North Carolina School Research Articles

Secondary Transmission of COVID-19 in K-12 Schools: Findings From 2 States.

We evaluated the impact of distancing practices on secondary transmission of severe acute respiratory syndrome coronavirus 2 and the degree of sports-associated secondary transmission across a large diverse cohort of schools during spring 2021. Participating districts in North Carolina and Wisconsin and North Carolina charter schools offering in-person instruction between March 15, 2021 and June 25, 2021 reported on distancing policies, community- and school-acquired infections, quarantines, and infections associated with school-sponsored sports. We calculated the ratio of school-acquired to community-acquired infection, secondary attack rates, and the proportion of secondary transmission events associated with sports. To estimate the effect of distancing and bus practices on student secondary transmission, we used a quasi-Poisson regression model with the number of primary student cases as the denominator. During the study period, 1 102 039 students and staff attended in-person instruction in 100 North Carolina school districts, 13 Wisconsin school districts, and 14 North Carolina charter schools. Students and staff had 7865 primary infections, 386 secondary infections, and 48 313 quarantines. For every 20 community-acquired infections, there was 1 within-school transmission event. Secondary transmissions associated with school sports composed 46% of secondary transmission events in middle and high schools. Relaxed distancing practices (<3 ft, 3 ft) and increased children per bus seat were not associated with increased relative risk of secondary transmission. With universal masking, in-person education was associated with low rates of secondary transmission, even with less stringent distancing and bus practices. Given the rates of sports-associated secondary transmission, additional mitigation may be warranted.

Editorial introductions.

Editorial introductions.

Masking Adherence in K-12 Schools and SARS-CoV-2 Secondary Transmission.

Masking is an essential coronavirus 2019 mitigation tool assisting in the safe return of kindergarten through 12th grade children and staff to in-person instruction; however, masking adherence, compliance evaluation methods, and potential consequences of surveillance are currently unknown. We describe 2 school districts' approaches to promote in-school masking and the consequent impact on severe acute respiratory syndrome coronavirus 2 secondary transmission. Two North Carolina school districts developed surveillance programs with daily versus weekly interventions to monitor in-school masking adherence. Safety teams recorded the proportion of students and staff appropriately wearing masks and provided real-time education after observation of improper masking. Primary infections, within-school transmission, and county-level severe acute respiratory syndrome coronavirus 2 infection rates were assessed. Proper mask use was high in both intervention groups and districts. There were variations by grade level, with lower rates in elementary schools, and proper adherence being higher in the weekly surveillance group. Rates of secondary transmission were low in both districts with surveillance programs, regardless of intervention frequency. Masking surveillance interventions are effective at ensuring appropriate masking at all school levels. Creating a culture of safety within schools led by local leadership is important and a feasible opportunity for school districts with return to in-person school. In our study of schools with high masking adherence, secondary transmission was low.

Reply by Authors.

Reply by Authors.

School Safety, Masking, and the Delta Variant.

School Safety, Masking, and the Delta Variant.

Community SARS-CoV-2 Surge and Within-School Transmission.

When the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began, experts raised concerns about in-person instruction in the setting of high levels of community transmission. We describe secondary transmission of SARS-CoV-2 within North Carolina kindergarten through 12th-grade school districts during a winter surge to determine if mitigation strategies can hinder within-school transmission. From October 26, 2020, to February 28, 2021, 13 North Carolina school districts participating in The ABC Science Collaborative were open for in-person instruction, adhered to basic mitigation strategies, and tracked community- and school-acquired SARS-CoV-2 cases. Public health officials adjudicated each case. We combined these data with that from August 2020 to evaluate the effect of the SARS-CoV-2 winter surge on infection rates as well as weekly community- and school-acquired cases. We evaluated the number of secondary cases generated by each primary case as well as the role of athletic activities in school-acquired cases. More than 100 000 students and staff from 13 school districts attended school in person; of these, 4969 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, North Carolina local health department staff identified an additional 209 infections among >26 000 school close contacts (secondary attack rate <1%). Most within-school transmissions in high schools (75%) were linked to school-sponsored sports. School-acquired cases slightly increased during the surge; however, within-school transmission rates remained constant, from presurge to surge, with ∼1 school-acquired case for every 20 primary cases. With adherence to basic mitigation strategies, within-school transmission of SARS-CoV-2 can be interrupted, even during a surge of community infections.

