of care to both patients and the health care delivery system. It is associated with poorer overall quality of patient care, lower patient satisfaction, and malpractice lawsuits, all of which have an economic impact. Despite the recent public interest the subject, only a few studies have attempted to quantify the economic magnitude of burnout in the form of easily understandable metrics. Without data, policymakers cannot holistically assess or address the issue.

A research team comprising members from the National University of Singapore, Stanford University, the Mayo Clinic, and the American Medical Association, developed a mathematical model using contemporary published research findings and industry reports to estimate burnout-associated costs related to physician turnover and reduced clinical hours at national and organizational levels. They found that on a national scale, physician burnout accounted for approximately $4.6 billion, or about $7,600 per employed physician per year. According to the researchers, these findings suggest that there may be substantial economic value for policy and organizational expenditures directed at reducing physician burnout.

The author of an accompanying editorial from The Permanente Federation and Southern California Permanente Medical Group says this research is much-needed because practicing medicine is harder than ever. His organization is dedicated to tackling burnout through establishing a culture of health and wellness, addressing needed changes to the practice environment, delivering emotional and peer support, and providing education on wellness and self-care strategies.

Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the lead author, Joel Goh, PhD, please contact Jack Loo at bizlooj@nus.edu.sg or +65-6516-5556.

2. Access to physician's notes may improve patient adherence to medications
Abstract: http://annals.org/aim/article/doi/10.7326/M18-3197
Editorial: http://annals.org/aim/article/doi/10.7326/M19-1366
URLs go live when the embargo lifts
Giving patients access to their physicians' visit notes may improve their understanding of and comfort with their medications, as well as improve their adherence to medication regimens. A brief research report is published in Annals of Internal Medicine.

As many as half of Americans with chronic illness do not take their medications as prescribed and, on average, patients remember about half of the information conveyed during an office visit. As patients increasingly read their visit notes through online portals (http://www.opennotes.org), reports suggest that patient access to notes may improve adherence.

Researchers from Harvard Medical School, the University of Washington and Beth Israel Deaconess Medical Center surveyed more than 29,000 patients at the original OpenNotes pilot sites (Beth Israel Deaconess Medical Center, Geisinger, and the University of Washington Medical Center) to. The researchers found that many patients at all three survey sites reported that note reading helped them understand why a medication was prescribed, answered their questions, and made them feel more comfortable and in control of their medications. Very few of the respondents reported that notes made them feel worried or confused about their medications.

According to the authors of an accompanying editorial from The Commonwealth Fund in New York City, the study findings are reassuring, as they showed no adverse effects of sharing clinical records with patients. The editorial authors recommend several measures, including medical education, physician preparedness regarding privacy and security protection, collaboration on mobile applications, and improved incorporation of nontraditional sources of patient information (wearables, social media, mobile devices), to improve the chances that increased transparency will have the hoped-for beneficial effects on the clinical experiences of patients and physicians.

Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The lead author, Dr. Catherine M. DesRoches, please contact Carolyn Assa at cassa@bidmc.harvard.edu.

3. Better supporting the care needs of older adults with disabilities could reduce Medicare spending
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2467
URLs go live when the embargo lifts
Implementation of comprehensive community-based long-term services and supports for older adults with disabilities may curb Medicare spending on this population in the long run. Findings from an observational study are published in Annals of Internal Medicine.

Nearly 15 million older Americans with disability live in the community and the availability and adequacy of support with daily activities has a profound effect on their participation in valued activities, quality of life, and health. While older adults with disability are heavy users of services and incur high health care spending, it is not known how adequacy of support may affect Medicare spending.

Researchers from the Johns Hopkins Bloomberg School of Public Health linked Medicare claims to data derived from in-person interviews with more than 3,700 community-living older adults with disability. The goal was to quantify differences in total Medicare spending by whether the participants experienced negative consequences due to inadequate support with household activities, mobility, or self-care. The researchers found that the participants with disability incurred Medicare spending that was more than twice as high as among those without disability. More than 1 in 5 older adults with mobility or self-care disability reported negative consequences due to no one being available to help and median per-person Medicare spending among those adults was significantly higher than for those who did not experience negative consequences.

According to the researchers, these findings suggest that the beneficial effects of comprehensive community-based long-term services and supports may extend beyond improved health, well-being and participation to reduced spending on health services. They propose greater use of strategies that target both health and function.

Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Jennifer L. Wolff, PhD, please contact Caitlin Hoffman at choffman@jhu.edu.

4. New Cholesterol guidelines focus on a healthy lifestyle and if likely to benefit, shared decision-making regarding statins
Abstract: http://annals.org/aim/article/doi/10.7326/M19-0365
URLs go live when the embargo lifts

New clinical practice guidelines on cholesterol management from the American Heart Association and American College of Cardiology (AHA/ACC) and multiple prevention oriented societies* endorse a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD). For primary prevention, in those likely to benefit, the guidelines recommend a clinician-patient risk discussion before a decision is made about statin treatment. A synopsis of the guidelines is published in Annals of Internal Medicine.

In November 2018, the AHA/ACC and multiple prevention oriented societies* released a new clinical practice guideline on cholesterol management that was accompanied by an in-depth risk assessment report on primary prevention of ASCVD.

