Pushing, standing and bringing to light: How medical trainees conceptualise professional resistance.

BACKGROUND: Much of the literature on harm and injustice in medical education focuses on the impact of oppression rather than trainees' efforts to create change. To acknowledge and make visible these efforts, medical education professionals must grasp how trainees perceive resistance and their role in effecting change. Employing functional linguistic and 'everyday' resistance theories, this critical qualitative study aims to understand trainees' conceptions of resistance practices and their representational choices in moments when they talked about and conceptualised resistance. METHODS: Gathering participants through professional networks and snowball sampling, this study employed in-depth interviews to explore the conceptualisations of resistance among North American medical trainees (9 medical students, 9 residents and fellows). With the use of an applied functional linguistic analysis framework, we analysed the representational metafunction in trainees' conceptualisation of their resistance efforts against social injustice. We began with open coding for 'everyday' acts of resistance and then shifted to focused coding on verbal process types in participants' language to characterise their conceptualisations of resistance. FINDINGS: Participants conceptualised their resistance practices in three distinct ways: first, an almost physical pushing back, drawing largely on material process types (doing); second, an embodied standing up and being present, based predominantly on material and relational process types (being); and third, an epistemic bringing to light, grounded mostly in mental and verbal process types (thinking). These processes of resistance reflect participants' conceptualisations of their efforts to challenge the status quo around inequity, harm and injustice in medical education. CONCLUSION: This study builds on resistance literature, offering a potential typology of resistance practices as pushing back, being and bringing to light. Because these are 'everyday' acts of resistance, these are tactics available to everyone, including faculty; we all have the power to resist, whether it is in teaching and learning or interacting with larger structures in medicine.

An Edge Computing System with AMD Xilinx FPGA AI Customer Platform for Advanced Driver Assistance System.

The convergence of edge computing systems with Field-Programmable Gate Array (FPGA) technology has shown considerable promise in enhancing real-time applications across various domains. This paper presents an innovative edge computing system design specifically tailored for pavement defect detection within the Advanced Driver-Assistance Systems (ADASs) domain. The system seamlessly integrates the AMD Xilinx AI platform into a customized circuit configuration, capitalizing on its capabilities. Utilizing cameras as input sensors to capture road scenes, the system employs a Deep Learning Processing Unit (DPU) to execute the YOLOv3 model, enabling the identification of three distinct types of pavement defects with high accuracy and efficiency. Following defect detection, the system efficiently transmits detailed information about the type and location of detected defects via the Controller Area Network (CAN) interface. This integration of FPGA-based edge computing not only enhances the speed and accuracy of defect detection, but also facilitates real-time communication between the vehicle's onboard controller and external systems. Moreover, the successful integration of the proposed system transforms ADAS into a sophisticated edge computing device, empowering the vehicle's onboard controller to make informed decisions in real time. These decisions are aimed at enhancing the overall driving experience by improving safety and performance metrics. The synergy between edge computing and FPGA technology not only advances ADAS capabilities, but also paves the way for future innovations in automotive safety and assistance systems.

Auto-CA: Automated Cobb Angle Measurement Based on Vertebrae Detection for Assessment of Spinal Curvature Deformity.

An accurate identification and localization of vertebrae in X-ray images can assist doctors in measuring Cobb angles for treating patients with adolescent idiopathic scoliosis. It is useful for clinical decision support systems for diagnosis, surgery planning, and spinal health analysis. Currently, publicly available annotated datasets on spinal vertebrae are small, making deep-learning-based detection methods that are highly data-dependent less accurate. In this article, we propose an algorithm based on convolutional neural networks that can be trained to detect vertebrae from a small set of images. This method can display critical information on a patient's spine, display vertebrae and their labels on the thoracic and lumbar, calculate the Cobb angle, and evaluate the severity of spinal deformities. The proposed achieved an average accuracy of 0.958 and 0.962 for classifying spinal deformities (i.e., C-shaped, S-shaped type 1, and S-shaped type 2) and severity of Cobb angle (i.e., normal, mild, moderate, and severe), respectively. The Cobb angle measurement had a median difference of less than 5° from the ground-truth with SMAPE of 5.27% and an error on landmark detection of 19.73. In addition, Lenke classification is used to analyze spinal deformities as types A, B, and C, which have an average accuracy of 0.924. Physicians can use the proposed system in clinical practice by providing X-ray images via the user interface.

'When I stood up for something it's because I felt a moral violation': Trainees' acts of resistance against social harm and injustice.

