University Of North Carolina At Chapel Hill Research Articles

Assessing Interprofessional Collaboration at Clinical Learning Sites: Methodology on Developing the IP-CLEAR Tool

Interprofessional Clinical Learning Environment Assessment and Reflection (IP-CLEAR) tool was developed by a team of faculty from the schools of nursing, pharmacy, and medicine at University of North Carolina at Chapel Hill (UNC-CH), with the support of the North Carolina Area Health Education Consortium (NC AHEC) and the UNC-CH Office of Interprofessional Education and Practice (IPEP). The IP-CLEAR tool is intended for use by clinical sites that have or want to have clinical learners engaged and integrated into an excellent interprofessional CLE. The development of the IP-CLEAR and projections for future work are described here.

Identifying and Responding to Lead in Drinking Water in a University Setting.

Lead is an established neurotoxicant, and it has known associations with adverse neurodevelopmental and reproductive outcomes. Exposure to lead at any level is unsafe, and the United States (US) has enacted various federal and state legislations to regulate lead levels in drinking water in K-12 schools and childcare facilities; however, no regulations exist for higher education settings. Upon the discovery of lead in drinking water fixtures in the University of North Carolina at Chapel Hill (UNC-CH) campus, a cross-campus water testing network and sampling plan was developed and deployed. The campaign was based on the US Environmental Protection Agency's (EPA) 3Ts (Training, Testing, and Taking Action) guidance. The seven-month campaign involved 5954 tests on 3825 drinking water fixtures across 265 buildings. A total of 502 (8.43%) tests showed lead above the limit of detection (1 part per billion, ppb), which represented 422 (11.03%) fixtures. Fewer than 1.5% of the tests were above the EPA action level for public water systems (15 ppb). In conclusion, systematic testing of all the fixtures across campus was required to identify localized contamination, and each entity in the cross-campus network undertook necessary roles to generate a successful testing campaign. UNC-CH established preventative measures to test drinking water fixtures every three years, which provide a framework for other higher education institutions in responding to lead contamination.

Retrospective Study of Prenatal and Postnatal Gaps in Oral Health Care Utilization: Medicaid Policy Implications.

To assess the frequency and timing of dental treatment completion among pregnant and post-partum women served through the University of North Carolina at Chapel Hill (UNC-CH) Prenatal Oral Health Program (pOHP) dental clinic in the context of North Carolina (NC) dental Medicaid policies. We completed a retrospective chart review of pregnant women referred to the program between May 2015 and May 2019. Data were collected from the time of referral until up to 2years after their estimated due date (EDD). We assessed pre- and post-delivery dental appointment timing and dental treatment completion. The initial study population included 264 pregnant women. Overall, 213 patients (81%) attended at least one appointment, and 32 patients (12%) completed recommended treatments prior to their EDD. Fifty patients (19%) returned after delivery to resume dental care, with only 25 patients (10%) completing their recommended treatment plan. Women re-entered dental care at a median of 67days (range 5-613days) after their EDD and completed treatment at a median of 378days (range 52-730days) following delivery. Despite dental clinic referral, most pregnant women do not complete recommended dental treatment before giving birth, and women who resumed dental care after birth demonstrated a lag-time between delivery and care completion. These findings highlight the need for extending post-pregnancy dental care coverage, which is limited under current dental Medicaid policies, posing a major public health issue for new mothers to continue oral health care.

Brain Tumor Microenvironment and Angiogenesis in Melanoma Brain Metastases.