Fully Integrated Readiness for Service Training (FIRST): An Accelerated Medical Training Program for Rural and Underserved North Carolina.

The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas. At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC's 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students. As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program. The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.

A Taste of Virtual Culinary Medicine and Lifestyle Medicine-An Online Course for Medical Students.

As medical schools work to train the next generation of providers, including robust content in nutrition education is paramount. The National Academy of Sciences sets the benchmark for 25 hours of nutrition education in medical schools, though many schools do not meet this requirement. Usually, nutrition lectures in medical schools are given in the pre-clinical years and focus on biochemistry and micronutrients. During the COVID-19 pandemic, there was a unique opportunity to quickly develop and implement an elective course for 3rd and 4th year medical students at the University of North Carolina School of Medicine. A course was created in lifestyle medicine and culinary medicine, and all were delivered remotely through Zoom. This course would be simple to replicate at other institutions and was very well received. This article will describe more of the resources, methods, and reactions to this course.

Small Group Tutorial Curriculum During Third Year Surgical Clerkship and Identification of Surgical Role Models.

Identification of surgical mentors is associated with medical student interest in surgical careers. Small group learning has been a fundamental component of the surgical clerkship at the University of North Carolina (UNC) School of Medicine for 14years. The curriculum was standardized on 2018 and has long been hypothesized to facilitate mentoring relationships. In this brief report, we administered a survey that assessed the relationship between students and surgical faculty serving as small group tutors. Analysis was performed by descriptive statistics and chi-square analysis. The survey yielded an 18.8% response rate. Greater than 50% of students identified their tutor as a surgical role model. Greater than 60% of students affirmed that their tutor at least somewhat influenced their interest in surgery. Larger longitudinal studies with higher response rates are needed to assess relationships over time, and if these relationships ultimately correlate with applications made to surgical residency programs.

Creating an Ultrasound Scholarly Concentration Program for Medical Students.

IntroductionPoint of care ultrasound (POCUS) is increasingly prevalent and standardized in undergraduate medical education (UME); however, roughly 25% of United States medical schools lack an ultrasound curriculum. One of the commonly cited barriers to ultrasound training in UME is faculty time resources. Here, we describe an ultrasound scholarly concentration program (SCP) designed to provide medical students with ultrasound opportunities in clinical and scholarly domains, while reducing the need for extensive faculty resources.MethodsSCPs at the University of North Carolina School of Medicine have 3 requirements: an elective course, a longitudinal portfolio, and a final scholarly project. Thus, the ultrasound SCP was designed to comprise an introductory clinical elective to ultrasound, development of a longitudinal scan portfolio, and a final scholarly project in ultrasound related research or educational innovation. A review of the literature and search of the top 50 US medical schools by US News & World Report was performed to assess the novelty of the ultrasound SCP.ResultsTo the best of our knowledge, the ultrasound SCP is the first scholarly concentration, track or pathway offered to medical students in the United States. It is the first description of a student designed and student led curriculum focused on providing meaningful ultrasound opportunities to students without necessitating unavailable faculty resources and educational infrastructure.ConclusionA novel ultrasound SCP is described which has clinical aims to expose students to clinical ultrasound as well as scholarly aims to facilitate ultrasound related research and educational innovation. It is designed to enable students to make ultrasound a defining characteristic of their medical school experience. The SCP relies on motivated student involvement and near-peer teaching in a way that is self-sustaining and self-improving.

Conference Proceedings of the 2020-2021 John B. Graham Student Research Symposium

Established in 1987, the John B. Graham Medical Student Research Society recognizes and promotes the research efforts of the medical student body at the University of North Carolina School of Medicine in basic science, public health, and clinical sciences. Throughout the year, members exchange ideas and share their experiences about conducting research. In addition, the Society serves to encourage collaboration with faculty to promote productive research opportunities for students. The following conference proceedings represent abstracts accepted for presentation at the 2020-2021 Student Research Day.

Impact of School Nurse Ratios and Health Services on Selected Student Health and Education Outcomes: North Carolina, 2011-2016.

