Search

We examined individual differences and predictions of children's patterns in behavioral, emotional and attentional efforts toward challenging puzzle tasks at 24 and 35 months using data from a large longitudinal rural representative sample. Using latent transition analysis, we found four distinct task-oriented patterns in problem-solving tasks within parent-toddler/preschooler dyads representing different levels of regulatory strengths and weaknesses. We also found the relatively more positive and adaptive task-oriented patterns (i.e., the positive-motivated pattern and the content-compliant pattern) were more stable, but the relatively negative patterns (i.e., the negative-disengaged pattern and the emotional-mixed pattern) had much more variability and change from 24 to 35 months. Finally, infant attention, positive parenting, and family economic strains also significantly predicted children's task-oriented patterns at 24 months after controlling for child gender, race and maternal education. These findings contribute to prevention/intervention strategies for young children's optimal performance during challenging problem solving and their later school success.

This article unpacks the challenge of culturally responsive teaching in rural community colleges, based on emerging insights from a study of two community colleges in North Carolina. Culturally responsive strategies ask, how do our classrooms welcome the perspectives, voices, and distinctive cultural resources of people of color and other minoritized groups?

This qualitative study used survey research to examine a blended co-taught model of instruction designed for students enrolled in an Occupational Course of Study via the North Carolina Virtual Public School. While blended learning has successfully served the needs of students with disabilities, face-to-face and virtual teachers identify the need for professional development to successfully implement the model. Our large scale survey of educators teaching in a blended program to meet the needs of these students demonstrates the need for multiple layers of support.

Previous studies suggest that the roots of school dropout (a) can be established early in life, (b) are likely to involve multilevel factors (home, child, classroom) operating prior to and during the elementary school years, and (c) can be identified by 3rd grade. The decision to drop out of school is thus a dynamic developmental process that can begin with disengagement in elementary school. Yet few studies have examined the multilevel factors that might contribute to children's early disengagement from school. In the present study, we examined associations between household chaos (i.e., disorganization and instability) from birth to age 5 and student (dis)engagement in third grade. We also examined positive parenting in early childhood (6-60 months) and child self-regulatory skills at kindergarten as potential mediators in this pathway. Participants were 1,097 children who participated in the Family Life Project, a longitudinal study of the development of children living in underresourced high poverty rural areas. Study questions were addressed using structural equation models. Results indicated that, even after taking into account a considerable number of covariates, early positive parenting and children's self-regulatory skills were viable process mechanisms through which early household disorganization, but not instability, was linked to student (dis)engagement in third grade. Findings are discussed with respect to the multilevel proximal forces at play in children's risk for early disengagement from school. [This article was co-authored by the Family Life Project Key Investigators.]

The relationships teachers build with their students are key to their academic success. Despite their likes, dislikes, or academic achievements, students yearn to feel a sense of belonging, a connection to someone or something within schools and classrooms. Whether a learning environment is face to face or online, students want to feel present. But with the challenges of online learning and socialization, support, and other activities that contribute to a sense of belonging, a virtual teacher has to work harder to provide students with a cohesive environment and the social connections that foster academic success. The Social Presence Model provides a framework to establish increased social presence, or connectedness, among teachers and students for a more enriching educational experience. The authors define social presence as an integration of five key elements that motivate participants to take active roles in their own and their peers' online learning experiences: (1) Affective Association (AA); (2) Community Cohesion (CC); (3) Interaction Intensity (II); (4) Knowledge and Experience (KE); and (5) Instructor Involvement (IV). This article presents definitions and quick tips for building social presence online using these five elements of the Social Presence Model.

Objective: Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses. Design: Quantitative, cross-sectional study. Setting: Large public university in the Southeastern USA. Method: Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers. Results: Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2 months that the dispensers were available, 33% had used them. More than one-third of students (37%)--and 53% of sexually active students--indicated intentions to use the dispensers in the next 6 months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students' intentions to use the dispensers (p < 0.001). Objective: Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses. Design: Quantitative, cross-sectional study. Setting: Large public university in the Southeastern USA. Method: Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers. Results: Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2 months that the dispensers were available, 33% had used them. More than one-third of students (37%)--and 53% of sexually active students--indicated intentions to use the dispensers in the next 6 months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students' intentions to use the dispensers (p < 001). Conclusion: Overall, results indicate that over a short time period, this condom distribution programme was successful in reaching students and providing free condoms. Implications for implementing condom distribution programmes on college campuses as well as future directions for research are discussed.