INTRODUCTION: As medical students around the world enter their chosen profession, they inherit a system that they did not design nor create, yet are still responsible for it. This system is rooted in centuries of social harm and inequity. This study examines trainees' professional acts of resistance to understand what trainees hope to accomplish in their resistance efforts, why they are resisting, and the tactics they use. METHODS: Drawing on counter-storytelling and critical theory, we collected in-depth qualitative interviews from nine medical students and nine residents/fellows across North America. Using theoretical guidance on how to study acts of resistance, data were analysed using a combination of coding techniques to understand resistors' intentions in resisting and the tactics they used to understand what, why, and how trainees were resisting. The analysis was returned to participants for member checking. RESULTS: Trainees described resisting systems of harm and injustice bequeathed to them by an older generation whose values and practices were reflective of a different time. Their motivations stemmed from deep-seated moral distress from the mistreatment of patients and learners. They hoped to re-envision medical education to be patient- and learner-centred. The tactics they chose depended on the level of power they had in the system and the extent to which they wished to have their efforts known. DISCUSSION: Trainees described intentional and deliberate acts of resistance to the social harm and injustice embedded in the broader profession to re-create the profession. Given that these acts spanned a large geographical area, this study suggests that trainees may be part of a larger social movement aimed at creating widespread change within the profession.

WNT7A promotes tumorigenesis of head and neck squamous cell carcinoma via activating FZD7/JAK1/STAT3 signaling / 国际口腔科学杂志·英文版

Wnt signaling are critical pathway involved in organ development, tumorigenesis, and cancer progression. WNT7A, a member of the Wnt family, remains poorly understood in terms of its role and the underlying molecular mechanisms it entails in head and neck squamous cell carcinoma (HNSCC). According to the Cancer Genome Atlas (TCGA), transcriptome sequencing data of HNSCC, the expression level of WNT7A in tumors was found to be higher than in adjacent normal tissues, which was validated using Real-time RT-PCR and immunohistochemistry. Unexpectedly, overexpression of WNT7A did not activate the canonical Wnt-β-catenin pathway in HNSCC. Instead, our findings suggested that WNT7A potentially activated the FZD7/JAK1/STAT3 signaling pathway, leading to enhanced cell proliferation, self-renewal, and resistance to apoptosis. Furthermore, in a patient-derived xenograft (PDX) tumor model, high expression of WNT7A and phosphorylated STAT3 was observed, which positively correlated with tumor progression. These findings underscore the significance of WNT7A in HNSCC progression and propose the targeting of key molecules within the FZD7/JAK1/STAT3 pathway as a promising strategy for precise treatment of HNSCC.

Placebo Response among Different Types of Sham Acupuncture for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Low back pain (LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect. OBJECTIVE: To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. METHODS: Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials (RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences (SMDs, Hedges'g) were applied to estimate the effect size. RESULTS: A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD -1.43, 95% confidence interval (CI) -1.95 to -0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status (SMD -0.49, 95% CI -0.70 to -0.29, I2=73%), but not in quality of life (SMD 0.34, 95% CI -0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response. CONCLUSIONS: Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study. (PROSPERO registration No. CRD42022304416).

Profiles of Military Medical Students' Well-being, Burnout, and Retention.

BACKGROUND: Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields. METHODS: Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles. RESULTS: Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students' falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service. CONCLUSIONS: These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students' career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community.

Military Medical Students' Coping With Stress to Maintain Well-being.

INTRODUCTION: Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students' self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term. METHODS: Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data. RESULTS: The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work-life balance (15.7%). The use of work-life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology. CONCLUSIONS: The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum.

Physician resistance to injustice: A scoping review.

Throughout history, physicians have been involved in acts of resistance to systems of harm and injustice. However, resistance has seemed to have had little legitimate place in physician professionalism or in formal professional practice. As the challenges to physicians and the profession continue to mount, there is a pressing need to understand how it might be articulated and understood. To do that we need to consider past instances of physician resistance to injustice and harm. A scoping review was conducted to understand how often and in what contexts physicians have been engaged in resistance. A search of multiple bibliographic databases returned 2123 papers, which, after filtering for relevance and inclusion, left 60 articles for full-text review. Of these, 95% were from the United States, suggesting that issues of legitimacy are even more acute outside the U.S. Narrative findings were organized around four themes: professional responsibility to resist, legitimate resistance, resistance to perceived threats, and resistance as moral agency. When physicians have resisted, they have done so with a sense of moral agency albeit with different levels of altruism. They have often engaged in resistance when they felt their personal and professional interests are threatened, with particular emphasis on threats to physician autonomy. The study suggests that, within the U.S. at least, physician resistance is a matter for concern but, it has been approached with little or no guidance or grounding. Moreover, there is a longstanding tension between those who have argued that physicians have a professional responsibility to resist and those who have considered resistance to be extraneous and even harmful to their work as healers. At a time when physicians are facing an ever-growing number of practical, ethical, and moral challenges, professional acts of resistance are of critical concern within the profession.