BackgroundHigh tumor-infiltrating lymphocytes (TILs) and hemorrhage are important prognostic factors in patients who have undergone craniotomy for melanoma brain metastases (MBM) before 2011 at the University of Pittsburgh Medical Center (UPMC). We have investigated the prognostic or predictive role of these histopathologic factors in a more contemporary craniotomy cohort from the University of North Carolina at Chapel Hill (UNC-CH). We have also sought to understand better how various immune cell subsets, angiogenic factors, and blood vessels may be associated with clinical and radiographic features in MBM.MethodsBrain tumors from the UPMC and UNC-CH patient cohorts were (re)analyzed by standard histopathology, tumor tissue imaging, and gene expression profiling. Variables were associated with overall survival (OS) and radiographic features.ResultsThe patient subgroup with high TILs in craniotomy specimens and subsequent treatment with immune checkpoint inhibitors (ICIs, n=7) trended to have longer OS compared to the subgroup with high TILs and no treatment with ICIs (n=11, p=0.059). Bleeding was significantly associated with tumor volume before craniotomy, high melanoma-specific expression of basic fibroblast growth factor (bFGF), and high density of CD31+αSMA- blood vessels. Brain tumors with high versus low peritumoral edema before craniotomy had low (17%) versus high (41%) incidence of brisk TILs. Melanoma-specific expression of the vascular endothelial growth factor (VEGF) was comparable to VEGF expression by TILs and was not associated with any particular prognostic, radiographic, or histopathologic features. A gene signature associated with gamma delta (gd) T cells was significantly higher in intracranial than same-patient extracranial metastases and primary melanoma. However, gdT cell density in MBM was not prognostic.ConclusionsICIs may provide greater clinical benefit in patients with brisk TILs in MBM. Intratumoral hemorrhage in brain metastases, a significant clinical problem, is not merely associated with tumor volume but also with underlying biology. bFGF may be an essential pathway to target. VEGF, a factor principally associated with peritumoral edema, is not only produced by melanoma cells but also by TILs. Therefore, suppressing low-grade peritumoral edema using corticosteroids may harm TIL function in 41% of cases. Ongoing clinical trials targeting VEGF in MBM may predict a lack of unfavorable impacts on TIL density and/or intratumoral hemorrhage.

Evaluating a CTSA-funded pilot grant program.

Pilot programs are integral to catalyzing and accelerating research at Clinical and Translational Science Award (CTSA) hubs. However, little has been published about the structure and operationalization of pilot programs or how they impact the translational research enterprise at CTSAs. The North Carolina Translational and Clinical Science Institute (NC TraCS), the CTSA hub at the University of North Carolina at Chapel Hill (UNC-CH) conducted an evaluation case study to describe the pilot program structure, assess process outcomes, and provide a framework for other institutions to utilize for the evaluation of their respective pilot programs. We describe the operationalization of our pilot program, the evaluation framework utilized to evaluate the program, and how we analyzed available data to understand how our pilot funding opportunities were utilized by investigators. We calculated application volumes and funding rates by investigator position title and pilot application type. We also reviewed feedback provided by pilot Principal Investigators (PIs) to understand how many pilot projects were completed, NC TraCS service utilization, and barriers to research. Limited data on publications and subsequent funding was also reviewed. Between 2009 and 2019 the NC TraCS Pilot Program received 2343 applications and funded 933 projects, ranging from $2000 to $100,000 in amount, with an overall funding rate of 39.8%. Utilization of NC TraCS services had positive impacts on both resubmission funding and project completion rates. This process evaluation indicates that the program is being operationalized in a way that successfully fulfills the program mission while meeting the needs of a diverse group of researchers.

Asynchronous pediatric caregiver simulation in a virtual setting during the COVID pandemic.

Patient simulation has been used widely in health professions education.1-3 The University of North Carolina at Chapel Hill (UNC-CH) Adams School of Dentistry has embraced patient simulations as a core component of student assessment. Students complete in-person interviews with standardized patient (SP) actors to practice interviewing skills and develop deeper diagnostic reasoning and critical thinking. Simulation exercises are treated as real-life events subject to professional codes of conduct and confidentiality regulations.4 Each SP encounter is video-recorded for student assessment and debriefing, and the videos are stored on university-approved digital storage platforms. In the spring semester of 2020, patient simulations were integrated into a pediatric dentistry course for second-year dental students. The pandemic prevented students from completing their final in-person simulation. As part of a larger evaluation of patient simulation in dental education, the UNC-CH Institutional Review Board deemed this nonhuman subjects research (IRB #20-0292). The original objective of the final encounter was to assess the student's ability to deliver oral health counseling and pediatric dental treatment plans. As an alternative to the in-person encounter, the SP encounter occurred virtually. Using secure Zoom, the course director video-recorded a simulated caregiver interview with the SP training specialist at the UNC-CH School of Medicine's Clinical Skills and Patient Simulation Center. Students responded to SP questions and delivered a prioritized list of treatment options. They had 24 hours to prepare and submit a 5–10-minute video for grading. The Clinical Skills and Patient Simulation Center provided a communication rubric template to the course director. Departmental faculty added checklists for the clinical interview, and Likert items for oral health counseling and pediatric treatment planning. Calibration occurred during weekly faculty meetings. Following the pandemic modification, the final rubric omitted all checklists, and included only 12 Likert items using a 4-point scale, with 1 = “poor” and 4 = “outstanding” (Figure 1). Originally, departmental faculty were scheduled to grade the in-person simulations remotely via video simulcast (Figure 2). Following the pandemic modification, the same faculty had 1 week to complete grading. A critical component of SP encounters is student debriefing and reflection.4 Better guidance from faculty would have standardized student attire and professionalism for their recordings. Students expressed enthusiasm for the future potential of asynchronous teledentistry; however, some were uncertain about the widespread applicability in comprehensive oral health care. Peer-to-peer reflection helped students understand alternative perspectives and integrate key concepts. As a quality improvement exercise, the consent process for recording SP encounters was revisited. Students signed a generic electronic media policy that included recording for educational purposes, which was assumed to cover SP encounters. Following the course modification, students will sign course-specific consents for recording these encounters moving forward. The main takeaway from the faculty was the general success of this modification to patient simulation in terms of providing students an opportunity to demonstrate their grasp of oral health counseling and pediatric dental treatment planning prior to entering clinic. By applying lessons learned, asynchronous teledentistry simulation may become a regular part of the student curriculum.