A panel of experts conducted a systematic review and meta-analyses of randomized controlled trials that examined cardiovascular outcomes. High-quality observational studies were used for estimation of ASCVD risk. An independent panel systematically reviewed the trial evidence about the benefits and risks of adding nonstatin medications to statin therapy compared with receiving statin therapy alone in persons who have ASCVD and judged to be at very high risk. Based on the evidence, the AHA/ACC Multi-Society recommendations include:

Maintaining a healthy lifestyle over the lifespan.

Use of maximally tolerated doses of statins in secondary prevention of ASCVD

Use of nonstatin medications in addition to statin therapy for patients at very high risk for ASCVD.

Use of statin therapy without risk stratification in severe primary hypercholesterolemia, often starting in childhood.

Use of moderate-intensity statin therapy without risk stratification in adults aged 40 to 75 years with diabetes mellitus and an LDL-C level of 1.8 mmol/L (70 mg/dL) or higher.

Clinician-patient risk discussion about statin therapy for adults aged 40 to 75 years without diabetes mellitus who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.

Use of moderate-intensity statin therapy if a risk discussion favors their use in adults aged 40 to 75 years without diabetes mellitus who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.

Use of a 3-tiered decision-making process in primary prevention in adults aged 40 to 75 years to personalize the risk decision. This includes enhancing factors such as family history of premature CAD, metabolic syndrome, chronic kidney disease, LDL-cholesterol level ?160 mg/dL; in women, history of pre-eclampsia or premature menopause (Coronary artery calcium scoring to improve risk stratification in moderate-risk patients for whom the benefits of statin therapy are uncertain.

Follow-up for adherence to medications and lifestyle and to assess adequacy of response.

*American Association of Cardiovascular and Pulmonary Rehabilitation, American Academy of Physician Assistants, Association of Black Cardiologists, American College of Preventive Medicine, American Diabetes Association, American Geriatrics Society, American Pharmacists Association, American Society for Preventive Cardiology, National Lipid Association, and Preventive Cardiovascular Nurses Association

Notes and media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To reach the corresponding author, Dr. Neil J. Stone, MD, please contact at n-stone@northwestern.edu.

Practice results in better learning. Consider learning a musical instrument, for example: the more one practices, the better one will be able to learn to play. The same holds true for cognition and visual perception: with practice, a person can learn to see better--and this is the case for both healthy adults and patients who experience vision loss because of a traumatic brain injury or stroke.

The problem with learning, however, is that it often takes a lot of training. Finding the time can be especially difficult for patients with brain injuries who may, for instance, need to re-train their brains to learn to process visual cues.

But what if this learning process could be accelerated?

That's what an international collaboration of researchers set out to determine. Teams members included University of Rochester researchers Duje Tadin, a professor of brain and cognitive sciences, and Krystel Huxlin, the James V. Aquavella, M.D. Professor in Ophthalmology at the University's Flaum Eye Institute, and Lorella Battelli, group leader at the Italian Institute of Technology and assistant professor at Harvard Medical School. Motivated by emerging evidence that brain stimulation might aid learning, Tadin and Huxlin collaborated with researchers at the Italian Institute of Technology to study how different types of non-invasive brain stimulation affect visual perceptual learning and retention in both healthy individuals and those with brain damage. Their results, published in a paper in the Journal of Neuroscience, could lead to enhanced learning efficacy for both populations and improved vision recovery for cortically blind patients.

ENHANCING LEARNING WITH BRAIN STIMULATION

Learning is difficult and often takes a long time, Tadin says, "because after early childhood our brains become less plastic." The brain's ability to change and reorganize itself decreases as a person ages, so learning new tasks, or re-learning tasks after experiencing a brain injury, becomes more challenging.

To test if and how visual perceptual learning might be accelerated, researchers presented study participants with a computer-based task. Participants were shown clouds of dots and were asked to determine which way the dots moved across the computer screen. The task measured the participants' motion integration threshold; motion perception is important in enabling people to see movement and to avoid or interact with moving objects. Participants were then asked to perform the task while sub-groups were given different types of brain stimulations, each involving a non-invasive electrical current applied over the visual cortex. The researchers found that one particular type of stimulation, called transcranial random noise stimulation (tRNS), had remarkable effects on improving participants' motion integration thresholds when they performed the task.

"All groups of participants got better at the dot motion task with practice, but the group that also trained with tRNS improved twice as much and was able to learn the motion task better than other groups," Tadin says.

Surprisingly, the researchers also found that when they re-tested the participants six months later, the boosts in performance were still there: the participants in the tRNS group had retained what they had learned and were still able to do better on the motion task compared to the groups that were given other stimulation techniques or training alone.

'SOMETHING WE'VE NEVER SEEN IN THIS PATIENT POPULATION'

Tadin, Huxlin, and Battelli then extended their findings to patients who had suffered a stroke or other traumatic brain injury that affected their visual cortex, rendering them partially blind.

Huxlin had previously developed an eye-training system to assist stroke patients with recovering vision. The system includes a computer-based device that delivers a set of exercises to stimulate the undamaged portions of the visual cortical system. Through this visual training, the undamaged areas learn to process visual information that would normally be processed by the damaged parts.