Behavioral regulation is an important school readiness skill that has been linked to early executive function (EF) and later success in learning and school achievement. Although poverty and related risks, as well as negative parenting, have been associated with poorer EF and behavioral regulation, chaotic home environments may also play a role in understanding both early EF and later behavioral regulation at school age. To explore these relationships, a unique longitudinal and representative sample was used of 1,292 children born to mothers who lived in low-wealth rural America who were followed from birth into early elementary school. This study examined whether household chaos, which was measured across the first 3 years of life, predicted behavioral regulation in kindergarten above and beyond poverty-related variables. In addition, this study tested whether parent responsivity and acceptance behaviors, measured during the first 3 years of life, as well as EF skills, which were measured when children were 3 to 5 years of age, mediated the relationship between early household chaos and kindergarten behavioral regulation. Results suggested that household chaos disorganization indirectly predicted kindergarten behavioral regulation through intermediate impacts on parenting behaviors and children's early EF skills. These findings suggest the importance of early household chaos disorganization, the parenting environment, and early EF skills in understanding behavioral regulation above and beyond poverty-related risks. [Additional research was provided by the Family Life Key Investigators: (1) Mark T. Greenberg, Human Development and Psychology, Pennsylvania State University; (2) Clancy B. Blair, Applied Psychology, New York University; (3) Margaret R. Burchinal, Psychology, University of North Carolina at Chapel Hill; (4) Martha Cox, Psychology, University of North Carolina at Chapel Hill; (6) Jennifer L. Frank, Educational Psychology, Counseling, and Special Education, Pennsylvania State University; and (7) W. Roger Mills-Koonce, Human Development and Family Studies, University of North Carolina-Greensboro.]

Despite policy efforts to encourage multiple measures of performance in newly developing teacher evaluation systems, practical constraints often result in evaluations based predominantly on formal classroom observations. Yet there is limited knowledge of how these observational measures relate to student achievement. This article leverages the random assignment of teachers to classrooms from the Measures of Effective Teaching (MET) study to identify teacher effectiveness using scores from the Framework for Teaching (FFT) instrument, one of the most widely used classroom observation protocols. While our evidence suggests that teacher performance, as measured by the FFT, is correlated with student achievement, noncompliance with randomization and the modest year-to-year correlation of a teacher's FFT scores constrain our ability to causally identify effective teachers. Implications for policy and practice are discussed.

This mixed-method study reports perspectives of virtual school teachers on the impact of online teaching on their face-to-face practice. Data from a large-scale survey of teachers in the North Carolina Virtual Public School (n = 214), focus groups (n = 7), and interviews (n = 5) demonstrate multiple intersections between online and face-to-face teaching. Seventy-seven percent of teachers agreed that teaching online impacted their face-to-face practice. Teachers discussed changes in instructional practices, communication modes, roles of teachers and students, and shifts in purpose and profession. Findings of this study have relevance for teacher education programs and in-service professional development for teachers who will be needed to bridge K-12 online and face-to-face modalities.

In this collaborative study, university researchers introduced the short video clips of teaching and learning within two elementary schools; these clips were shared in site faculty meetings to encourage dialogue and collaboration. Researchers conducted pre- and post-surveys with teachers and pre- and post-interviews with principals to understand perceptions of using brief video clips as a tool for facilitating communication, reflection, and collaboration in the school setting.

A considerable body of literature suggests that children's child-care experiences may impact adrenocortical functioning in early childhood. Yet emerging findings also suggest that the magnitude and sometimes the direction of child-care effects on development may be markedly different for children from higher risk contexts. Using data from a large population-based sample of families from predominantly low-income backgrounds in rural communities, we tested the degree to which links between children's child-care experiences (at 7-36 months) and their subsequent cortisol levels (at 48 months) were moderated by their level of cumulative environmental risk. Our results provided evidence of a crossover interaction between cumulative risk and child-care quantity. For children from low-risk contexts, greater weekly hours in child care were predictive of higher cortisol levels. In contrast, for children facing several cumulative risk factors, greater hours in child care per week were predictive of lower cortisol levels. These effects were robust after adjusting for several controls, including children's cortisol levels in early infancy. Child-care quality and type were not predictive of children's cortisol levels, and neither mitigated the conditional effect of child-care quantity on cortisol. These findings suggest that links between child care and children's development may differ as a function of children's broader ecologies.

Purpose: The authors examined the language used by mothers from low-income and rural environments with their infants at ages 6 and 15 months to identify predictors of maternal language use at the 15-month time point. Method: Maternal language use by 82 mothers with their children was documented during book-sharing interactions within the home in a prospective longitudinal study. The authors analyzed transcripts for maternal language strategies and maternal language productivity. Results: Analyses indicated variability across mothers in their language use and revealed some stability within mothers, as maternal language use at the 6-month time point significantly predicted later maternal language. Mothers who used more language strategies at the 6-month time point were likely to use more of these language strategies at the 15-month time point, even after accounting for maternal education, family income, maternal language productivity, and children's communicative attempts. Conclusions: Mothers' language use with their children was highly predictive of later maternal language use, as early as age 6 months. Children's communication also influenced concurrent maternal language productivity. Thus, programs to enhance maternal language use would need to begin in infancy, promoting varied and increased maternal language use and also encouraging children's communication. (Contains 4 tables.)