Determination of adequate school nurse staffing is a complex process. School nurse-to-student ratios and the health services school nurses provide to students should be considered. The purpose of this study was to examine the impact of North Carolina school nurse-to-student ratios and school nurse health services on the health and education outcomes (eg, absences, grades, self-management) of students receiving services for asthma and diabetes. This study of all 115 school districts in North Carolina used the Annual School Health Services Report Survey from 2011 to 2016. Descriptive statistics for health services, programs and outcomes, and generalized linear modeling were used to estimate the association of ratios and health services with asthma and diabetes outcomes. By the 2015-2016 school year, the average ratio decreased to 1:1086 in North Carolina public schools. Annually, 100,187 students received services for asthma, 3832 students received services for type 1 diabetes, and 913 students received services for type 2 diabetes. Lower ratios and nurse health services were associated with improved student outcomes, including decreased absences (p=.05), improved grades (p=.05), and student self-management of their health condition (p=.05). Lower school nurse-to-student ratios and services were associated with improvements in students' health and education outcomes.

Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools.

In an effort to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), North Carolina closed prekindergarten through grade 12 public schools to in-person instruction on March 14, 2020. On July 15, 2020, North Carolina's governor announced schools could open via remote learning or a hybrid model that combined in-person and remote instruction. In August 2020, 56 of 115 North Carolina school districts joined The ABC Science Collaborative (ABCs) to implement public health measures to prevent SARS-CoV-2 transmission and share lessons learned. We describe secondary transmission of SARS-CoV-2 within participating school districts during the first 9 weeks of in-person instruction in the 2020-2021 academic year. From August 15, 2020 to October 23, 2020, 11 of 56 school districts participating in ABCs were open for in-person instruction for all 9 weeks of the first quarter and agreed to track incidence and secondary transmission of SARS-CoV-2. Local health department staff adjudicated secondary transmission. Superintendents met weekly with ABCs faculty to share lessons learned and develop prevention methods. Over 9 weeks, 11 participating school districts had >90 000 students and staff attend school in person. Among these students and staff, 773 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, health department staff determined an additional 32 infections were acquired within schools. No instances of child-to-adult transmission of SARS-CoV-2 were reported within schools. In the first 9 weeks of in-person instruction in North Carolina schools, we found extremely limited within-school secondary transmission of SARS-CoV-2, as determined by contact tracing.

A Legal Right to Clozapine Therapy for Incarcerated Individuals With Treatment-Resistant Schizophrenia.

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.S. Food and Drug Administration. In this column, the authors argue that incarcerated individuals with TRS have a statutory and constitutional right to treatment with clozapine.

A Non-randomized Trial of Kundalini Yoga for Emotion Regulation within an After-school Program for Adolescents

Adolescence is a critical age for developing difficulties with emotion regulation and other psychosocial problems. Yoga programs implemented in schools may be a promising method of intervention, as previous research suggests that they improve emotion regulation and other psychological outcomes in adolescents. This study examined the effects of the Kundalini Yoga-based Y.O.G.A for Youth (Y4Y) after-school program on adolescents’ self-reported emotion dysregulation and psychological functioning. A sample of 119 students, ages 11–14, was recruited through after-school programs for middle school students in the North Carolina school system. Within four public schools, participants participated in 6 weeks of either the Y4Y after-school program (n = 52), or an alternate activity (n = 66) and completed self-report measures of emotion dysregulation, anxiety, depression, stress and mindfulness before and after the 6 weeks. Results from this study suggest that the students who participated in the Y4Y program reported significant decreases in emotion dysregulation over the 6-week program. They also reported significant decreases in anger, depression and fatigue over one yoga session. Students in the comparison condition only reported significant decreases in fatigue over one session of the program but reported no significant changes in any of the other outcomes. Results from exploratory between-subject analyses also suggested that the Y4Y program’s impact on depression, stress and anxiety depended on the school setting in which they were implemented. These findings suggest that the Y4Y program improved emotion dysregulation in adolescent students. However, some of its benefits may be influenced by the school environment.

Editorial introductions

Editorial introductions

AAV Jude: An Interview with R. Jude Samulski.