Working with participants who had experienced traumatic brain injuries, the researchers coupled Huxlin's visual training therapy and tRNS applied to both damaged and undamaged parts of the patients' brains. These participants, too, experienced improvement in visual processing and function after only 10 days.

"This fast improvement is something we've never seen in this patient population," Huxlin says.

The research offers promise for overcoming key hurdles in vision therapy for patients who have experienced a stroke or traumatic brain injury. Re-learning visual perception lost because of neurological damage typically requires months of training. Moreover, it's unclear how long the recovered abilities are retained once the therapy has ended.

"The beauty of this combined therapy is the very short training," Battelli says. "When you work with stroke patients you quickly realize that there is a lot of fluctuation in their ability to stay on task. Thus, training that is short and effective is a big advantage."

But, while the two-pronged approach could lead to more efficient therapies, it's less clear exactly why the approach works. That will be the focus of future research, Tadin says. "It appears that tRNS helps put the brain in a more plastic state, which makes it more amendable to training-induced change, or learning. What we hope to learn with future work is why this happens."

The number of asylum seekers on wait lists in Mexican border cities or those waiting to get on these lists has grown to 18,700, according to a new report.

The report produced by the University of California San Diego School of Global Policy and Strategy's Center for U.S.-Mexican Studies and the University of Texas at Austin's Robert Strauss Center reveals the number of asylum-seekers has grown by more than 14,000 in just over the last three months. It also reveals wait times are longer than ever before, averaging about one month, and asylum seekers are arriving to an increasing number of cities.

Authors of the report began studying the issue in fall 2018, only a few months after Customs and Border Protection officials were stationed along the United States' international boundary with Mexico. In a process known as "metering," the officials tell arriving asylum seekers that U.S. ports are full and that they need to wait their turn in Mexico, while simultaneously accepting limited numbers of asylum seekers per day for processing. In response to the growing number of asylum seekers in border cities, Mexican authorities created informal wait lists.

"Our latest report shows that the situation in border cities is getting worse over time," said Savitri Arvey, a graduate student in the master of public policy program at the School of Global Policy and Strategy and researcher at the Center for U.S.-Mexican Studies. "We found that migrant shelters across the entire border are over capacity, and asylum seekers have begun arriving in smaller cities without the infrastructure to receive them. This has left thousands of asylum seekers to rent hotel rooms or even sleep on the streets, increasing their vulnerability for predation by organized crime or other opportunistic actors."

The influx has led the wait lists to close in Piedras Negras and Ciudad Acuna, and wait list procedures to change in other cities. Additionally, Tijuana, Ciudad Juarez and Mexicali, which have some of the longest lists along the border, are also receiving asylum seekers returned by U.S. authorities due to Migrant Protection Protocols.

According to the authors, the report is the most comprehensive analysis of asylum seekers waiting to enter the U.S., and the wait list structures. It compiles fieldwork carried out in 13 cities along the U.S.-Mexico border, drawing upon interviews with government officials, representatives from civil society organizations and members of the public on both sides of the border.

Immune cells prioritise the clearance of dead cells overriding their normal migration to sites of injury

University of Sheffield research paves the way for new therapies to manipulate how white blood cells get to and are kept at sites of injuries during healing

Dead cells disrupt immune responses and undermine defence against infection, new research has found.

The study, led by scientists at the University of Sheffield, revealed that cells which are programmed to die, a process known as apoptosis, can disrupt the normal function of immune cells, called macrophages. This can impact on how well they respond to wounds and patrol the body to seek out infection.

Our macrophages are needed at wound sites to prevent infection and to aid healing processes, but these white blood cells can also cause and worsen many human diseases, including cancer, heart disease and neurodegenerative disorders.

The findings, published in the journal PLOS Biology, show that immune cells prioritise the clearance of dead cells, which overrides their normal migration to sites of injury, impairing immune responses.

The research, which seeks to understand how immune cells are controlled, could help pave the way for new therapies to manipulate these cells and accelerate healing processes. This study gives scientists new insights into the mechanisms that control immune cells within our bodies, such as how they get to and are kept at sites of injuries.

Dr Iwan Evans, from the Department of Infection, Immunity and Cardiovascular Disease at the University of Sheffield who co-author of the paper, said: "Billions of cells die within our bodies on a daily basis and many of these are removed and digested by our immune cells.

"If this removal process goes wrong it can lead to damaging autoimmune conditions. Excessive or inappropriate immune responses worsen or cause a very broad range of human diseases from cancer to neurodegeneration.

"This work studies fundamental biological processes that are going on inside our bodies everyday that are necessary to keep us healthy."

The research to investigate the interactions between dying cells and immune cells was conducted using fruit flies which contain macrophage-like cells highly similar to our own immune cells. The new study also uncovered a novel role for a protein called Six-Microns-Under (or Simu) in keeping immune cells at sites of injury. Without this protein the macrophages left wound sites precociously.

Hannah Roddie, fellow co-author of the study and Research Associate at the Department of Infection, Immunity and Cardiovascular Disease at the University of Sheffield, said: "The study shows that the way fruit fly blood cells respond to injuries and dying cells is even more similar to how our own immune cells respond than previously thought.