Placebo Response among Different Types of Sham Acupuncture for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials / 中国结合医学杂志

BACKGROUND@#Low back pain (LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect.@*OBJECTIVE@#To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses.@*METHODS@#Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials (RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences (SMDs, Hedges'g) were applied to estimate the effect size.@*RESULTS@#A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD -1.43, 95% confidence interval (CI) -1.95 to -0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status (SMD -0.49, 95% CI -0.70 to -0.29, I2=73%), but not in quality of life (SMD 0.34, 95% CI -0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response.@*CONCLUSIONS@#Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study. (PROSPERO registration No. CRD42022304416).

Fast Control for Backlight Power-Saving Algorithm Using Motion Vectors from the Decoded Video Stream.

Backlight power-saving algorithms can reduce the power consumption of the display by adjusting the frame pixels with optimal clipping points under some tradeoff criteria. However, the computation for the selected clipping points can be complex. In this paper, a novel algorithm is created to reduce the computation time of the state-of-the-art backlight power-saving algorithms. If the current frame is similar to the previous frame, it is unnecessary to execute the backlight power-saving algorithm for the optimal clipping points, and the derived clipping point from the previous frame can be used for the current frame automatically. In this paper, the motion vector information was used as the measurement of the similarity between adjacent frames, where the generation of the motion vector information requires no extra complexity since it is generated to reconstruct the decoded frame pixels before the display. The experiments showed that the proposed work can reduce the running time of the state-of-the-art methods by 25.21% to 64.22%, while the performances are maintained; the differences with the state-of-the-art methods in PSNR are only 0.02~1.91 dB, and those in power are only -0.001~0.008 W.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education.

PURPOSE: Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD: Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS: IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS: This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

Patient delay to diagnosis and its predictors among colorectal cancer patients: A cross-sectional study based on the Theory of Planned Behavior.

PURPOSE: The prognosis for colorectal cancer is closely related to the time of diagnosis. However, patient delay is common and become a major contributor to delays in cancer diagnosis. We aimed to investigate patient delay and its predictors based on the Theory of Planned Behavior among colorectal cancer patients. METHODS: In total, 303 colorectal cancer patients were recruited from a Grade-A tertiary cancer center in southern China by convenience sampling. The participants' general information, stigma, self-efficacy, and knowledge about colorectal cancer were assessed by a self-designed general information questionnaire, the Social Impact Scale, the General Self-Efficacy Scale, and the section of the Bowel Cancer Awareness Measure on total knowledge of colorectal cancer. Descriptive statistics, univariate analysis, and binary logistic regression were applied for data analysis. RESULTS: The median patient delay was four months (range: 1 day-10 years). The prevalence of prolonged patient delay (≥3 months) was 57.8%. Identified by binary logistic regression, prolonged patient delay was associated with having no close family members/friends in medical professionals, unwillingness to accept colonoscopy, blood in stools, dyspepsia, insufficient support from family members, more measures taken to control symptoms, lower perceived severity of symptoms, knowledge shortage, negative help-seeking attitudes, lower self-efficacy, and higher stigma. CONCLUSIONS: Patient delay was considerable in individuals with colorectal cancer in China. Factors associated with patient delay are complex in Chinese culture. To shorten patient delay, culturally sensitive interventions may be required to improve knowledge, alleviate cancer stigma, enhance self-efficacy to seek medical attention, and promote positive help-seeking behaviors.

Touchless Head-Control (THC): Head Gesture Recognition for Cursor and Orientation Control.

The touchless techniques in human-computer interaction (HCI) can effectively expand computer access capabilities for disabled people. This paper presents Touchless Head-Control (THC), an assistive system method for computer cursor control based on head pose captured with an RGB camera. Our work aimed to replace the standard cursor control using a device on the user's head. The convolutional neural networks with predicted fine-grained feature maps and binned classification were applied to estimate the head pose angles. The mouse pointer or cursor is moved to actual locations on the screen based on head movement (yaw and pitch) and the center position of the face. Head tilt to the right or left (roll) to control the mouse button. In addition, the proposed method can be used to simulate the movement of the robot or joystick using the head to control objects within three degrees of freedom (DOF). Various participants were involved in the interaction design evaluation, in which target selection accuracy, travel time, and path efficiency were measured. This technology allows people with limited motor skills to easily control a PC cursor and 3D object orientation without the use of additional equipment or sensors.

Blood lipid and hematoma enlargement and outcome in patients with intracerebral hemorrhage / 国际脑血管病杂志

Early hematoma enlargement is one of the main factors of early neurological deterioration in patients with intracerebral hemorrhage. The correlation between blood lipid and hematoma enlargement is a research hotspot at present. This article reviews the relationship between blood lipid and hematoma enlargement and outcomes in patients with intracerebral hemorrhage, as well as the correlation between statin treatment and hematoma enlargement.

