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AbstractThe decision-making process for potential college students in the United States is overwhelming because of the volume of information available and the complexity of higher education systems. Prospective students must consider institutional rankings, academic programs, and financial aid opportunities in addition to completing numerous forms. For some students, there exist personal and professional advisors and resources to assist with navigating the process. Others with less social and cultural capital must figure out the system with little or no assistance while facing other barriers. Public libraries can be a resource for the college-bound community; however, research shows that public libraries are not actively engaged in supporting this user group. To provide focused, quality information services to any demographic, it is important to understand the perspectives of public-facing information workers. Through a cross-sectional online questionnaire of library staff across four states, this study sought to learn staff perspectives on the role of public libraries in serving prospective college students. The survey received 160 responses of which 100 open-ended responses pertained to the role of public libraries. Qualitative inductive analysis point to three core themes on the role of public libraries in serving this population, that of connector, provider, and supporter. A fourth theme suggests staff see the role as one for others to meet. This article provides insight into past examinations of public library support of college literacy offering an opening to further discussions on serving this overlooked user group. [ABSTRACT FROM AUTHOR]

This case study analyzes the news media's framing of National Football League (NFL) quarterback Joe Burrow and his background during the 2019 football season, from the announcement of Burrow as a Heisman trophy finalist to the aftermath of his selection as the first overall pick in the 2020 NFL draft. With his heightened visibility on the field, Burrow's background was increasingly of interest to football fans and sports journalists. It was not Burrow's fairly "typical" family background as the child of a football coach in a nuclear family that received the most attention, but the Appalachian town of Athens, OH, where Burrow was a high school student, that became an important narrative. Emerging theme analysis suggests that sports journalists often extended idealized narratives to frame Burrow as an overcomer of a systemic cultural background with which he did not immediately identify. That narrative often utilized stereotypical representations of rural Appalachia as a place dominated by cultural poverty, highlighted representations of engrained hopelessness and lack of agency in the region, and reinforced problematic understandings of the nature of structural poverty and the ways it may be effectively challenged. The research addresses gaps in the literature about the college student-athlete in nuanced conversations about race and class in athlete-to-career narratives and notes the ways an athlete may call on such mediated tropes to extend a narrative for possible community or self-benefit. [ABSTRACT FROM AUTHOR]

While many studies have found positive correlations between greenness and human health, rural Central Appalachia is an exception. The region has high greenness levels but poor health. The purpose of this commentary is to provide a possible explanation for this paradox: three sets of factors overwhelming or attenuating the health benefits of greenness. These include environmental (e.g., steep typography and limited access to green space used for outdoor recreation), social (e.g., chronic poverty, declining coal industry, and limited access to healthcare), and psychological and behavioral factors (e.g., perceptions about health behaviors, healthcare, and greenness). The influence of these factors on the expected health benefits of greenness should be considered as working hypotheses for future research. Policymakers and public health officials need to ensure that greenness-based interventions account for contextual factors and other determinants of health to ensure these interventions have the expected health benefits.

The discipline of geography is an increasingly necessary lens required to understand population-level diseases. Syndemics, or co-occurring diseases or epidemics within a specific population, are contextualized by place--preexisting social, economic, and political structures. Nurse practitioners are well-positioned to critically assess the impact of geography on patient health and well-being. This perspective provides a brief summary of syndemic crises, with a case example in the West Virginia coalfields. The position of this paper is one that supports geography, in addition to social determinants of health, as a framework for syndemics. A geographic perspective provides a more comprehensive picture of marginalized populations and regions facing the phenomenon. Given the significance of holistic nursing, attention to the role of geography in syndemics provides an increased dimension of care and treatment. [ABSTRACT FROM AUTHOR]

This paper employs approaches from religious studies and Appalachian studies to examine the history, influence, and future of a multifaceted ethos of extraction, particularly as it influences the coal industry, in the Appalachian region of the United States. While many studies of extraction and the coal industry focus on their economic and political dimensions, by examining a broader ethos of extraction, this paper highlights multiple religious influences, including the entanglements between religious communities and extraction-based industries, the powerful moral narratives that serve to interpret and justify extraction, and the dynamics involved in shaping local identities and perceptions of place that enable this ethos to influence post-coal transition efforts. The result is a broad survey of the influences and impacts of resource extraction in Appalachia that challenges many of the longstanding stereotypes that can still be commonly found deployed about the region. In examining these influences, the paper also describes how academic interpreters have helped to shape popular conceptions of the Appalachian region that ultimately support ongoing extractive practices. Building upon insights from grassroots, anti-extractive activist communities in the region, the paper concludes by suggesting some ways that academics might adopt restorative ethics and practices in their work to address the entanglements between extractive scholarship and exploitation and devise alternative paths for just futures. [ABSTRACT FROM AUTHOR]

Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence rates. The aim was to understand what each facility is providing regarding diabetes education and services within West Virginia. This study reports cognitive interview qualitative findings from a multi-methods study. Individuals were recruited through an online search to identify clinics, organizations, and hospital staff that provided diabetes education in the state of West Virginia. Eligible participants were individuals who facilitated and managed diabetes education and support in counties of West Virginia. The interviews followed an 11-item interview guide, approved, and reviewed by a practicing Registered Dietitian and Certified Diabetes Care Education Specialist in West Virginia. All qualitative data from the interviews were hand-coded using grounded theory, by two researchers. 15 participating organizations from the state of West Virginia were included and described three phenomena: Diabetes Education Implementation (differences in: evaluation measures, modality, delivery format, topical areas); Barriers to Care (staffing, lack of training, evaluation, loss of research partnerships and funding); and Facilitators to Care (community-based involvement, interdisciplinary collaboration, capacity building (trainings). There are concerns with program drift and "risky" adaptations such as inconsistent evaluative measures, lack of training for program facilitators, variety of delivery formats, and content material. Findings recommend more alignment in program delivery to better implementation. Further studies should assess patient experiences with implemented diabetes education programs in West Virginia to further support the current research findings. [ABSTRACT FROM AUTHOR]

Key Takeaways: While the Safe Drinking Water Act (SDWA) applies to all public water systems in the United States, the severity and prevalence of violations vary among locations. A study investigated drinking water quality, indicated by statistics of the SDWA in the 13 Appalachian states from 2010 to 2022, to identify any differences in violations. The need for better water system management and infrastructure in economically disadvantaged regions is clear, along with public education and effective policies. [ABSTRACT FROM AUTHOR]

We investigated environmental supports, an understudied aspect of Social Cognitive Career Theory (SCCT), with rural Appalachian youth, an understudied population. We developed a new measure of proximal influences that bolster the pursuit of postsecondary education, the Assessment of Postsecondary Supports (APSS). Across 3 studies, we develop and validate the new measure, finding strong internal consistency and construct validity. Moreover, scores on the APSS were positively correlated with college-going self-efficacy (CGSE) and college outcome expectations (COE), explaining more unique variance than a measure of perceived educational barriers. [ABSTRACT FROM AUTHOR]

A striking effort is under way to use energy investment, a key feature of US federal climate policy, to build solar farms on former mining lands and in legacy mining communities in central Appalachia. Focusing on community solar initiatives, we consider the geosociality of energy transitions from the perspective of communities where many people have considerable knowledge of energy systems and how they work. We note that the politics of place-making in the context of environmental sacrifice and capital abandonment enables negotiations around energy that often seek to bridge deep social contradictions. We highlight how solar energy's diffuse networks of power, both social and electrical, privilege forms of temporal labor that are alliance-building, compositionist, para-ethnographic and intimately concerned with the capacity to build relations. Vernacular energy expertise can play a major role in creating novel forms of political sociality. In West Virginia, this both builds on and significantly shifts the emphasis of long legacies of energetic place-making. We expect the ongoing development of community-led solar investment to contribute to substantially important diversifying effects in West Virginian communities, especially when these efforts can more explicitly address the state's extreme geographical, race, and class-based inequalities. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory disease disproportionately affects residents of Appalachia, particularly those residing in Central Appalachia. Asthma is particularly burdensome to Central Appalachian residents regarding cost and disability. Improving our understanding of how to mitigate these burdens requires understanding the factors influencing asthma control among individuals with asthma living in Central Appalachia, specifically rural Kentucky. Methods: This community-based, cross-sectional epidemiologic study used survey data to identify characteristics associated with uncontrolled and controlled asthma. The designation of "uncontrolled asthma" was based on a self-report of ≥ 2 asthma exacerbations in the past year. Individuals with ≤ 1 or no exacerbations were considered to have controlled asthma. Chi-square or Fisher exact tests assessed the association between categorical variables and asthma control categories. Logistic regression was conducted to determine the impact of factors on the likelihood of uncontrolled asthma. Results: In a sample of 211 individuals with self-reported asthma, 29% (n = 61, 46 females) had uncontrolled asthma. Predictors of uncontrolled asthma included depression (odds ratio 2.61, 95% CI 1.22–5.61, p =.014) and living in multi-unit housing (odds ratio 4.99, 95% CI 1.47–16.96, p =.010) when controlling for age, sex, financial status, and occupation. Being overweight or obese was not a predictor of uncontrolled asthma. Physical activity and BMI did not predict the likelihood of uncontrolled asthma. Conclusion: This study highlights significant challenges rural communities in Appalachian Kentucky face in managing asthma. Factors like depression, housing conditions, and a lack of self-management strategies play pivotal roles in asthma control in this population. [ABSTRACT FROM AUTHOR]