"We are now looking into what signals macrophages use to track down dying cells and how they choose between the dead cells and wounds. We're fascinated to understand how immune cells are kept at the sites of injuries."

'Statistical significance' is one of the most widely misunderstood phrases in science, according to a 2013 Scientific American article.

It's a controversial topic. Probability values (p-values) have been used as a way to measure the significance of research studies since the 1920s, with thousands of researchers relying on them since. With this reliance, though, comes misunderstanding and, therefore, misuse.

This misunderstanding is what the latest episode of the How Researchers Changed the World podcast explores, in conversation with statistician Ron Wasserstein.

In particular, the podcast focuses on Ron's research into the misuse of p-values as a measure of statistical significance, which culminated in his 2016 paper: 'The American Statistical Association's statement on P-values: Context, Process and Purpose.'

Significance tests and p-values are widely used, according to Ron, to remove 'uncertainty' from scientific research. But uncertainty exists everywhere, and scientific research is no exception. For Ron, uncertainty in research should be embraced and accepted.

"Significance tests and dichotomised p-values ... have turned many researchers into what I'll call 'scientific snowbirds', trying to avoid dealing with uncertainty by escaping to a happier place." - Ron Wasserstein

With increasing use, and misuse, of p-values, statistics as a whole was starting to get a bad name. Some journals even banned the use of p-values and other statistical methods. So, Ron was tasked with leading the creation of a framework outlining how p-values should be used in research, which would be published as a statement by the American Statistical Association , a leading authority in the statistics world.

"We were challenged to do the ASA statement on p-values because of these attacks on statistics as a whole field of research." - Ron Wasserstein

It wasn't a simple task, but although the debate regarding p-values continues, the statement has had an impact on the research world beyond what Ron could ever have imagined...

CAMBRIDGE, MA -- The ultimate degree of control for engineering would be the ability to create and manipulate materials at the most basic level, fabricating devices atom by atom with precise control.

Now, scientists at MIT, the University of Vienna, and several other institutions have taken a step in that direction, developing a method that can reposition atoms with a highly focused electron beam and control their exact location and bonding orientation. The finding could ultimately lead to new ways of making quantum computing devices or sensors, and usher in a new age of "atomic engineering," they say.

The advance is described today in the journal Science Advances, in a paper by MIT professor of nuclear science and engineering Ju Li, graduate student Cong Su, Professor Toma Susi of the University of Vienna, and 13 others at MIT, the University of Vienna, Oak Ridge National Laboratory, and in China, Ecuador, and Denmark.

"We're using a lot of the tools of nanotechnology," explains Li, who holds a joint appointment in materials science and engineering. But in the new research, those tools are being used to control processes that are yet an order of magnitude smaller. "The goal is to control one to a few hundred atoms, to control their positions, control their charge state, and control their electronic and nuclear spin states," he says.

While others have previously manipulated the positions of individual atoms, even creating a neat circle of atoms on a surface, that process involved picking up individual atoms on the needle-like tip of a scanning tunneling microscope and then dropping them in position, a relatively slow mechanical process. The new process manipulates atoms using a relativistic electron beam in a scanning transmission electron microscope (STEM), so it can be fully electronically controlled by magnetic lenses and requires no mechanical moving parts. That makes the process potentially much faster, and thus could lead to practical applications.

Using electronic controls and artificial intelligence, "we think we can eventually manipulate atoms at microsecond timescales," Li says. "That's many orders of magnitude faster than we can manipulate them now with mechanical probes. Also, it should be possible to have many electron beams working simultaneously on the same piece of material."

"This is an exciting new paradigm for atom manipulation," Susi says.

Computer chips are typically made by "doping" a silicon crystal with other atoms needed to confer specific electrical properties, thus creating "defects' in the material -- regions that do not preserve the perfectly orderly crystalline structure of the silicon. But that process is scattershot, Li explains, so there's no way of controlling with atomic precision where those dopant atoms go. The new system allows for exact positioning, he says.

The same electron beam can be used for knocking an atom both out of one position and into another, and then "reading" the new position to verify that the atom ended up where it was meant to, Li says. While the positioning is essentially determined by probabilities and is not 100 percent accurate, the ability to determine the actual position makes it possible to select out only those that ended up in the right configuration.

Atomic soccer

The power of the very narrowly focused electron beam, about as wide as an atom, knocks an atom out of its position, and by selecting the exact angle of the beam, the researchers can determine where it is most likely to end up. "We want to use the beam to knock out atoms and essentially to play atomic soccer," dribbling the atoms across the graphene field to their intended "goal" position, he says.

"Like soccer, it's not deterministic, but you can control the probabilities," he says. "Like soccer, you're always trying to move toward the goal."

In the team's experiments, they primarily used phosphorus atoms, a commonly used dopant, in a sheet of graphene, a two-dimensional sheet of carbon atoms arranged in a honeycomb pattern. The phosphorus atoms end up substituting for carbon atoms in parts of that pattern, thus altering the material's electronic, optical, and other properties in ways that can be predicted if the positions of those atoms are known.

Ultimately, the goal is to move multiple atoms in complex ways. "We hope to use the electron beam to basically move these dopants, so we could make a pyramid, or some defect complex, where we can state precisely where each atom sits," Li says.

