Middle-aged white adults in America are expiring at alarming rates, succumbing to what Case and Deaton term "deaths of despair" as a result of drug overdose, suicide and alcohol-related diseases. ...This chapter extends theory on deaths of despair to Appalachia, summarizing trends in mortality and morbidity across the region due to these causes. It finds that not only do disparities in deaths of despair affect Appalachia compared to the rest of the United States, but they also appear subregionally, within groups of counties. Central Appalachia carries the highest burden, with widespread overdose deaths, high rates of suicide and many alcohol-related diseases frustrating efforts to improve population health. The chapter also illustrates the potential mediating effects of urbanicity and gender, with those who are male or residing in more urban counties facing smaller disparities (compared to non-Appalachian counterparts) than women or rural dwellers do. The recent uptick in opioid overdose deaths cannot be ignored as a major contributor to the deaths of despair in Appalachia, and the authors present a compelling case for more scholarly attention to opioid overdose in particular.
Individualism: The Cultural Logic of Modernity explores ideas of the modern sovereign individual in the western cultural tradition. Divided into two sections, this volume surveys the history of ...western individualism in both its early and later forms: chiefly from the sixteenth to the eighteenth centuries, and then individualism in the twentieth century. These essays boldly challenge not only the exclusionary framework and self-assured teleology, but also the metaphysical certainty of that remarkably tenacious narrative on "the rise of the individual." Some essays question the correlation of realist characterization to the eighteenth-century British novel, while others champion the continuing political relevance of selfhood in modernist fiction over and against postmodern nihilism. Yet others move to the foreground underappreciated topics, such as the role of courtly cultures in the development of individualism. Taken together, the essays provocatively revise and enrich our understanding of individualism as the generative premise of modernity itself. Authors especially considered include Locke, Defoe, Freud, and Adorno. The essays in this volume first began as papers presented at a conference of the American Comparative Literature Association held at Princeton University. Among the contributors are Nancy Armstrong, Deborah Cook, James Cruise, David Jenemann, Lucy McNeece, Vivasvan Soni, Frederick Turner, and Philip Weinstein.
Maintain Your Brain (MYB)i is a randomised controlled trial (RCT) of multiple online interventions designed to target modifiable risk factors for Alzheimer's disease and dementia. Traditional ...clinical trial management systems (CTMS) requirements consist of features such as management of the study, site, subject (participant), clinical outcomes, external and internal requests, education, data extraction and reporting, security, and privacy. In addition to fulfilling these traditional requirements, MYB has a specific set of features that needs to be fulfilled. These specific requirements include: (i) support for multiple interventions within a study, (ii) flexible interoperability options with third-party software providers, (iii) study participants being able to engage in online activities via web-based interfaces throughout the trial (from screening to follow-up), (iv) ability to algorithmically personalize trial activities based on the needs of the participant, and (v) the ability to handle large volumes of data over a long period. This paper outlines how the existing CTMSs fall short in meeting these specific requirements. The presented system architecture, development approach and lessons learned in the implementation of the MYB digital platform will inform researchers attempting to implement CTMSs for trials comparable to MYB in the future.
The most insightful essays take an expansive focus on poetry as an opportunity to loosen categories that might owe more to our moment than to Shakespeare's. ...Colin Burrow uses the breadth and ...complexity of Shakespeare's handling of classical sources in his early and late drama, as well as in the poems, to describe how "the traditional distinction between the poems and the plays has broken down" in criticism from the past two decades (103). Enriching formal analysis with archival sensitivity, Catherine Nicholson reads two quartos printed by George Eld in 1609-The Famous History of Troilus and Cressida and Shake-speares Sonnets-for traces of early modern habits of commonplacing and Erasmian copia, showing that "Shakespeare reveals himself as a consummate practitioner of rhetorical and poetic strategies that take commonness as the paradoxical ground of excellence" (186).
East Tennessee State University and NORC at the University of Chicago (on behalf of the Appalachia Funders Network) documented the current burden of obesity, diabetes, and chronic disease mortality ...in central Appalachia. We conducted an analysis of county-level data to provide a comprehensive picture of the health condition of the region and explore urban/rural disparities. More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate. The disparity is more pronounced in rural communities. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. We will present study methods and findings, including maps and graphs that document these disparities.
