The North Carolina state system of allotting administrative positions to the public schools and community colleges

The purpose of this study was to analyze the North Carolina state system of allotting administrative positions to the community colleges/technical institutes and public elementary/secondary schools and to make recommendations concerning future allocations. The study is factual in its presentation; it deals with five questions which serve as guides in directing the study. The writer sought to present an orderly arrangement of historical data, legal documents, and state and federal documents relating to the study

Lack of quadriceps dysfunction in women with early knee osteoarthritis

Quadriceps dysfunction, specifically weakness and central activation failure (CAF), has been implicated in the development and progression of knee osteoarthritis (OA), though few data are available to confirm its presence in early OA. The purpose of this study was to determine the presence and magnitude of quadriceps dysfunction in those with and without early knee OA. Thirty-five female volunteers were classified into two groups, OA ( n  = 22) and control ( n  = 13), based on the presence [Kellgren-Lawrence (K-L) grade 2] or absence (K-L grade 0–1) of mild OA, respectively. Isometric quadriceps strength and central activation ratio (CAR) were assessed and compared between groups utilizing a one-way ANOVA. Frequency statistics and Fisher's exact test were used to compare the percentage of women with and without CAF between groups. Quadriceps strength (control: 1.47 ± 0.62 Nm/kg; OA: 1.30 ± 0.62 Nm/kg; p  = 0.45) was not significantly different for women with and without mild OA. Further, the CAR (control: 0.91 ± 0.07; OA: 0.87 ± 0.12; p  = 0.19) did not differ between groups; however, women in both groups presented with CAF (control: 54%; OA: 73%; p  = 0.29). Our results suggest that the women with mild osteoarthritis do not present with quadriceps dysfunction. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:595–599, 2010Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69188/1/21038_ftp.pd

Adjusting bone mass for differences in projected bone area and other confounding variables: an allometric perspective.

The traditional method of assessing bone mineral density (BMD; given by bone mineral content [BMC] divided by projected bone area [Ap], BMD = BMC/Ap) has come under strong criticism by various authors. Their criticism being that the projected bone "area" (Ap) will systematically underestimate the skeletal bone "volume" of taller subjects. To reduce the confounding effects of bone size, an alternative ratio has been proposed called bone mineral apparent density [BMAD = BMC/(Ap)3/2]. However, bone size is not the only confounding variable associated with BMC. Others include age, sex, body size, and maturation. To assess the dimensional relationship between BMC and projected bone area, independent of other confounding variables, we proposed and fitted a proportional allometric model to the BMC data of the L2-L4 vertebrae from a previously published study. The projected bone area exponents were greater than unity for both boys (1.43) and girls (1.02), but only the boy's fitted exponent was not different from that predicted by geometric similarity (1.5). Based on these exponents, it is not clear whether bone mass acquisition increases in proportion to the projected bone area (Ap) or an estimate of projected bone volume (Ap)3/2. However, by adopting the proposed methods, the analysis will automatically adjust BMC for differences in projected bone size and other confounding variables for the particular population being studied. Hence, the necessity to speculate as to the theoretical value of the exponent of Ap, although interesting, becomes redundant

Feasibility of using quadriceps-strengthening exercise to improve pain and sleep in a severely demented elder with osteoarthritis – a case report

BACKGROUND: Osteoarthritis (OA) of the knee, which is prevalent among older adults in nursing homes, causes significant pain and suffering, including disturbance of nocturnal sleep. One nonpharmacologic treatment option is quadriceps-strengthening exercise, however, the feasibility of such a treatment for reducing pain from OA in severely demented elders has not been studied. This report describes our test of the feasibility of such an exercise program, together with its effects on pain and sleep, in a severely demented nursing home resident. CASE PRESENTATION: The subject was an elderly man with severe cognitive impairment (Mini-Mental Status Exam score 4) and knee OA (Kellgren-Lawrence radiographic grade 4). He was enrolled in a 5-week, 10-session standardized progressive-resistance training program to strengthen the quadriceps, and completed all sessions. Pain was assessed with the Western Ontario and MacMaster OA Index (WOMAC) pain subscale, and sleep was assessed by actigraphy. The patient was able to perform the exercises, with a revision to the protocol. However, the WOMAC OA pain subscale proved inadequate for measuring pain in a patient with low cognitive functioning, and therefore the effects on pain were inconclusive. Although his sleep improved after the intervention, the influence of his medications and the amount of daytime sleep on his nighttime sleep need to be considered. CONCLUSIONS: A quadriceps-strengthening exercise program for treating OA of the knee is feasible in severely demented elders, although a better outcome measure is needed for pain