Implications of Removing Rosiglitazone's Black Box Warning and Restricted Access Program on the Uptake of Thiazolidinediones and Dipeptidyl Peptidase-4 Inhibitors Among Patients with Type 2 Diabetes.

Medications are increasingly being approved with limited, short-term evidence regarding safety. Regulatory safety concerns may emerge for these drugs but later may be reversed if additional evidence suggests no warning is indicated. To describe trends over time in the initiation of rosiglitazone and pioglitazone-both in the thiazolidinedione (TZD) class-and medications from the dipeptidyl peptidase-4 (DPP-4) inhibitor class before and after the FDA removed a black box warning and restricted access program for rosiglitazone regarding an increased risk of myocardial infarction. This retrospective study evaluated initiation of TZDs and DPP-4 inhibitors using 2001-2015 administrative claims data from a U.S. commercially insured population. Patients were aged 18-64 years and were new users of either a TZD or DPP-4 inhibitor. Among all patients who were new users of either a TZD or a DPP-4 inhibitor during each quarter-year (Q), the percentage of patients who initiated rosiglitazone, pioglitazone, and DPP-4 inhibitors were calculated. There were 630,977 patients eligible for the study. During 2007, rosiglitazone initiators decreased from 39.1% to 8.0% in 2007 Q4 when the black box warning was implemented. During 2010, rosiglitazone initiators decreased from 7.6% to 1.0%, as safety evidence accumulated and the restricted access program requirement was announced. Rosiglitazone initiation remained below 1.0%, even after regulatory restrictions were removed in November 2013. Pioglitazone initiation decreased from 46.4% in 2010 Q1 to 14.8% in 2011 Q4 and remained relatively constant between 14.5% and 17.8% after regulatory restrictions for rosiglitazone were removed. After DPP-4 inhibitors first became available in 2006 Q3, initiation of this medication class increased rapidly, stayed relatively constant between 42.8% and 45.5% in 2009, and then quickly rose and remained above 80% from 2012 through 2015. This case study provides some evidence that adding and later reversing drug safety warnings-particularly those with restricted access requirements-may affect the uptake of the targeted product into the population when multiple clinically relevant treatment alternatives are available (such as type 2 diabetes). Once a treatment falls out of favor, removal of safety warnings and/or restricted access programs may not lead to increased use. This project was not directly supported by any funding. Hickson was supported by the National Heart, Lung, and Blood Institute through a National Research Service Award (NRSA) training grant (4T32HL007055-41) as a postdoctoral research fellow with the Cardiovascular Disease Epidemiology Program at The University of North Carolina at Chapel Hill (UNC-CH). Cole was supported by a NRSA Predoctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by The Cecil G. Sheps Center for Health Services Research, UNC-CH (grant no. T32-HS000032) and a predoctoral fellowship from the American Foundation for Pharmaceutical Education. Unrelated to this project, Cole was a part-time employee of Truven Health Analytics/IBM Watson Health. Dusetzina has nothing to disclose.

Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting.

There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children. A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4-12. Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference. Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

Data-Informed Ebook Discovery: An Analytical Approach to the User Experience

ABSTRACTThis article reports on an effort to better understand the discoverability of ebook collections at the University of North Carolina at Chapel Hill (UNC-CH). Library staff analyzed titles in nine ebook packages across disciplines and conducted a two-pronged analysis of how discoverable titles in these collections were, both in Summon Discovery Service and the online catalog, and the quality of what could be discovered about the ebooks with these tools. This study revealed that discoverability of ebooks is not equal across collections, and some collections require more work to make them discoverable in Summon and the catalog. Finally, the majority of titles were discovered in Summon, but the catalog still seems to be a better discovery engine for these ebooks.