This is the first time electronically distinct dopant atoms have been manipulated in graphene. "Although we've worked with silicon impurities before, phosphorus is both potentially more interesting for its electrical and magnetic properties, but as we've now discovered, also behaves in surprisingly different ways. Each element may hold new surprises and possibilities," Susi adds.

The system requires precise control of the beam angle and energy. "Sometimes we have unwanted outcomes if we're not careful," he says. For example, sometimes a carbon atom that was intended to stay in position "just leaves," and sometimes the phosphorus atom gets locked into position in the lattice, and "then no matter how we change the beam angle, we cannot affect its position. We have to find another ball."

Theoretical framework

In addition to detailed experimental testing and observation of the effects of different angles and positions of the beams and graphene, the team also devised a theoretical basis to predict the effects, called primary knock-on space formalism, that tracks the momentum of the "soccer ball." "We did these experiments and also gave a theoretical framework on how to control this process," Li says.

The cascade of effects that results from the initial beam takes place over multiple time scales, Li says, which made the observations and analysis tricky to carry out. The actual initial collision of the relativistic electron (moving at about 45 percent of the speed of light) with an atom takes place on a scale of zeptoseconds -- trillionths of a billionth of a second -- but the resulting movement and collisions of atoms in the lattice unfolds over time scales of picoseconds or longer -- billions of times longer.

Dopant atoms such as phosphorus have a nonzero nuclear spin, which is a key property needed for quantum-based devices because that spin state is easily affected by elements of its environment such as magnetic fields. So the ability to place these atoms precisely, in terms of both position and bonding, could be a key step toward developing quantum information processing or sensing devices, Li says.

ITHACA, N.Y. - Far below Bermuda's pink sand beaches and turquoise tides, geoscientists have discovered the first direct evidence that material from deep within Earth's mantle transition zone - a layer rich in water, crystals and melted rock - can percolate to the surface to form volcanoes.

Scientists have long known that volcanoes form when tectonic plates (traveling on top of the Earth's mantle) converge, or as the result of mantle plumes that rise from the core-mantle boundary to make hotspots at Earth's crust. But obtaining evidence that material emanating from the mantle's transition zone - between 250 to 400 miles (440-660 km) beneath our planet's crust - can cause volcanoes to form is new to geologists.

"We found a new way to make volcanoes. This is the first time we found a clear indication from the transition zone deep in the Earth's mantle that volcanoes can form this way," said senior author Esteban Gazel, associate professor in the Department of Earth and Atmospheric Sciences at Cornell University. The research published in Nature.

"We were expecting our data to show the volcano was a mantle plume formation - an upwelling from the deeper mantle - just like it is in Hawaii," Gazel said. But 30 million years ago, a disturbance in the transition zone caused an upwelling of magma material to rise to the surface, forming a now-dormant volcano under the Atlantic Ocean and then forming Bermuda.

Using a 2,600-foot (over 700-meter) core sample - drilled in 1972, housed at Dalhousie University, Nova Scotia - co-author Sarah Mazza of the University of Münster, in Germany, assessed the cross-section for isotopes, trace elements, evidence of water content and other volatile material. The assessment provided a geologic, volcanic history of Bermuda.

"I first suspected that Bermuda's volcanic past was special as I sampled the core and noticed the diverse textures and mineralogy preserved in the different lava flows," Mazza said. "We quickly confirmed extreme enrichments in trace element compositions. It was exciting going over our first results ... the mysteries of Bermuda started to unfold."

From the core samples, the group detected geochemical signatures from the transition zone, which included larger amounts of water encased in the crystals than were found in subduction zones. Water in subduction zones recycles back to Earth's surface. There is enough water in the transition zone to form at least three oceans, according to Gazel, but it is the water that helps rock to melt in the transition zone.

The geoscientists developed numerical models with Robert Moucha, associate professor of Earth sciences at Syracuse University, to discover a disturbance in the transition zone that likely forced material from this deep mantle layer to melt and percolate to the surface, Gazel said.

Despite more than 50 years of isotopic measurements in oceanic lavas, the peculiar and extreme isotopes measured in the Bermuda lava core had not been observed before. Yet, these extreme isotopic compositions allowed the scientists to identify the unique source of the lava.

"If we start to look more carefully, I believe we're going to find these geochemical signatures in more places," said co-author Michael Bizimis, associate professor at the University of South Carolina.

Gazel explained that this research provides a new connection between the transition zone layer and volcanoes on the surface of Earth. "With this work we can demonstrate that the Earth's transition zone is an extreme chemical reservoir," said Gazel. "We are now just now beginning to recognize its importance in terms of global geodynamics and even volcanism."

Said Gazel: "Our next step is to examine more locations to determine the difference between geological processes that can result in intraplate volcanoes and determine the role of the mantle's transition zone in the evolution of our planet."

WASHINGTON, D.C. May 13, 2019 -- Children's brains are sponges. These voracious little learners glean all kinds of information from the people around them. In particular, children mimic and learn speech patterns from their family. Previous work has shown that infants attend selectively to their mother's voice over another female's voice. But new research suggests that children learn new words best from other children.

"Much of what we know about the world is learned from other people," said Yuanyuan Wang from Ohio State University who will present research findings from a collaborative work with Amanda Seidl from Purdue University at the 177th Meeting of the Acoustical Society of America. "This is especially true for young children."

