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Research on the development of executive functions (EFs) and self-regulation (SR) has focused heavily on the early childhood years, when these abilities first emerge. Less is known in comparison about how these abilities develop through adolescence, and how contextual factors, such as parenting, influence their development in later years. Using longitudinal data from the Study of Early Child Care and Youth Development (SECCYD), we used random intercept cross-lagged panel modeling (RI-CLPM) to examine the bidirectional linkages between three parenting behaviors (i.e., autonomy support, supportive presence, hostility), child EFs (i.e., working memory, inhibitory control) and child SR outcomes, from early childhood to adolescence. Parenting in early childhood was significantly associated with change in child EFs from early to middle childhood, but not from middle childhood to adolescence. Specifically, greater autonomy support in early childhood was associated with stronger child working memory and inhibitory control in middle childhood; greater supportive presence in early childhood was associated with stronger child working memory in middle childhood; and higher rates of hostility in early childhood were associated with weaker child inhibitory skills in middle childhood. Reciprocal effects of child EF and SR on parenting were also observed. Specifically, stronger child inhibitory control in early childhood was associated with less hostility in middle childhood, and stronger child self-regulation in middle childhood was associated with greater supportive presence in adolescence. Accounting for lagged and stability effects, there was significant residual covariance between parenting behaviors and child SR in adolescence, suggesting that parenting continues to be associated with the development of SR skills through adolescence. Understanding reciprocal linkages between parenting and child EF/SR through adolescence is critical in developing targeted parenting interventions beyond early childhood to improve children's outcomes.

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Inadequate sleep in adolescents has been linked to an increase in screen-based media use, especially at bedtime. Parents can play a critical role in regulating adolescent media use and promoting healthy sleep, yet few studies have evaluated parental effects on these outcomes. This study examined the effects of general and media-specific parenting behaviors and family conflict on adolescent sleep outcomes, both directly and indirectly through bedtime media use. Data were collected from 345 middle-schoolers (Mage = 12.65 ± 0.67 years; 47% female; 59% White) at two time points, six months apart. The findings revealed that parental involvement had a significant positive effect on sleep duration that was mediated by bedtime media use. Family conflict had a direct positive effect on daytime sleepiness. Adolescent sleep interventions could benefit from a parenting component focused on positive involvement and fostering a family climate conducive to sleep.

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OBJECTIVE/DESIGN: Bedtime media use has been associated with poor sleep and attention difficulties among adolescents, but much of this research has been cross-sectional, limiting current understanding of directionality of effects. This 2-wave prospective study tested bidirectional effects between bedtime media use and sleep measures, including time in bed, sleep onset latency, and daytime sleepiness, and further examined whether bedtime media use and sleep variables were related to attention control difficulties. SETTING/PARTICIPANTS: Data were collected from 345 middle-schoolers (ages 12-14, 47% female) at baseline (T1) and at 6-month follow-up (T2). MEASUREMENTS: Students self-reported their access to media devices and internet in their bedroom, bedtime media use, sleep, and attention control. Data were analyzed using cross-lagged panel modeling. RESULTS: Greater bedtime media use (at T1) was associated with less time in bed and longer sleep onset latency at T2, controlling for T1 levels of these variables. In the case of sleep effects on bedtime media use, greater daytime sleepiness and less time in bed (at T1) were associated with greater bedtime media use at T2, controlling for T1 levels. Further, greater daytime sleepiness (at T2, controlling for T1 levels) was associated with greater attention control difficulties at T2. CONCLUSIONS: Findings provide evidence for some reciprocal relations between bedtime media use and poor sleep in adolescents. Furthermore, higher daytime sleepiness was linked to greater attention control difficulties.

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OBJECTIVE: Explore the feasibility of an online behavioral weight management program for college students. METHODS: The program focused on behavioral strategies to modify eating and exercise behaviors of students interested in losing weight and/or developing a healthy lifestyle. Specific tools included weekly chat meetings with a facilitator, calorie and fat gram recommendations, daily food logs, and exercise guidance. RESULTS: Three hundred thirty-six students participated from 2 northeastern universities. Overweight/obese students wanting to lose weight had a mean body mass index of 30.6 kg/m(2) at baseline and lost an average of 5.1 ± 6.0 lbs. Those of healthy weight wanting to lose weight had a mean body mass index of 22.0 kg/m(2) at baseline and lost an average of 1.8 ± 3.2 lbs. Twenty-three percent of students lost > 5% of their baseline weight. CONCLUSIONS AND IMPLICATIONS: Use of an online behavioral weight management program may be a feasible way to help college students develop healthy eating and exercise behaviors.