Using the Social Presence Model (SPM), the authors explore the teacher and student experience at the North Carolina Virtual Public School (NCVPS), the largest public online secondary school where teachers design and develop the curriculum. Through a series of surveys, focus groups, and interviews, this two-year mixed methods study investigates the concept of social presence through the SPM. The overall findings suggest that teachers value all five elements of the SPM and see it as an important new heuristic for achieving increased student satisfaction and outcomes. Students largely did not find the Model useful, except for the Instructor Involvement element. Furthermore, because of their online learning experiences, students noted an increased investment in their own learning. Further analysis suggests the importance of integrating connectedness and social presence into student orientations and teacher professional development opportunities. Overall, social presence serves as learning a new language--a new literacy--that is essential to a successful online teaching and learning experience.

The current study is one of the first prospective examinations of longitudinal associations between observed father caregiving behaviors and child cortisol reactivity and regulation in response to emotional arousal. Observations of father and mother caregiving behaviors and child cortisol levels in response to challenges at 7 months and 24 months of child age were collected. Analyses were based on a subsample of children from the Family Life Project who lived with both their biological mothers and fathers and for whom there was at least partial cortisol data (7 months: n = 717; 24 months: n = 579). At the challenge conducted at 7 months of child age, 49.0% of the sample were girls; racial composition of the sample was 25.8% African American and 74.2% European American. At the challenge conducted at 24 months of child age 49.9% of the sample were girls; racial composition was 24.7% African American and 75.3% European American. We conducted analyses across assessment points simultaneously using mixed linear modeling for repeated measures data to test for differential effects of fathering across infancy and toddlerhood. Concurrent measures of father negativity were positively associated with greater increases in child cortisol levels in response to emotion challenge at 7 months (p = 0.01) and with higher overall levels of cortisol at 24 months (p less than 0.001). However, there was no evidence that father caregiving during infancy independently predicted later cortisol activity during toddlerhood. (Contains 2 figures and 4 tables.)

Background: The hindfoot fusion nail has become a popular implant for tibiotalocalcaneal (TTC) arthrodeses given its rigidity, ease of insertion, and potential for less invasive surgical approaches. The purpose of this study was to evaluate fusion and complication rates following the use of a straight, retrograde intramedullary nail for TTC arthrodeses, and the influence of diabetes and smoking on these results. Methods: A review of patient cases performed by a single surgeon at a single institution was performed. Variables included age, comorbidities, smoking history, BMI, hemoglobin A1c, preoperative and postoperative visual analog scale pain scores, assessment of healing, and complications. Relative and absolute risk were assessed for smoking, diabetes, fusion, and surgical complications through risk ratios. Cox proportional hazards survival analyses were performed to assess the effects of smoking and diabetes on fusion rates and complications. Linear regressions were performed to investigate the effects of smoking and diabetes on patient-reported pain levels. Results: Of 103 patients, there were 37 cigarette smokers and 30 diabetic patients. Eighty-three patients achieved union of all involved joints and 19 patients achieved union of 1 or 2 joints. Smokers demonstrated a 1.46 (risk ratio) (95% CI 1.03-2.07) times greater risk of nonunion but were not at an increased risk of experiencing surgical complications (0.86, 95% CI 0.56-1.33). Diabetic patients did not demonstrate an increased risk of nonunion (0.86, 95% CI 0.56-1.33) or complications (1.18, 95% CI 0.76-1.83). Conclusion: Because of increased nonunion risk, patients undergoing elective tibiotalocalcaneal arthrodesis should be counseled increased nonunion risks associated with smoking. In this series, we did not find a relationship between diabetes and complications or nonunion. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

In this three-year, mixed methods case study, the benefits and challenges of online learning for at-risk high school students were examined. A key finding was that at-risk students identify the benefits and challenges of online learning to be the same. While students appreciate the opportunity to work ahead and study at their own pace, they see it as a challenge to be responsible for their own learning and manage their time. The authors of this paper argue that, with proper support structures in place, students who are at-risk for dropping out can overcome challenges and find success in an online learning environment.