The Omega‐6 to Omega‐3 Fatty Acid Ratio Predicts Brain Activity During Planning Tasks in Middle Childhood.

The Omega‐6 to Omega‐3 Fatty Acid Ratio Predicts Brain Activity During Planning Tasks in Middle Childhood.

In Memoriam: Steve Wing

In Memoriam: Steve Wing

A Virological Perspective on Cancer

A Virological Perspective on Cancer

A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience.

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. 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. 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/HER2- breast cancer, and 3.03 years (95% CI lower limit 1.94, upper limit not estimable) for HER2+ breast cancer (p = .0037). 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. Patients with breast cancer brain metastases often require unique multidisciplinary care to meet the numerous and uncommon challenges associated with their conditions. Here, the development and characteristics of a clinic designed specifically to provide for the multidisciplinary needs of patients with breast cancer brain metastases are described. This clinic may serve as a model for other institutions interested in creating specialty clinics with similar objectives.

Beyond Incentives for Involvement to Compensation for Consultants: Increasing Equity in CBPR Approaches

Community-based participatory research (CBPR) strives for equitable collaboration among community and academic partners throughout the research process. To build the capacity of academia to function as effective research partners with communities, the North Carolina Translational and Clinical Sciences Institute (NC TraCS), home of the University of North Carolina at Chapel Hill (UNC-CH)'s Clinical and Translational Sciences Award (CTSA), developed a community engagement consulting model. This new model harnesses the expertise of community partners with CBPR experience and compensates them equitably to provide technical assistance to community-academic research partnerships. This paper describes approaches to valuing community expertise, the importance of equitable compensation for community partners, the impact on the community partners, opportunities for institutional change, and the constraints faced in model implementation. Community Experts (CEs) are independent contractor consultants. CEs were interviewed to evaluate their satisfaction with their engagement and compensation for their work. (1) CEs have knowledge, power, and credibility to push for systems change. (2) Changes were needed within the university to facilitate successful consultation to community-academic partnerships. (3) Sustaining the CE role requires staff support, continued compensation, increased opportunities for engagement, and careful consideration of position demands. (4) The role provides benefits beyond financial compensation. (5) Opportunities to gather deepened relationships within the partnership and built collective knowledge that strengthened the project. Leveraging CE expertise and compensating them for their role benefits both university and community. Creating a place for community expertise within academia is an important step toward equitably including the community in research.

The tricky matter of secondary genomic findings

The tricky matter of secondary genomic findings

Introduction

Introduction Melvin I. Urofsky For a long time, scholars as well as in­ terested layfolk have been asking where they can find an index to the Journal. While some of the more recent issues have been indexed in various compendia, there has been no eas­ ily accessible means oflooking up articles and authors that appeared earlier in our history. I must confess that I have often mumbled about the lack ofan index when doing my own work. I “know” that someone wrote something about some person or issue, but after nearly twenty years as editor I have no idea when that partic­ ular article appeared. So you can imagine my (scholarly) joy when Joel Fishman, a law librarian and expert indexer, approached us to discuss com­ piling an index, going back to when we were the Supreme Court Historical Society Yearbook in the 1970s. It is a well-done project, and I fully anticipate that people who for whatever reason are trying to find some­ thing in the back issues will greet it with the same pleasure I did. The index is also avail­ able on the Society’s website at http://www. supremecourthistory.org/publications/, where it is fully searchable. Mark R. Killenbeck of the University of Arkansas Law School provides us some in­ sight on one ofthe most unusual exchanges of letters between a sitting Supreme Court Jus­ tice and the man who appointed him. Thomas Jefferson had never likedJohn Marshall’s lead­ ing the Court away from the earlier tradition of seriatim opinions, in which each judge wrote separately on each case, and he fumed even more when the men he and James Madison put on the Court to counter Marshall’s influ­ ence seemed to meekly fall into line. Although there had been serious discussion about the value ofseriatim versus opinions ofthe Court, this may have been one ofthe most fascinating exchanges, since it involveda former President and a sitting Justice. In his essay, John Orth of The University ofNorth Carolina atChapel Hill, notes that law students tend to fall asleep when the Eleventh Amendment is discussed in federal jurisdic­ tion classes. Well, I do not know if I actually fell asleep (I had a pretty good teacher for that course), but I must admit that the discussion was nowhere near as much fun as John makes it. Moreover, this may be the first time that the v vi JOURNAL OF SUPREME COURT HISTORY Journal has published a quasi-Science fiction piece with alternate universes. On many occasions I have noted that the field of constitutional history is a rather close-knit group, and this is even truer of its subset, the history of the Supreme Court. I count both Mark Killenbeck and John Orth as friends as well as colleagues, and I have known Barbara Perry since she was a graduate as­ sistant to another old friend, the great Henry Abrahams. Barbara is a formerjudicial fellow of the Court, and after a stint at Sweet Briar, has returned to the University of Virginia as a senior fellow at the Miller Center. We all know that the Constitution pro­ vides that the President shall nominate people to the judiciary, and we also know that when vacancies occur, especially on the high court, the President gets a great deal of advice— unwanted as well as wanted—from a lot of people as to whose name should go to the Senate for confirmation. It is not well-known, however, that at least since the early nineteenth century members of the Court have also ten­ dered their views to the Chief Executive on who should be their future colleagues, and how often these suggestions have borne fruit. While not an alternative universe, Barbara’s essay will also cause us to rethink some older assumptions. Finally, and as always, we welcome Grier Stephenson’s “Judicial Bookshelf” to inform us about some of the new books that have recently appeared dealing with the Supreme Court and its members. As I have said before, we sometimes tend to take the “Bookshelf” for granted because it is always timely, always perceptive, and always well-written. The fact that we assume so much about...

