Orphanages, especially larger ones, have had some well publicised examples of poor care. In large institutions children, but particularly babies, may not receive enough eye contact, physical contact, and stimulation to promote proper physical, social or cognitive development. In the worst cases, orphanages can be dangerous and unregulated places where children are subject to abuse and neglect. One significant study, which disputes this, was carried out by Duke University. Their researchers concluded that institutional care in America in the 20th century produced the same health, emotional, intellectual, mental, and physical outcomes as care by relatives, and better than care in the homes of strangers. One explanation for this is the prevalence of permanent temporary foster care. This is the name for a long string of short stays with different foster care families. Permanent temporary foster care is highly disruptive to the child and prevents the child from developing a sense of security or belonging. Placement in the home of a relative maintains and usually improves the child’s connection to family members.