Treatment courts aim to reduce criminal recidivism by addressing the behavioral health care needs of persons with psychiatric or substance use disorders that contribute to their offending. Stable funding and access to behavioral health providers are crucial elements of success for the treatment court model. What happens when courts lose state funding and must rely on local initiatives and resources? In this study, a survey of North Carolina treatment court professionals identified resource gaps and unmet needs. The authors argue that continuing state investment could make treatment courts more viable and effective. Medicaid expansion is a potential new resource for these problem-solving courts. [ABSTRACT FROM AUTHOR]

Public health surveillance systems likely underestimate the true prevalence and incidence of SARS-CoV-2 infection due to limited access to testing and the high proportion of subclinical infections in community-based settings. This ongoing prospective, observational study aimed to generate accurate estimates of the prevalence and incidence of, and risk factors for, SARS-CoV-2 infection among residents of a central North Carolina county. From this cohort, we collected survey data and nasal swabs every two weeks and venous blood specimens every month. Nasal swabs were tested for the presence of SARS-CoV-2 virus (evidence of active infection), and serum specimens for SARS-CoV-2-specific antibodies (evidence of prior infection). As of June 23, 2021, we have enrolled a total of 153 participants from a county with an estimated 76,285 total residents. The anticipated study duration is at least 24 months, pending the evolution of the pandemic. Study data are being shared on a monthly basis with North Carolina state health authorities and future analyses aim to compare study data to state-wide metrics over time. Overall, the use of a probability-based sampling design and a well-characterized cohort will enable collection of critical data that can be used in planning and policy decisions for North Carolina and may be informative for other states with similar demographic characteristics. [ABSTRACT FROM AUTHOR]

A person's interest in a driver's license is "substantial," and as the U.S. Supreme Court has observed, the suspension of a license by the state can result in "inconvenience and economic hardship suffered," including because a license may be "essential in the pursuit of a livelihood." However, forty-four U.S. states currently require indefinite suspension of driver's licenses for non-driving-related reasons, such as failure to appear in court or pay fines for traffic infractions. There are no systematic, peer-reviewed analyses of individual-level or countylevel data regarding such suspensions. This study describes North Carolina's population of suspended drivers and assesses how driver's license suspension statutes operate relative to geography, race, and poverty level. First, it analyzes four decades of active-suspension data in North Carolina and finds over 1,225,000 active suspensions for failures to appear or pay traffic fines, amounting to one in seven adult drivers in the state. Second, it compares these data to county-population data; county-level traffic-stop data, collected as required by statute in North Carolina; and county-level data on the volume and composition of traffic court dockets. This study reveals that driver's license suspensions are not associated with either the volume of traffic stops or the size of the traffic court docket. In contrast, we find that black and Latinx people are overrepresented relative to the population. Linear mixed-level modeling regression analyses demonstrate that the population of white people below the poverty line and black people above the poverty line are most strongly associated with more suspensions. Finally, this Article explores implications of these results for efforts to reconsider the imposition of driver's license suspensions for non-driving-related reasons. These patterns raise constitutional concerns and practical challenges for policy efforts to undo such largescale suspension of driving privileges. [ABSTRACT FROM AUTHOR]

Background: There are currently limited human in vivo data characterizing the role of the meniscus in load distribution within the tibiofemoral joint. Purpose/Hypothesis: The purpose was to compare the strains experienced in regions of articular cartilage covered by the meniscus to regions of cartilage not covered by the meniscus. It was hypothesized that in response to walking, tibial cartilage covered by the meniscus would experience lower strains than uncovered tibial cartilage. Study Design: Descriptive laboratory study. Methods: Magnetic resonance imaging (MRI) of the knees of 8 healthy volunteers was performed before and after walking on a treadmill. Using MRI-generated 3-dimensional models of the tibia, cartilage, and menisci, cartilage thickness was measured in 4 different regions based on meniscal coverage and compartment: covered medial, uncovered medial, covered lateral, and uncovered lateral. Strain was defined as the normalized change in cartilage thickness before and after activity. Results: Within each compartment, covered cartilage before activity was significantly thinner than uncovered cartilage before activity (P < .001). After 20 minutes of walking, all 4 regions experienced significant cartilage thickness decreases (P < .01). The covered medial region experienced significantly less strain than the uncovered medial region (P = .04). No difference in strain was detected between the covered and uncovered regions in the lateral compartment (P = .40). Conclusion: In response to walking, cartilage that is covered by the meniscus experiences lower strains than uncovered cartilage in the medial compartment. These findings provide important baseline information on the relationship between in vivo tibial com-pressive strain responses and meniscal coverage, which is critical to understanding normal meniscal function. [ABSTRACT FROM AUTHOR]

The article discusses the main goals of the Pre-K and Kindergarten Demonstration Program in North Carolina. It states that the program aims to improve the statewide teacher effectiveness and practices in the classroom. It notes the promotion of practices that address needs of the child and ensure effective transitions between pre-K and kindergarten. It mentions the promotion of collaboration across pre-K and Kindergarten community. INSETS: A Kindergarten Guided Observation;Reflections From NC Demonstration Program Particip;A Preschool Guided Observation.