Application of Hybrid Multiple Attribute Decision-Making Model to Explore the Design Strategies of Children's Facilities in Neighborhood Open Spaces Based on Sensory Integration Theory.

In recent years, the prevalence of sensory integration disorders in children in urban areas has increased. Most existing sensory integration treatments are located in hospital-based sensory integration units; however, medical resources are extremely limited, making it difficult to guarantee the appropriate treatment time and intervention results for many children. The concept of sensory integration therapy must be disseminated widely and correctly to meet these children's needs. Although most urban communities have a high number of children's spaces, these spaces require improvement. This study proposes the incorporation of the concept of sensory integration therapy into neighborhood open spaces for children to positively impact children's sensory development. The purpose of this study is to determine the effective facility factors of an occupational therapy room, translate them into a community facility design, clarify the categories and relative importance of each design attribute, and explore the design strategies of the children's facilities in neighborhood open spaces based on the sensory integration theory. This study investigates the importance of the sensory integration treatment level. The facilities in neighborhood open spaces for children can be considered systemic structures consisting of five partitioned units with different levels of importance among the synergistic components within each unit. These structures will enable children to experience sensory stimulation during daily outdoor play and will serve as preventive and therapeutic tools.

The development of cooperation and self-control in middle childhood: Associations with earlier maternal and paternal parenting.

Developmental theories and previous research have emphasized the significance of cooperation and self-control in middle childhood. The present study extends previous research by examining (a) the growth of cooperation and self-control as well as the relations between them in middle childhood (third to sixth grade) and (b) the extent to which mothers' and fathers' parenting during early childhood (54 months and first grade) was associated with children's cooperation and self-control. The sample included 705 children (51% female, 86% White) and their mothers, fathers, and teachers in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD). Children, on average, exhibited increases in self-control but not cooperation from third to sixth grade though the increases were smaller for children who had higher self-control or cooperation at third grade. Children who exhibited higher self-control at third grade tended to exhibit higher cooperation at third grade; similar positive associations emerged for the changes in self-control and cooperation over time. In addition, if a child exhibited higher self-control at one time point relative to their typical average level, they tended to also exhibit higher cooperation at the same time point relative to their typical average level. However, these relative deviations within person were not associated over time. Lastly, maternal and paternal sensitive and stimulating parenting in early childhood was positively associated with children's cooperation and self-control in middle childhood. Overall, our findings shed light on the growth of and the relations between cooperation and self-control in middle childhood and highlight the role of maternal and paternal parenting in early childhood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Design of Magnamosis System for Endoscopic Tissue Clamping / 中国医疗器械杂志

Based on the principle of magnetic anastomosis technique, the design of magnetic anastomosis system for endoscopic tissue clamping is proposed. The system includes a semi-ring magnet, a special structure transparent cap and a detachable push rod. With the help of the existing digestive endoscopy and endoscopic tissue gripper, the endoscopic close clamping and anastomosis of the bleeding or perforated tissue can be completed. After the anastomosis, the magnet falls off and is discharged through the digestive tract. Animal experiments showed that the system was easy to use, the fistula was clamped firmly, the magnet was discharged for 7~21 days, and there was no magnet retention and digestive tract obstruction. Further safety verification, optimization of endoscopic operation, the system can be used in clinical trial.

Children's developing work habits from middle childhood to early adolescence: Cascading effects for academic outcomes in adolescence and adulthood.

Children's work habits at school include being a hard worker, turning in work on time, following classroom rules, and putting forward one's best effort. Models on youth character, noncognitive skills, and social-emotional learning suggest that self-management skills like work habits are critical for individuals' subsequent academic success. Using data from 1,124 children in the NICHD Study of Early Childcare and Youth Development (49% female; 77% White), we examined children's developing work habits from first to sixth grade and their developmental cascading effects on academic outcomes at the beginning and end of high school as well as at age 26. The findings on differential stability of work habits (i.e., bivariate correlations) suggest that children were likely to maintain their relative position among peers from first to sixth grade. The complementary findings on mean-level changes from the latent growth curves suggest that children's work habits exhibited mean-level increases over the same period, meaning that children's work habits became more advanced from first to sixth grade. Models used to examine the developmental cascades of work habits suggest that children's work habits at first grade and the growth in children's work habits from first to sixth grade (a) directly predicted their academic outcomes at the beginning and the end of high school, and (b) indirectly predicted their educational attainment at age 26 through their academic outcomes during adolescence. These findings underscore the importance of foundational noncognitive skills during middle childhood that predict individuals' academic outcomes up to 20 years later in adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).