Objectives: Oral health during the perinatal period and beyond affects the health and well‐being of women and their offspring. Oral self‐care behaviours can maintain or improve oral health; depression or stress during the perinatal period may compromise these behaviours. The aim of the study was to investigate the independent and combined effects of depression and stress on oral self‐care behaviours of perinatal women in Appalachia, given the high burden of oral disease in this region. Methods: A total of 1172 women in the first or second trimester of pregnancy were enrolled in the Center for Oral Health Research in Appalachia, cohort 2 (COHRA2) in West Virginia or Pittsburgh, Pennsylvania. Participants completed the Center for Epidemiological Studies Depression Scale, Perceived Stress Scale‐10, and self‐report items about oral self‐care behaviours (i.e. toothbrushing and flossing) during pregnancy and five times in the 2+ years following birth. A Generalized Estimating Equation approach was used to analyse the longitudinal data. Results: Maternal depression and stress were independently negatively related to toothbrushing and flossing frequency. These findings for toothbrushing were more pronounced in those with high levels of depression and high levels of stress, so there were both independent and combined effects. Frequency of toothbrushing and flossing stayed constant over time, so time was not associated with outcomes. About three‐fourths of the sample reported toothbrushing levels that are consistent with established guidelines (i.e. two times daily), but almost half of the participants had very low levels of flossing (i.e. once or less a week). Conclusion: Interventions targeting stress and depression throughout the perinatal period might be helpful in improving oral self‐care behaviours and oral health among women in Appalachia, in addition to the benefit of decreasing emotional distress. [ABSTRACT FROM AUTHOR]

From Oliver Twist (1837) to David Copperfteld (1850), Charles Dickens's novels explored the loss of the mother as the inauguration of a state of precariousness that both triggers and hinders protagonists' Bilclung This fundamental rupture with motherhood as both an embodied state and a symbolic personification of the sanctity of the domestic sphere triggers plots of individual development with far-ranging social implications. By expanding the focus on an individual protagonist's misfortunes to aft flictions faced by entire socio-economic categories, wider social critique in the Dickensian novel often relies on the sympathy engendered by the displacement of its vulnerable children. This article explores how Barbara Kingsolver's Demon Copperhead (2022), a contemporary novel that revisits the plot of Dickens's David Copperfield in a modern setting, repurposes the social critique of its informing text while producing a politically charged novel in its engagement with problematic constructions of motherhood. [ABSTRACT FROM AUTHOR]

Red spruce (Picea rubens Sarg.) is a commercially and ecologically important conifer species that primarily exists at northern latitudes of eastern North America and extends southward following the Appalachian Mountains into North Carolina and Tennessee. Due to a warming climate and human-caused disturbances, only fragmented, sky-island populations remain at the highest peaks of the southern Appalachians where their habitat continues to be threatened. While they have been recognized for the rare wildlife habitat they provide in the region, these populations remain understudied. This work aimed to examine differences in stem form between the northern and southern populations of red spruce and to provide additional quantitative methods for managing red spruce stands through providing regionally fitted stem taper models. First, we examined differences in stem form using two methods: a sectional rate of change in diameter and a region variable added to the Kozak (2004) Model 02 taper model. The sectional taper comparison showed significant differences (P  < .05) in taper rate throughout the stem that were most pronounced below breast height and above the midpoint. The nested model comparison also showed a significant difference after performing a likelihood ratio test. These results agreed that significant differences in stem form between the two populations exist and supported the idea that localized taper models would provide the best results. Next, we evaluated four stem taper models for their ability to predict upper stem diameters and total volume in southern Appalachian red spruce: a quadratic polynomial, a segmented, a variable exponent, and a geometric model. Fitting data came from a 1992 study across three southern Appalachian spruce-fir sites. Validation data came from a new dataset collected in 2022 at Unaka Mountain, Tennessee. Based on past studies and our results, we found that the Kozak (My last words on taper equations. For Chron 2004;80:507–15. https://doi.org/10.5558/tfc80507-4.) Model 02 variable exponent and the Max and Burkhart (Segmented polynomial regression applied to taper equations. For Sci 1976;22:283–9.) segmented polynomial models performed equally well. The choice of the final model should depend on the users' objectives and practical limitations (i.e. programming ability, availability of fitting data, error tolerance). [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints. Methods This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients’ (a) HF-related health status and depression/anxiety scale scores; and from caregivers’ (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants. Results The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p