Summarizes survey results concerning employment patterns of, and child care arrangements used by, parents of four-year olds in three North Carolina counties. Child care arrangements varied by site, marital status, race, family socioeconomic characteristics, and parental educational level. (BB)

Background. Breast cancer brain metastasis (BCBM) confers a poor prognosis and is unusual in requiring multidisciplinary care in the metastatic setting. The University of North Carolina at Chapel Hill (UNC-CH) has created a BCBM clinic to provide medical and radiation oncology, neurosurgical, and supportive services to this complex patient population. We describe organization and design of the clinic as well as characteristics, treatments, and outcomes of the patients seen in its first 3 years. Methods. Clinical and demographic data were collected from patients in a prospectively maintained database. Descriptive statistics are reported as percentages and means. The Kaplan-Meier method was used to estimate time-to-event outcomes. Results. Sixty-five patients were seen between January 2012 and January 2015. At the time of presentation to the BCBM clinic, most patients (74%) had multiple (≥2) brain metastases and had received prior systemic (77%) and whole-brain radiation therapy and/or central nervous system stereotactic radiosurgery (65%) in the metastatic setting. Seventy-eight percent returned for a follow-up visit; 32% were enrolled in a clinical trial. Median time from diagnosis of brain metastasis to death was 2.11 years (95% confidence interval [CI] 1.31-2.47) for all patients, 1.15 years (95% CI 0.4-2.43) for triple-negative breast cancer, 1.31 years (95% CI 0.51-2.52) for hormone receptor-positive/HER22 breast cancer, and 3.03 years (95% CI lower limit 1.94, upper limit not estimable) for HER21 breast cancer (p = .0037). Conclusion. Patients with BCBM have unique and complex needs that require input from several oncologic disciplines. The development of the UNC-CH multidisciplinary BCBM clinic is a model that can be adapted at other centers to provide coordinated care for patients with a challenging and complex disease. [ABSTRACT FROM AUTHOR]

Objective: To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness.Design: In-person survey from October 1986 to June 1988.Setting: 13 internal medicine and family practices in North Carolina.Patients: 2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses.Measurements and Main Results: The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35% of blacks vs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others).Conclusion: Patients' choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients' preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament injuries (ACL) commonly occur during jump landing and cutting tasks. Attempts to landsoftly and land with greater knee flexion are associated with decreased ACL loading. However, their effects on performance areunclear.Hypothesis: Attempts to land softly will decrease peak posterior ground-reaction force (PPGRF) and knee extension moment atPPGRF compared with a natural landing during stop-jump and side-cutting tasks. Attempts to land with greater knee flexion atinitial ground contact will increase knee flexion at PPGRF compared with a natural landing during both tasks. In addition, bothlanding techniques will increase stance time and lower extremity mechanical work as well as decrease jump height and movementspeed compared with a natural landing during both tasks.Study Design: Controlled laboratory study.Methods: A total of 18 male and 18 female recreational athletes participated in the study. Three-dimensional kinematic andkinetic data were collected during stop-jump and side-cutting tasks under 3 conditions: natural landing, soft landing, and landingwith greater knee flexion at initial ground contact.Results: Attempts to land softly decreased PPGRF and knee extension moment at PPGRF compared with a natural landing duringstop-jump tasks. Attempts to land softly decreased PPGRF compared with a natural landing during side-cutting tasks. Attemptsto land with greater knee flexion at initial ground contact increased knee flexion angle at PPGRF compared witha natural landing during both stop-jump and side-cutting tasks. Attempts to land softly and land with greater knee flexion at initialground contact increased stance time and lower extremity mechanical work, as well as decreased jump height and movementspeed during both stop-jump and side-cutting tasks.Conclusion: Although landing softly and landing with greater knee flexion at initial ground contact may reduce ACL loading duringstop-jump and side-cutting tasks, the performance of these tasks decreased, as indicated by increased stance time and mechanicalwork as well as decreased jump height and movement speed.Clinical Relevance: Training effects tested in laboratory environments with the focus on reducing ACL loading may be reduced inactual competition environments when the focus is on athlete performance. The effects of training programs for ACL injury preventionon lower extremity biomechanics in athletic tasks may need to be evaluated in laboratories as well as in actualcompetitions. [ABSTRACT FROM AUTHOR]