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INTRODUCTION: The direct fundoscopic examination is an important clinical skill, yet the examination is difficult to teach and competency is difficult to assess. Currently there is no defined proficiency assessment for this physical examination, and the objective of this study was to assess the feasibility of a simulation model for evaluating the fundoscopic skills of residents. METHODS: Emergency medicine and ophthalmology residents participated in simulation sessions using a commercially available eye simulator that was modified with customized slides. The slides were designed with the goal of having a quantifiable measure of visualization in addition to a more traditional descriptive outcome. To assess feasibility, participants' ease of use, time to perform the examination, and user satisfaction were assessed. RESULTS: The simulation could be completed in a timely fashion (mean time per slide, 61-95 seconds), and there were no significant differences in performance between emergency medicine and ophthalmology residents in completion of this task. Residents expressed an interest in fundoscopy through simulation but found this model technically challenging. CONCLUSIONS: This simulation model has potential as a means of training and testing fundoscopy. A concern was low user satisfaction, and further refinement of the model is needed.

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This article provides a review of the evaluation and treatment of common injuries to the shoulder, humerus, and clavicle in the emergency department (ED) setting. In addition to a focused review of the shoulder's physical examination, topics include common emergent injuries such as glenohumeral dislocations, proximal humerus fractures, and acromioclavicular separations as well as less common, but important injuries including pectoralis and biceps tendon injuries and sternoclavicular dislocations. Accurate recognition and management of these injuries is essential in the optimal care of patients in the ED.

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BACKGROUND: Trampoline-related injuries are preventable by avoidance. There are few published reports focusing on cervical spine injuries from trampolines in the paediatric population. METHODS: Patients younger than 18 years of age who presented to Stollery Children's Hospital (Edmonton, Alberta) between 1995 and 2006, with a cervical spine injury or death from trampoline use were identified via a medical records database search. Data were collected retrospectively from the hospital charts, and were presented using descriptive statistics. RESULTS: There were seven cases of cervical spine injury secondary to trampoline use. Four patients had lasting neurological deficits at discharge from hospital, and another patient died at the scene due to refractory cardiac arrest. Injuries were sustained both on (n=5) and off (n=2) the trampoline mat from mechanisms that included attempted somersaults on the trampoline and falls from the trampoline. All the trampolines were privately owned home trampolines. An ambulance was called for five patients, intravenous fluids were administered to two patients with hypotension and spinal shock, and cardiopulmonary resuscitation was performed on one patient. All six patients surviving the initial injury were admitted to hospital for a mean +/- SD of 9.5+/-9.0 days. These six patients underwent imaging including x-rays, computed tomography and magnetic resonance imaging, and three patients required surgery for spinal stabilization. CONCLUSION: Cervical spine injuries from trampolines lead to severe neurological sequelae, death, hospitalization and significant resource use. The authors agree with the Canadian Paediatric Society's statement that trampolines should not be used for recreational purposes at home, and they support a ban on all paediatric use of trampolines.

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BACKGROUND: Internet-based weight-loss programs appear promising in the short-term but, to date, have not been able to produce the level of weight loss seen in traditional in-person treatment; thus, novel approaches are necessary. Using a combination of interactive technology and in-person support has been beneficial in other areas of medicine. PURPOSE: The aim of this study is to compare 12-month weight-loss outcomes of an Internet-only behavioral weight-loss treatment with the same program supplemented with monthly in-person meetings. METHODS: One hundred and twenty-three participants were randomized to an Internet-only (n = 62) or an Internet + in-person treatment (I+IPS; n = 61). All participants then participated in a 12-month behavioral weight-loss program conducted over the Internet. The groups met online weekly for the first 6 months and biweekly for the second half of the intervention. The I+IPS group had access to the same Web site as the Internet-only group but, once a month, attended an in-person meeting in place of an online chat. Assessments included body weight, program adherence, and social support measures. RESULTS: An intent-to-treat analysis (n = 123) revealed there were no significant Group x Time differences (p = .15) in weight loss at either 6 (-6.8 +/- 7.8 vs. -5.1 +/- 4.8, p = .15) or 12 months (-5.1 +/- 7.1 kg vs. -3.5 +/- 5.1 kg, p = .17, for Internet-only and I+IPS, respectively). Differences between groups for those completing all measures (n = 77) also revealed no significant differences at 6 months (-9.2 +/- 7.0 kg vs. -6.9 +/- 4.2 kg, p = .08) or 12 months (-8.0 +/- 7.5 kg vs. -5.6 +/- 5.5 kg, p = .10 for the Internet-only and I+IPS conditions, respectively). CONCLUSIONS: Supplementation of an Internet weight-loss treatment with monthly in-person meetings did not result in greater weight losses over 12 months. Dynamic, socially supportive, and interactive elements of the Web site may have obviated the need for further interpersonal behavioral counseling.

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