Editor's note: It is rare that a breakthrough study performed as a graduate student sets the course for the rest of a scientist's distinguished career. But Richard Jude Samulski's study in the early 1980s on an emerging viral vector-adeno-associated virus (AAV)-played a profound role in shaping the evolution of the gene therapy field. Samulski et al. stuck to their beliefs in the clinical potential of AAV, riding out some difficult times for the field to emerge emboldened. Until 2016, Samulski was the head of the Gene Therapy Center at the University of North Carolina School of Medicine. In October 2020, the German big pharma Bayer agreed to acquire Samulski's company AskBio for an impressive $4 billion. Kevin Davies recently interviewed Samulski to learn about his early research career highlights, the launch and evolution of AskBio, and his hopes for the future of AAV therapy. (This interview has been lightly edited for clarity and length.).

613: Scoping Review of Augmented Renal Clearance (ARC) in the Critically Ill Oncology Patient Population

1UNC Eshelman School of Pharmacy, Chapel HIll, NC 2North Carolina School of Science and Math, Durham, NC 3University of North Carolina School of Pharmacy, Chapel Hill, NC

Survey of Lead in Drinking Water from Schools and Child Care Centers Operating as Public Water Suppliers in North Carolina, USA: Implications for Future Legislation.

Few schools and child care facilities test for Pb in their drinking water. Reviewing the United States Environmental Protection Agency Lead and Copper rule data can contribute to guiding future legislation on Pb testing. This work aims to (i) identify variations in Pb levels in North Carolina school and child care drinking water by building age, (ii) evaluate the effect of corrosion control measures on reducing these levels, and (iii) evaluate the adequacy of Pb reporting limits according to modern instrumentation. To achieve these objectives, information on 26,608 water samples collected in 206 North Carolina child centers between 1991 and 2019 has been analyzed. Lead concentrations were above a recently proposed 5 μg/L trigger level in 12.3%, 10.4%, 7.5%, and 0.9% of samples from pre-1987, 1987-1990, 1991-2013, and post-2013 buildings, respectively. Thus, recently proposed legislation requiring testing only for pre-1987 (or pre-1991) buildings will fail to identify all centers at risk. The odds that a greater than 5 μg/L Pb level is detected has been decreasing over the years, with a faster decreasing rate for buildings reporting corrosion control. Over 15% of samples report a method detection limit of 5 μg/L. For accurate results, future legislation should require sub-μg/L detection limits, which are easily achievable with commonly available instrumentation.

In Memoriam: Gerald Freedman (1927–2020)

Acclaimed theater and artistic director Gerald Freedman passed away on 17 March 2020. In a career spanning almost seventy years, Freedman became one of the more accomplished and influential directors in American theater. His credits are almost too numerous to list, but highlights include directing book scenes for the original Broadway productions of West Side Story and Gypsy, and a long association with Joseph Papp's Public Theatre, where he directed the world premiere of Hair and served as artistic director. His other stints as artistic director include The Acting Company with John Houseman and Stratford, Connecticut's American Shakespeare Theatre. Additionally, Freedman had a long tenure as artistic director of the Great Lakes Theater Festival in Cleveland, Ohio, from 1985 to 1997. He also served as Dean of the School of Drama at the University of North Carolina School of the Arts.Freedman holds a significant place in the production history of Arthur Miller's work. Miller's 1972 play The Creation of the World and Other Business had much trouble during the rehearsal period over artistic differences between Miller and the production staff. The original director Harold Clurman and most of the cast, including Barbara Harris and Hal Holbrook, were replaced, and Miller rewrote much of the material. Freedman took over the direction, but the Broadway production with Zoe Caldwell, Bob Dishy, and George Grizzard was largely panned and ran for only twenty performances. Freedman had greater critical success with his direction of the 1990 Roundabout Theatre production of The Crucible, which was the first major New York revival in almost twenty years. At the Great Lakes Theatre Festival in 1994, Freedman directed Death of Salesman, featuring Hal Holbrook as Willy Loman and Elizabeth Franz as Linda. The production subsequently went on a seven-city U.S. national tour.When the Arthur Miller Society was formed in 1995, Freedman graciously accepted an invitation to join the honorary board. The theater world is forever changed because of his significant contributions.—Steve Marino