Background: Altered local mechanical loading may disrupt normal cartilage homeostasis and play a role in the progression ofosteoarthritis. Currently, there are limited data quantifying local cartilage strains in response to dynamic activity in normal orinjured knees.Purpose/Hypothesis: To directly measure local tibiofemoral cartilage strains in response to a dynamic hopping activity in normalhealthy knees. We hypothesized that local regions of cartilage will exhibit significant compressive strains in response to hopping,while overall compartmental averages may not.Study Design: Controlled laboratory study.Methods: Both knees of 8 healthy subjects underwent magnetic resonance imaging before and immediately after a dynamic hoppingactivity. Images were segmented and then used to create 3-dimensional surface models of bone and cartilage. These preandpostactivity models were then registered using an iterative closest point technique to enable site-specific measurements ofcartilage strain (defined as the normalized change in cartilage thickness before and after activity) on the femur and tibia.Results: Significant strains were observed in both the medial and lateral tibial cartilage, with each compartment averaginga decrease of 5%. However, these strains varied with location within each compartment, reaching a maximum compressive strainof 8% on the medial plateau and 7% on the lateral plateau. No significant averaged compartmental strains were observed in themedial or lateral femoral cartilage. However, local regions of the medial and lateral femoral cartilage experienced significant compressivestrains, reaching maximums of 6% and 3%, respectively.Conclusion: Local regions of both the femur and tibia experienced significant cartilage strains as a result of dynamic activity. Anunderstanding of changes in cartilage strain distributions may help to elucidate the biomechanical factors contributing to cartilagedegeneration after joint injury.Clinical Relevance: Site-specific measurements of in vivo cartilage strains are important because altered loading is believed tobe a factor contributing to the development and progression of osteoarthritis. Specifically, this methodology and data could beused to evaluate the effects of soft tissue injuries (such as ligament or meniscus tears) on cartilage strains in response to dynamicactivities of daily living. [ABSTRACT FROM AUTHOR]

The article presents a study on the most efficient strategy for the diagnosis of meniscus tears. Topics covered include patient history and physical examination (H&P), magnetic resonance imaging (MRI) as part of the diagnostic strategy, and decision analysis. Also mentioned is diagnostic imaging as the fastest rising segment of costs in the health care system in the U.S.

Children’s drawings are thought to reflect their mental representations of self and their interpersonal relations within families. Household chaos is believed to disrupt key proximal processes related to optimal development. The present study examines the mediating role of parenting behaviors in the relations between two measures of household chaos, instability and disorganization, and how they may be evidenced in children’s representations of family dysfunction as derived from their drawings. The sample (N = 962) is from a longitudinal study of rural poverty exploring the ways in which child, family, and contextual factors shape development over time. Findings reveal that, after controlling for numerous factors including child and primary caregiver covariates, there were significant indirect effects from cumulative family disorganization, but not cumulative family instability, on children’s representation of family dysfunction through parenting behaviors. Results suggest that the proximal effects of daily disorganization outweigh the effects of periodic instability overtime. [ABSTRACT FROM PUBLISHER]

The article presents research which compared the patterns in meniscal tear as well as bone contusions in female and male patients with noncontact anterior cruciate ligament injuries. Topics covered include the association of valgus load with such injuries in female patients as well as participation of 73 patients in the study. Also mentioned is the assessment of isolated lateral meniscal tears in participants.

The article discusses a study that determines the impact of knee extension constraint training on lower extremity movement patterns in athletic tasks. Fifty-nine athletes were recruited and screened via a motion analysis test. An image of a knee extension constraint training device instrumented to a knee brace is also shown. It is mentioned that time and sex did not have an interaction impact on the knee flexion angle at the peak impact posterior ground-reaction force.

This section of the publication "Monographs of the Society for Research in Child Development" offers information on the families who participated in the Family Life Project (FLP). It includes data on pregnancy and birth circumstances of the study child, characteristics of families and caregivers, and characteristics of the study children. It notes that the FLP study was conducted in six poor U.S. counties located in North Carolina and Pennsylvania.

This section presents a chapter from the book "Monographs of the Society for Research in Child Development." It discusses the sampling and recruiting process used by researchers of the Family Life Project (FLP). It describes the aspects of sampling design which involved that selection of rural sites in the U.S. and the strategy of conducting hospital visits to ensure the participation of mothers and newborn infants coming from low-income and African American families.

The article discusses a study "Anterior Cruciate Ligament (ACL) Reconstruction in Adolescent Patients: Limb Asymmetry and Functional Knee Bracing," by Boyi Dai and colleagues. It revealed that a bilateral knee kinematic and kinetic asymmetries were observed 6 months after Anterior cruciate ligament reconstruction (ACL-R). The study indicated the importance of examining current rehabilitation. Thus ACL-R resulted in identifying ways to normalize mechanical asymmetries during sports activities.