Digital Curation Education in Practice: Catching up with Two Former Fellows

From 2008-2010, as part of the grant: ‘DigCCurr I: Preserving Access to Our Digital Future: Building an International Digital Curation Curriculum’ (DigCCurr I) funded through the Institute of Museum and Library Services, a number of fellows at the School of Information and Library Science (SILS) at the University of North Carolina at Chapel Hill (UNC-CH) were comprehensively trained by library and archive professionals in digital curation theory and practice. This paper examines the curriculum skill areas matrix of the DigCCurr I program from the perspective of two former fellows, now employed in professional positions that utilize digital curation principles. Each fellow offers an analysis of digital curation functions and subfunctions as they relate to her current position, deriving suggestions for future iterations of the DigCCurr program and other graduate programs meant to prepare digital curators. While DigCCurr has been reported by its creators, a group of seasoned digital curation professionals and educators from around the world, this paper provides a fresh perspective from graduates of the program who are applying their newly learned digital curation skills and knowledge in the workforce.

New legal model suggested for DNA samples given to biobanks

New legal model suggested for DNA samples given to biobanks

"Daddy! Are We There, Yet?" Children's Literature, Progress, and the Demise of Innocence – A Review of "Relentless Progress: The Reconfiguration of Children's Literature, Fairy Tales, and Storytelling"