According to Wang, speech is loaded with important paralinguistic information about the speaker including age, gender and even social class. Children learn and process this information in speech to understand and integrate speaker-specific information.

The research team wanted to determine what age group was most influential to 2-year-old toddlers based on how they pick up new words. To evaluate this, they set up two experiments. In the first experiment, toddlers watched side-by-side video clips of two speakers reciting a nursery rhyme while listening to speech that matched either the age or gender of one of the two speakers. The toddlers were successful at matching the vocal age and gender they heard to visual attributes on the screen. In the second experiment, toddlers were taught new words during a learning task using speakers of different ages. The researchers found the toddlers learned new words more effectively from other children. In the study the child talkers were slighly older, between 8-10 years old.

"It is fascinating to learn children showed selected learning from other child talkers," Wang said. "This has implications for social cognition and selective social learning."

Wang believes that toddlers are interested in the development of their own speech patterns and may be more attuned to the sound of other child speakers that resemble their own. This ability to learn selectively from a particular social group may serve as a foundation for developing preferences among social groups later in life.

"Sensitivity to talker properties is found to be related to speech processing and language development," Wang said. "These are related to later personal, academic, social and overall achievements."

New research from King's College London finds that teacher assessments are equally as reliable as standardised exams at predicting educational success.

The researchers say their findings, published today in the Journal of Child Psychology and Psychiatry, question whether the benefits of standardised exams outweigh the costs.

Teacher assessments were found to correlate strongly with exam scores across English, mathematics and science from age 7-14, with both measures equally as powerful at predicting later exam success. Teacher assessments predicted around 90% of the differences between pupils in exam performance at GCSE and A-level.

Co-lead researcher Dr Kaili Rimfeld, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), said: 'We have shown for the first time that teacher assessments predict GCSE and A-level results just as well as earlier exam scores. The fact that exam scores correlate so highly with the teacher assessments raises questions about the value of the testing culture that characterises compulsory education in the UK.'

Co-lead researcher Dr Margherita Malanchini, from the IoPPN and the University of Texas at Austin, said: 'While testing can stimulate both pupils and teachers to focus their efforts, high-stakes exams may shift the educational experience away from learning towards exam performance. For these reasons, we suggest that teacher assessments could be relied on for monitoring progress, instead of exam scores, in particular during earlier school years.'

Previous research has looked at how either exam scores or teacher assessments predict educational success, but not compared the two. The researchers were able to make the comparison by linking data from over 5,000 twin pairs in the Twins Early Development Study (TEDS) with teacher assessments and exam scores in the National Pupil Database.

Previous research from King's College London has established that genetic factors are the major influence on exam results for GCSEs and A-levels. Using data from TEDS, the researchers showed a strong genetic correlation between teacher assessments and exam scores, confirming that both measures were identifying the same pupils and largely measuring the same ability.

Teachers in the UK are required to assess their pupils until age 14, and children sit standardised exams throughout school education in the UK, including SATS at age 7 and 11, GCSEs at age 16 and A-levels at age 18.

Dr Rimfeld said: 'We are not arguing against testing in general, or that teachers should increase their workloads by adding further assessments. On the contrary, we have demonstrated that current methods of teacher assessment are powerful predictors of success, allowing schools to reduce testing and still monitor progress effectively.'

Dr Malanchini said: 'Our results should inform the debate about testing during both primary and secondary education. Trusting teachers to implement the curriculum and monitor progress could benefit the wellbeing of pupils and teachers and help to bring joy back to the classroom.'

Previous research has suggested high-stakes exams can impact teachers' morale as well as pupils' wellbeing and mental health. The researchers are now looking to study the links between school experiences and mental health among young people.

Young adults with a history of childhood abuse or neglect are more prone to using e-cigarettes during the transition to adulthood, according to a new study led by researchers at Virginia Commonwealth University.

"E-cigarette use has overtaken cigarette smoking among American adolescents. Those who have experienced childhood maltreatment may be at particular risk of using e-cigarettes, as these experiences have been linked to future nicotine dependence," said Sunny Shin, Ph.D., an associate professor in the School of Social Work and the Department of Psychiatry in the School of Medicine. "However, because e-cigarettes are relatively new, research is limited in the area."

The study, "Adverse Childhood Experiences and E-Cigarette Use During Young Adulthood," was published in The American Journal on Addictions, the official journal of the American Academy of Addiction Psychiatry.

The study relied on a sample of 208 people aged 18-21 and examined the relationship between childhood maltreatment and e-cigarette use, and explored the potential role of impulsivity in linking childhood maltreatment to e-cigarette use via a series of models controlling for demographic characteristics.

Previous studies have linked childhood maltreatment to nicotine dependence. But little research has been done to test the association between childhood maltreatment and e-cigarette use, including research that aims to understand the pathways linking childhood abuse and neglect with e-cigarette use.

"Young adults exposed to [childhood maltreatment] are at risk for developing addictive behaviors, including nicotine dependence. Empirically based knowledge about the pathways or mechanisms linking [childhood maltreatment] to e-cigarette use would increase the success of prevention and intervention efforts targeted for this highly vulnerable population," according to the study. "Thus, the present study examined the relationship between exposure to [childhood maltreatment] and e-cigarette use, and explored the potential role of impulsivity in linking this relationship."