Objectives To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. Design Cluster randomized controlled trial. Setting Twenty-four nursing homes in North Carolina. Participants Residents with advanced dementia and feeding problems and their surrogates. Intervention Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. Measurements Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. Results Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34). Conclusion A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. [ABSTRACT FROM AUTHOR]

Background: While the majority of quadriceps muscle strains can be managed nonoperatively, rare cases remain symptomatic despite nonoperative treatment.Purpose: The purpose of this study is to report on results of surgical treatment of a limited number of cases of persistently symptomatic tears of the reflected head of the rectus femoris.Study Design: Case series; Level of evidence, 4.Methods: The records of 5 patients with chronic tears of the rectus femoris treated with excision of the reflected head were reviewed. A telephone interview regarding return to sport and current limitations was completed if patients were available for further follow-up.Results: A review of 5 cases of surgical treatment of chronic tears of the reflected head of the rectus was completed. Patients included 1 woman and 4 men with an average age of 21 years (range, 18-24 years). Three patients played football (2 kickers) and 2 played soccer at a collegiate level. All 5 reported a significant decrease in pain during sport and activities of daily living and were able to return to collegiate athletics. Two patients had a late recurrence of pain with kicking that resolved with nonoperative treatment, 1 had residual thigh pain with intense play, 1 had no pain but noted decreased kicking accuracy, and 1 patient returned to play without symptoms.Conclusion: Strain injuries to the reflected head of the rectus femoris can benefit from delayed excision in rare cases that fail nonoperative management. High-level kicking athletes are likely to experience significant reduction in pain, but may have some residual or recurrent symptoms that limit competitive level of play postoperatively. [ABSTRACT FROM AUTHOR]

Background: Implementing an anterior cruciate ligament injury prevention program to athletes before the age at which the greatest injury risk occurs (15-17 years) is important from a prevention standpoint. However, it is unknown whether standard programs can modify lower extremity biomechanics in pediatric populations or if specialized training is required.Hypothesis/Purpose: To compare the effects of traditional and age-specific pediatric anterior cruciate ligament injury prevention programs on lower extremity biomechanics during a cutting task in youth athletes. The authors hypothesized that the age-specific pediatric program would result in greater sagittal plane motion (ie, hip and knee flexion) and less motion in the transverse and frontal plane (ie, knee valgus, knee and hip rotation) as compared with the traditional program.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Sixty-five youth soccer athletes (38 boys, 27 girls) volunteered to participate. The mean age of participants was 10 ± 1 years. Teams (n, 7) were cluster randomized to a pediatric injury prevention program, a traditional injury prevention program, or a control group. The pediatric program was modified from the traditional program to include more feedback, progressions, and variety. Teams performed their programs as part of their normal warm-up routine. Three-dimensional lower extremity biomechanics were assessed during a sidestep cutting task before and after completion of the 9-week intervention period.Results: The pediatric program reduced the amount of knee external rotation at initial ground contact during the cutting task, F(2,62) = 3.79, P = .03 (change: pediatric, 7.73° ± 10.71°; control, –0.35° ± 7.76°), as compared with the control group after the intervention period. No other changes were observed.Conclusion: The injury prevention program designed for a pediatric population modified only knee rotation during the cutting task, whereas the traditional program did not result in any changes in cutting biomechanics. These findings suggest limited effectiveness of both programs for athletes younger than 12 years of age in terms of biomechanics during a cutting task. [ABSTRACT FROM AUTHOR]

Municipalities have revenue motives for enforcing traffic laws in addition to public-safety motives because many traffic offenses are punished via fines and the issuing municipality often retains the revenue. Anecdotal evidence supports this revenue motive. We empirically test the revenue motive using a panel of annual data for North Carolina counties from 1990 to 2003. We find that significantly more tickets are issued in the year following a decline in revenue but that the issuance of traffic tickets does not decline in years following revenue increases. Elasticity estimates reveal that a 10 percent decrease in negative revenue growth results in a 6.4 percent increase in the growth rate of traffic tickets. Our results suggest that tickets are used as a revenue-generation tool rather than solely a means to increase public safety. [ABSTRACT FROM AUTHOR]

Objectives: To determine if athletes with a self reported history of previous injury have a higher incident injury rate than athletes without a self reported injury history. Methods: A prospective cohort study of Classic League soccer players playing at the level under 12 through under 18. Injury history forms were mailed to all registering Classic League soccer players in the North Carolina Youth Soccer Association during 1997-2000 (n = 7000); 1483 (19%) returned the baseline questionnaire and were followed up for in juries. Results: There were 5139 player-seasons of follow up and an estimated 171 957 athlete-exposures. More than half self reported on injury history (59.7%). Overall, the unadjusted incidence rate was 4.6 (95% confidence interval (CI) 4.3 to 4.9) incident in juries per 1000 athlete-exposures. Multivariate generalised Poisson regression modelling indicated that players with one previous injury had a twofold greater risk of incident injury (IRR = 2.6; 95% CI 2.0 to 3.3), and those with two or more previous injuries had a threefold greater risk of incident injury (IRR = 3.0; 95% CI 2.3 to 3.8) compared with athletes with no previous injuries. Conclusions: Injury history was associated with an increased injury rate. This suggests that, even in these youth soccer players, those with an injury history may be at higher risk. [ABSTRACT FROM AUTHOR]

