On behalf of the Appalachia Funders Network (AFN), with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago conducted a study to ...analyze the current burden of obesity and chronic disease in central Appalachia and identify promising practices and strategies that are having a positive impact on the reduction of obesity in the region. Central Appalachia consists of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. Regional recommendations to reduce childhood obesity and improve the overall population’s health were developed based on a review of current literature, a survey, and focus groups with both community groups and funders.
Research Objective: On behalf of the Appalachian Funders Network, with funding from the Robert Wood Johnson Foundation, East Tennessee State University and NORC at the University of Chicago ...documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. An analysis of county-level data was conducted in order to provide a comprehensive picture of the health condition of the region. Contributing factors, such as physical inactivity and food environment, were also investigated to determine how the built environment impacts obesity.
Study Design: Several secondary data sources were utilized, including the County Health Rankings, CDC Diabetes Interactive Atlas, USDA Food Environment Atlas, and mortality data from the CDC National Center for Health Statistics, National Vital Statistics System. Variables analyzed included: adult obesity prevalence, adult diabetes prevalence, food insecurity, access to exercise opportunities, physical inactivity, and premature chronic disease mortality. The mortality analyses focused on four of the leading causes of death: heart disease, stroke, diabetes, and chronic lower respiratory disease, for persons age 25 to 64 from 2009 to 2013. When available, county-level estimates were used to create maps of the region, documenting the disparities compared to the rest of the nation.
Population Studied: Health disparities were documented within the counties of central Appalachia, consisting of parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia.
Principal Findings: 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, and the state mortality rate for the Appalachian region of all six states is higher than the national rate. The disparity is more pronounced in rural communities, as the rural counties of central Appalachia have a higher mortality rate than urban counties within central Appalachia and rural counties across the United States. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally.
Conclusions: 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.
Implications for Policy or Practice: Obesity and chronic disease in central Appalachia are significant public health concerns that must be addressed in order to improve the health of the region.
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.
This thesis examined the role of procedural learning in human probabilistic category learning (PCL). It was proposed that there was a lack of clear behavioural evidence for learning without awareness ...in PCL. Eleven experiments are reported that investigated the characteristics of learning in a prototypical probabilistic category learning task (the weather prediction task). The results were interpreted as contradicting the popular interpretation of weather prediction task learning as procedurally based. Rather, it was shown that behavioural data was consistent with declarative learning. This learning was not dissociable with measures of cue knowledge. Strategy analysis converged with the behavioural data, suggesting the dominance of declarative learning in this task. It was proposed that a single system account (e.g., Lagnado et al., 2006; Newell et al., 2007) which does not posit a role for procedural learning was the most appropriate way to understand learning in the weather prediction task.
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).
Using a natural gradient of dissolved organic carbon (DOC) source and concentration in rivers of northern Florida, we investigated how terrestrially-derived DOC affects denitrification rates in river ...sediments. Specifically, we examined if the higher concentrations of DOC in blackwater rivers stimulate denitrification, or whether such terrestrially-derived DOC supports lower denitrification rates because (1) it is less labile than DOC from aquatic primary production; whether (2) terrestrial DOC directly inhibits denitrification via biochemical mechanisms; and/or whether (3) terrestrial DOC indirectly inhibits denitrification via reduced light availability to—and thus DOC exudation by—aquatic primary producers. We differentiated among these mechanisms using laboratory denitrification assays that subjected river sediments to factorial amendments of NO₃ ⁻ and dextrose, humic acid dosing, and cross-incubations of sediments and water from different river sources. DOC from terrestrial sources neither depressed nor stimulated denitrification rates, indicating low lability of this DOC but no direct inhibition; humic acid additions similarly did not affect denitrification rates. However, responses to addition of labile C increased with long-term average DOC concentration, which supports the hypothesis that terrestrial DOC indirectly inhibits denitrification via decreased autochthonous production. Observed and future changes in DOC concentration may therefore reduce the ability of inland waterways to remove reactive nitrogen.
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