In addition to finding childhood maltreatment is significantly associated with e-cigarette use, the study found that childhood maltreatment was also related to "negative urgency" -- or the tendency to engage in impulsive risky behavior in response to intense negative emotions -- which, in turn, was also significantly correlated with lifetime e-cigarette use.

"What we found is that not only are maltreated young adults more likely to use e-cigarettes, but they are doing so because they are unable to stop their behavior when distressed," Shin said. "They may use e-cigarettes to cope with trauma-related negative emotions. Our findings suggest that targeting trauma-related negative emotions and emotion-related impulsivity may be most effective in preventing e-cigarette use among victimized young adults."

The long-term health consequences of e-cigarettes are unclear, but recent studies have connected e-cigarette use to various adverse health outcomes, including heart attack, respiratory problems and asthma.

The researchers were interested in looking at e-cigarette use among young adults, as nicotine is highly addictive and harmful to adolescent brain development. Young people exposed to adverse childhood experiences such as child abuse and neglect were considered to be a particularly high-risk population.

"Our findings suggest that exposure to [childhood maltreatment] is significantly related to lifetime e-cigarette use," according to the study. "This finding is consistent with the empirically supported proposition that [childhood maltreatment] is significantly associated with the use of other tobacco products such as cigarettes. Our finding is particularly noteworthy because previous studies have demonstrated that individuals who have experienced [childhood maltreatment] are more prone to nicotine dependence."

Further research will be needed to more fully understand the findings, the study concludes, including using longitudinal designs, more representative samples, and measures of motives to use e-cigarettes.

With the goal of preparing scholars from underrepresented groups to succeed in graduate and professional programs, Penn State, the University of North Carolina at Chapel Hill (UNC) and the University of Maryland, Baltimore County (UMBC) partnered to develop undergraduate programs aimed at increasing retention and academic performance of historically racially underrepresented undergraduates in science, technology, engineering and mathematics (STEM) fields.

In a new study published in the journal Science, the authors describe promising early results in expanding diversity and inclusion in STEM by leveraging lessons learned from successful programs with immersive interinstitutional partnering. This approach could serve as a model for other universities with different populations of students, sizes and cultures.

The interinstitutional approach was based on the Meyerhoff Scholars Program (MYS) at UMBC, a successful program with a 30-year history of increasing retention and academic performance of underrepresented scholars who have a high likelihood of continuing on to pursue a doctorate in a STEM field. The authors found that the MYS model worked at Penn State and UNC, institutions which were much different than UMBC, with student outcomes that immediately matched or exceeded MYS. This model could provide a new paradigm for inclusive excellence in STEM.

The Millennium Scholars Program at Penn State and the Chancellors Science Scholars Program at UNC were established and designed to replicate or adapt all the major components of MYS, including establishment of key administrators and senior faculty as program champions; allocation of space and funding for staff, scholarships, activities and assessment; recruitment of diverse staff, targeted student recruitment, and cohort building, including an intensive summer bridge program; early placement in research labs and summer internships; intensive academic advising and counseling; community service; and regular program evaluations.

Historical records of STEM student demographics, academic performance and retention at both Penn State and UNC identified disparities for racially underrepresented students. These findings were critical drivers for broadening support and instituting new programs.

"This is encouraging progress in establishing a model for institutional support that opens pathways for underrepresented scholars to achieve the highest levels of success in STEM fields," said Eric J. Barron, Penn State president and co-author of the study. "These talented young individuals are future leaders in academia and industry who will play a vital role in advancing our economy and quality of life."

Student applicants to all three programs were selected based on academic merit, STEM research and social justice interests as well as interviews. At Penn State, the Millennium Scholars Program cohort received full tuition and other support. Most students on all three campuses majored in biology, chemistry, computer science, mathematics, physics, statistics or a combination of these areas. The Millennium Scholars Program at Penn State included majors from five STEM colleges: Engineering, Information Sciences and Technology, Earth and Mineral Sciences, Agricultural Sciences and the Eberly College of Science.

"The Millennium Scholars Program is designed to support high-achieving undergraduate STEM students in a way that will ultimately prepare them to continue on to complete a Ph.D. in a STEM field." said Amy Freeman, director of the Millennium Scholars Program and co-author of the study. "The cycle to complete this long-term goal is about 8 years and the Millennium Scholars Program addresses the first half of that journey, which includes completion of the B.S., excellent academic performance and a high level of research early on. To date, we have graduated two classes, most of whom have continued on to enroll in graduate programs. We are committed to assisting students who have both the passion and the ability to advance the frontiers of knowledge and change the world."

The university partnership included several weeks of faculty and staff training at UMBC, with additional training at UNC and Penn State. Faculty and staff from the Penn State and UNC programs were embedded in portions of the UMBC program student selection and summer bridge events at UMBC. Staff also met biweekly to discuss the program; team members met monthly to develop and implement evaluation plans; and faculty leadership met regularly to address administrative goals. Summer retreats were held that involved participants from all three campuses.