To determine whether self-reports of delayed care predict increased mortality and functional decline in community-dwelling elderly.Longitudinal cohort study.Five counties in North Carolina.A total of 4,162 randomly sampled individuals aged 65 and older.The primary outcome was the proportional hazard ratio (HR) for death in cohorts stratified by self-reports of delayed or foregone care. A secondary outcome, functional decline, measured the cohorts' odds of developing increased dependency in activities of daily living (ADLs). Control variables included predisposing, enabling, and need factors.Of 3,964 eligible participants reporting, 61% never, 27% once in a while, and 12% quite often delayed care. Over 3 years, 13% of participants died, and 17% developed increased ADL dependency. Nevertheless, in unadjusted and adjusted models, neither 3-year mortality HRs nor the odds of functional decline differed between cohorts reporting varying degrees of delayed care. Survival probabilities remained higher for 15 years among those reporting delaying care often.The inability of self-reported delay to predict adverse outcomes in community-dwelling elderly suggests the need for better understanding and support of the care-seeking process and additional measures of timeliness of access. [ABSTRACT FROM AUTHOR]

Objective: National data describing the placement of feeding tubes demonstrated a rapid increase in use in the early and mid-1990s. In the past several years, substantial concerns have arisen regarding the appropriateness of the procedure in many chronically ill patients. The purpose of this study is to determine whether the use of feeding tubes has continued to increase through the 1990s despite these widely publicized concerns.Design: Repeated measure cross-sectional study of the North Carolina Discharge Database.Setting: Analyses of all nonfederal hospital inpatient admissions in North Carolina.Measurements and Main Results: We examined the absolute numbers and rates of feeding tube placements from 1989 to 2000. The rate of feeding tube placement increased from 59/100,000 persons in 1989 to 94/100,000 persons in 2000, an overall 60% increase with slowing in the rate of increase in the late 1990s. However, when outpatient procedures were included, the increase in tube feeding continued throughout the 11-year period of observation. The increase was due to an increase in utilization within all hospitals over the time period. Utilization did not differ between profit and not for profit hospitals. The relative growth rate of inpatient feeding tube placement did not differ by age group but the absolute increase was greatest in those age 75 years and over.Conclusions: Our study demonstrates that the use of feeding tubes has continued to increase through the 1990s. This increase occurred despite ongoing controversy in the medical literature about feeding tube placement in chronically ill patients. [ABSTRACT FROM AUTHOR]

Reports results of a study of school administrators in North Carolina, that focuses on the relationship between pre-kindergarten program characteristics and costs. Questionnaire results; Estimates direct instructional costs of alternative programs; Projects total operating costs per capita.

This paper examines the dimensions of internal stratification in a regionally specific sample of smallholders selected from three North Carolina Piedmont counties. It differs from other smallholder samples in that most respondents are black, low income, and produce flue-cured tobacco. Nevertheless, data analysis reveals that the important dimensions of internal stratification are similar to those identified in previous research. Promax factor analysis shows that the major dimensions of internal stratification are wale of the farm enterprise, off-farm family labor, farm operator's age and education, and land tenure. Canonical discriminant analysis discloses the difference between smallholders who do and who do not own tobacco allotments. These results suggest the importance of incorporating both land tenure and choice of commodity into subsequent analyses of internal stratification among smallholders. [ABSTRACT FROM AUTHOR]

Many studies have sought to describe the complexity and diversity among small-scale farms by means of typologies. Now appropriate methodological techniques must be identified or developed to complement theoretical concerns about heterogeneity among small-scale farmers. Using data from a panel study on small-scale tobacco producers from the Piedmont area of North Carolina, an empirically based typology is generated via cluster analysis. Senior agriculturalist, full-time, and part-time small holders are the descriptive names given to the types identified. The value of cluster analysis for typology creation is demonstrated through an analysis of which farm operators left agriculture during the drought and low-farm-income crisis of 1981 to 1983. The results show that part-time farmers are less likely than either senior agriculturist or full-time farmers to continue as active farm operators. [ABSTRACT FROM AUTHOR]

This study determined how gynecologists' sex, beliefs, appropriateness ratings, and practice characteristics influence hysterectomy rates in North Carolina. Gynecologists who performed hysterectomies at higher rates were further from training, practiced in areas with fewer gynecologists, and had more patients with abnormal bleeding or cancer. Male gynecologists performed 60% more hysterectomies than female gynecologists, but this may have been because they were further from their training. Appropriateness ratings were affected by gynecologists' attitudes toward surgery, recency of training and practice case mix, and by patients' expressed desire to avoid surgery, but they did not predict hysterectomy rates. To decrease their chances of undergoing hysterectomy, patients should express their preferences and possibly seek the opinion of more recently trained gynecologists. [ABSTRACT FROM AUTHOR]