Storytelling, Self, Society ,7:77-82, 2011 Copyright©Taylor &Francis Group, LLC ISSN1550-5340 print /1932-0280 online DOI:10.1080/15505340.2011.530121 Routledge Taylor &Francis Group REVIEW ESSAY "Daddy! Are We There, Yet?" Children's Literature, Progress, and the Demise of Innocence - A Review of Relentless Progress: The Reconfiguration of Children ' s Literature, Fairy Tales , and Storytelling Brian Sturm Zipes,Jack. Relentless Progress:TheReconfiguration ofChildren's Literature, FairyTales ,andStorytelling. NewYork:Routledge, 2009.$34.95. In Relentless Progress, JackZipes offers a collection of essaysthatare both provocative andtroubling. With hisusualbreadth anddepth ofreading andanalysis ,Zipesdraws together opinions andresearch from multiple disciplines tobuild a cogent argument aboutthenegative impact ofglobalization andconsumerism onpeople'sability todevelopcommunity andindividuality. He claimsthat these social forcesare changing ("reconfiguring" to use his term)children, books, and stories intocommodities thatcreatesame-mindedness through simplified andgeneralized narratives ("mereentertainment") thatservethecorporate and media-driven needstoreachthewidest possibleaudience, all tothedetriment of self-actualization anddiscovery. Address correspondence toBrian Sturm, School ofInformation and Library Science, University ofNorth Carolina atChapel Hill, 216Lenoir Drive, CB#3360, 100 Manning Hall, Chapel Hill, NC 27599-3360. E-mail: sturm@ils.unc.edu 78 STURM Thebookis a masterpiece ofdesign, withthefirst three chapters addressing themostpressing needsandproblems thatarisefrom current, socialpressures andtheculture industry. Chapter four serves as thepivotal moment when thetone ofthebookmovesfrom anemphasis onexcoriating thehegemonic elements of ourconsumerist society toan exploration ofpotential solutions (albeittentative ones),andthechapter itself follows thisform as manifested byitssubtitle, Three Complaints and ThreeWishes. The final three chapters offer thereader thepalliative hopethat all is notlost(as thefirst chapters seemtoemphasize), andthat amidst - andagainst - thetideoftheculture industry, authentic stories (invarious forms) continue tosurvive, replicate, andprovide soul-sustenance tothose willing toseekthem out. Chapter one,"The Reconfiguration ofChildren andChildren's Literature in theCulture Industry," decriesthemarket forces at workinchildren's livesthat transform them intoexpectant andhigh-speed consumers who"assumefunctions within a socio-economic system thatfurthers exploitation ofindividuals of all agesandthecommunities inwhich they live"(3). Zipescontends that children's literature, produced in vastquantities of decreasing qualityandby fewer and fewer international publishing conglomerates, hasbecomemore commodified and inextricably interwoven withcommercial products andsequels.Thebottom line governs mostpublishing choices,andchildren arebeingconditioned toreadin newways:tofurther consumption rather thanenlightenment. Therealdanger to children ofthisdevolution inchildren's literature is lessinthecontent they view (whichis also becoming moreintense andchaotic)andmoreintheprocessby whichchildren becomeindoctrinated andslavishconsumers whowillbe "more docile,flexible, andoperational as plug-in adults"(27-28). Technology hasalso had a significant impacton children's literacies, as imageandthescreenhave replaced writing andthebook.The "slowdeliberate, andreflective processthat complex reading entails isbeing replaced bythequickimages, instant recognition, andnon-reflective viewing ofthescreen, bigandlittle" (25). Chapter two,"Misreading Children andtheFateof theBook,"furthers the argument beguninchapter onewithstatistics on thedeclineinreading andthe negative impact offederal legislation which required accountability intheteachingofreading andconsequently fostered "misreading," orreading forprofit or passingtestsrather thanforexploring theself.Whilethebookis an enduring format (albeitan increasingly homogeneous one), Zipes contends thatunderstanding how and whychildren read is moreimportant thantheirformat or content ofchoice.He supports UrsulaK. Le Guin'snotion ofbooksas "social vectors" thatnotonlyconnectreaderswiththeauthor's mindbutalso build communities ofconversation withother readers. However, he believesthatthe pedagogicalstructure of reading education and adults'unfamiliarity withand resistance tomultimodal literacies (e.g.,alphabetic, oral,visual)arecontributing tothereconfiguring ofchildren andtheir literature and"negating] thepromises oftheEnlightenment" (44). REVIEW ESSAY 79 Chapter three, "WhyFantasy Matters Too Much,"explores theimportance of fantasy andthefantastic as subversive antitheses tothestandardization ofthecultureindustry . Peoplerelyon fantasy to engagewithpossibilities andopenthe doortopotential unlessit,too,iscommoditized tofurther thevaluesofcorporate society. As reality outstrips fiction initsbizarreness andperversity andthemedia andcorporations manipulate what webelievetobepersonal fantasies (what Zipes callsthe"fantastic spectacle"), whatrolecanthefantastic playinchildren's literature andlives?Zipessuggests that"[w]e do notneedfantasy tocompensate for dulllives,but. . . forspiritual regeneration andtocontemplate alternatives to ourharsh realities. Morethan titillation, weneedthefantastic for resistance" (48). Zipesthen showshowvarious children's authors haveusedthefantastic tofoster alternative thinking andoffset theinfluences oftheculture industry. Inchapter four, "TheMulticultural Contradictions ofInternational Children's Literature: Three Complaints andThree Wishes," Zipeslistshiscomplaints about children's literature (andmulticultural children's literature inparticular) as 1)his intolerance ofthebanality in thefieldofchildren's literature anditscriticism, 2) hisfrustration with thegeneral public'signorance ofchildren's literature and multicultural literature, and3) hisconcern that globalization cutspeopleoff from localculture, leaving them marginalized andincreasingly intolerant. Also,"multicultural " literature written aboutother cultures, rather than bymembers ofthose cultures andthen translated into English, actually augments thehegemonic values itattempts toexpose.Zipesthen offers histhree wishes for multicultural literature: 1)itshould evolvefrom critical collaborations acrosscultures that seektoeducate children abouttherealities ofchildren's lives,tobecomemorethan just"optimistic stories that givesuperficial glancesintoother cultures" (75); 2) itshould then...

Introduction

Introduction