To see if the programs were working, student outcomes were compared with institutionally matched, nonprogram student samples identified based on similar ethnicity, gender, academic interest and academic credentials. In all cases, average cohort STEM retention and average cohort GPAs for STEM-retained students were substantially higher for program participants regardless of ethnicity or gender. GPAs of female program participants were also considerably higher than those of female nonparticipants. Underrepresented program participants also had a substantial GPA benefit compared to matched noncohort underrepresented students.

"Cultivating talent and promoting the full inclusion of excellence across STEM at Penn State is the focus, and the early results highlight that this program is working," said Mary Beth Williams, senior associate dean for undergraduate education in the Eberly College of Science and co-author of the study. "These outcomes are a positive indicator that show that we are moving in the right direction."

Important factors in the success of the program included: commitment to the entire Meyerhoff Scholars Program model, including foundational program elements such as the summer bridge program and community building; sufficient and sustained administrative support; recruitment of full-time program staff; faculty and staff training; and faculty participation.

Students in the cohorts benefited from interacting with program staff who had similar experiences navigating issues of ethnicity and culture. Faculty were a key part of program activities, including student recruitment, summer bridge programming, fundraising efforts, program administration, and workshops to raise awareness about ethnicity and gender issues in STEM. Faculty engaged students starting in their first year and provided research experiences throughout the program. Faculty also explored pedagogical practices that appear to positively affect students' learning and academic performance.

"This program reflects Penn State values and the importance we place on equality and opportunity at our University," said Barron. "With the proven success of this program at UMBC, and the early findings here at Penn State and UNC, we are excited for the opportunity to expand the program at Penn State and help scale it nationally."

In-store mobile phone use that is unrelated to shopping may be associated with an increase in unplanned purchases, according to a study published in the Journal of the Academy of Marketing Science.

Dr Michael Sciandra at Fairfield University, US and colleagues investigated the impact of mobile phone use on in-store shopping behaviour. They found that those who used mobile phones in store for purposes unrelated to shopping, such as making phone calls, sending text messages, checking emails or listening to music, were more likely to make unplanned purchases and forget items they had planned to buy. The authors observed this effect even when phones were only used for part of the shopping trip, suggesting that in-store mobile phone use may consume attentional resources even after the phone is put away.

Dr Michael Sciandra, corresponding author of the study said: "Our finding that phone use that is unrelated to shopping negatively affects shopping behaviour was in stark contrast to beliefs held by consumers. The vast majority of shoppers we asked thought that mobile phones did not have any negative effect."

The researchers asked 231 participants to complete a simulated shopping task. While the participants either refrained from using their phone, or used it for an unrelated task either constantly (simulated phone call) or intermittently, they were shown a first person perspective video of someone grocery shopping. The participants were given a shopping list of items and were asked to compare the list to the products the person in the video placed in the cart, or picked up and put down. The participants' mobile phone dependence was assessed via self-report.

The authors found that consumers who are highly dependent upon mobile phones, characterized by excessive use of and reliance on the device, were the most at risk of deviating from a shopping plan while engaging in shopping-unrelated mobile phone use.

Dr Sciandra said: "Mobile phones are quickly becoming the principal distractor for many consumers and they offer a unique form of interruption. Our findings may influence consumers' attitudes towards mobile phone use while shopping and persuade them to reflect on how these devices impact our lives, both positively and negatively."

The authors note that part of the study is based on a simulated shopping experience only, therefore caution should be taken when applying these conclusions from this to real life settings.

A fainting episode causing traumatic nerve damage affecting his right hand could be why Leonardo da Vinci's painting skills were hampered in his late career. While the impairment affected his ability to hold palettes and brushes to paint with his right hand, he was able to continue teaching and drawing with his left hand. According to most authors, the origin of da Vinci's right hand palsy was related to a stroke.

Doctors writing in the Journal of the Royal Society of Medicine reached a different conclusion after analysing a 16th-century drawing of an elderly da Vinci, together with a biography and an engraving of the Renaissance polymath artist and inventor in earlier years.

The authors, Dr Davide Lazzeri, a specialist in plastic reconstructive and aesthetic surgery at the Villa Salaria Clinic in Rome, and Dr Carlo Rossi, a specialist in neurology at the Hospital of Pontedera, focused on a portrait of da Vinci drawn with red chalk attributed to 16th-century Lombard artist Giovan Ambrogio Figino*. The drawing is a rare rendering of da Vinci's right arm in folds of clothing as if it was a bandage, with his right hand suspended in a stiff, contracted position.

Dr Lazzeri said: Rather than depicting the typical clenched hand seen in post-stroke muscular spasticity, the picture suggests an alternative diagnosis such as ulnar palsy, commonly known as claw hand."

He suggests that a syncope, or faint, is more likely to have taken place than a stroke, during which da Vinci might have sustained acute trauma of his right upper limb, developing ulnar palsy. The ulnar nerve runs from the shoulder to little finger and manages almost all the intrinsic hand muscles that allow fine motor movements.

While an acute cardiovascular event may have been the cause of da Vinci's death, his hand impairment was not associated with cognitive decline or further motor impairment, meaning a stroke was unlikely. Dr Lazzeri said: "This may explain why he left numerous paintings incomplete, including the Mona Lisa, during the last five years of his career as a painter while he continued teaching and drawing."