Genetic Effects on Bone Loss in Peri- and Postmenopausal Women: A Longitudinal Twin Study

This longitudinal twin study was designed to assess the heritability of bone loss in peri- and postmenopausal women. A sample of 724 female twins was studied. Baseline and repeat BMD measurements were performed. Results of genetic model-fitting analysis indicated genetic effects on bone loss account for similar to 40% of the between-individual variation in bone loss at the lumbar spine, forearm, and whole body. Introduction: BMD and bone loss are important predictors of fracture risk. Although the heritability of peak BMD is well documented, it is not clear whether bone loss is also under genetic regulation. This study was designed to assess the heritability of bone loss in peri- and postmenopausal women. Materials and Methods: A sample of 724 female twins (177 monozygotic [MZ] and 185 dizygotic [DZ] pairs), 45-82 yr of age, was studied. Each individual had baseline BMD measurements at the lumbar spine, hip, forearm, and total body by DXA and at least one repeat measure, on average 4.9 yr later. Change in BMD (Delta BMD) was expressed as percent of gain or loss per year. Intraclass correlation coefficients for ABMD were calculated for MZ and DZ pairs. Genetic model-fitting analysis was conducted to partition the total variance of ABMD into three components: genetic (G), common environment (C), and specific environment, including measurement error (E). The index of heritability was estimated as the ratio of genetic variance over total variance. Results: The mean annual Delta BMD was -0.37 +/- 1.43% (SD) per year at the lumbar spine, -0.27 +/- 1.32% at the total hip, -0.77 +/- 1.66% at the total forearm, -0.36 +/- 56% at the femoral neck, and -0.16 +/- 0.81% at the whole body. Intraclass correlation coefficients were significantly higher in MZ than in DZ twins for all studied parameters, except at the hip sites. Results of genetic model-fitting analysis indicated that the indices of heritability for ABMD were 0.38, 0.49, and 0.44 for the lumbar spine, total forearm, and whole body, respectively. However, the genetic effect on ABMD at all hip sites was not significant. Conclusions: These data suggest that, although genetic effects on bone loss with aging are less pronounced than on peak bone mass, they still account for similar to 40% of the between-individual variation in bone loss for the lumbar spine, total forearm, and whole body in peri- and postmenopausal women. These findings are relevant for studies aimed at identification of genes that are involved in the regulation of bone loss

Thigh Muscle Cross-Sectional Areas and Strength in Advanced versus Early Painful Osteoarthritis – an Exploratory Between-Knee, Within-Person Comparison in Osteoarthritis Initiative Participants

OBJECTIVE: To compare cross-sectional and longitudinal side differences in thigh muscle anatomic cross-sectional areas (ACSAs), strength, and specific strength (strength/ACSA) between knees with early versus advanced painful radiographic osteoarthritis in the same person. METHODS: Forty-four of 2,678 Osteoarthritis Initiative participants (31 women and 13 men) met the inclusion criteria of bilateral frequent knee pain, medial joint space narrowing (JSN) in 1 knee, and no medial (or lateral) JSN in the contralateral knee. Thigh muscle ACSAs of the quadriceps, hamstrings, adductors, and individual quadriceps heads at consistent locations were determined using magnetic resonance imaging. Isometric muscle strength was determined in extension/flexion (Good Strength Chair). Baseline quadriceps ACSAs and strength were considered primary end points, and longitudinal changes of these factors were considered secondary end points (by paired t-tests). RESULTS: No significant side differences in quadriceps (or other thigh muscle) ACSAs, strength, or specific strength were observed between medial JSN knees versus knees without JSN, or between specific medial JSN knee strata and contralateral knees without JSN, either in men or women. Two-year longitudinal changes in thigh muscle ACSAs and strength were small (<5.2%) and did not differ significantly between medial JSN knees and knees without JSN. CONCLUSION: In the context of previous findings that side differences in pain are associated with side differences in quadriceps ACSAs, the current results suggest that quadriceps (and other thigh muscle) properties are not independently associated with radiographic disease status (JSN) once knees have reached frequent pain status. Further, our longitudinal findings indicate that a more advanced radiographic stage of knee osteoarthritis is not necessarily associated with a longitudinal decline in muscle function. Copyright 2013 by the American College of Rheumatolog