We characterized concentrations of trihalomethanes (THMs), a measure of disinfection byproducts (DBPs), in tap water samples collected from households with utility-supplied water in two rural counties in Appalachian Virginia, and assessed associations with pH, free chlorine, and metal ions which can impact THM formation. Free chlorine concentrations in all samples (n = 27 homes) complied with EPA drinking water guidelines, though 7% (n = 2) of first draw samples and 11% (n = 3) of 5-min flushed-tap water samples exceeded the US Safe Drinking Water Act (SDWA) maximum contaminant level (MCL) for THM (80 ppb). Regression analyses showed that free chlorine and pH were positively associated with the formation of THM levels above SDWA MCLs (OR = 1.04, p = 0.97 and OR = 1.74, p = 0.79, respectively), while temperature was negatively associated (OR = 0.78, p = 0.38). Of the eight utilities serving study households, samples from water served by three different utilities exceeded the EPA MCL for THM. Overall, these findings do not indicate substantial exposures to DBPs for rural households with utility-supplied water in this region of southwest Virginia. However, given the observed variability in THM concentrations between and across utilities, and established adverse health impacts associated with chronic and acute DBP exposure, more research on DBPs in rural Central Appalachia is warranted. HIGHLIGHTS 11% (n = 3) of tap water samples exceeded the EPA MCL threshold for THMs (>80 ppb).; Mean free chlorine residual in tap water samples was ≥0.2 ppm, aligning with regulatory guidance.; More research is warranted to characterize rural exposures and assess potential drivers of DBP formation in small rural systems.;

AbstractStudents in Appalachia have a heritage of problem-solving. We explore how computational thinking (CT) relates to and complements this heritage by analyzing 34 local ingenuity stories, and perspectives from 35 community members about the relevance of CT. We found the two problem-solving approaches are meaningfully different, but can be used in concert. Since equating them could contribute to confusion and cultural erasure, researchers and educators bringing CT as a problem solving strategy into rural and other resourceful cultures must clarify what they mean by “CT helps problem solving.” In these cultures, CT skills are better introduced as new tools to expand students’ problem-solving toolkits, rather than tools that are identical to or better than those traditionally used in their culture. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints. Methods: This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients' (a) HF-related health status and depression/anxiety scale scores; and from caregivers' (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants. Results: The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p <.05) and lower depression/anxiety scores at 6 months, the study endpoint. The family caregivers in the intervention group had significantly lower scores on caregiving burden (p <.05) and depression/anxiety (p <.01) at 3 months. The mean helpfulness rating was M = 4.46 out of 5 (SD = 0.49). Conclusions: The FamPALcare intervention was found to be effective at improving patient HF-related health status and reducing caregiver burden and improving both patient and caregiver depression and anxiety scores. The FamPALcare HF intervention was found feasible and consistently delivered (fidelity). The FamPALcare intervention's cost-effectiveness and helpfulness ratings information will be used to plan for subsequent clinical trials. Trial registration: ClinicalTrials.gov NCT04153890, Registered on 4 November 2019, https://clinicaltrials.gov/ct2/show/NCT04153890. [ABSTRACT FROM AUTHOR]

Objective: The aim was to determine the impact of consolidation of two rural level 1 trauma centers on adult trauma patients presenting to the remaining level 1 trauma center. To our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed. Methods: A single institution, retrospective study was conducted at a rural level 1 trauma center. Adult trauma patients who presented to our center from January 2017 to January 2022 were included. The cohorts spanned 33 months pre- and post-consolidation. Multiple demographic and outcome measures were gathered. Data were analyzed using the student's t-test and Chi-squared testing. Results: There was a 33% increase in overall trauma activations and 9% increase in transfers from outside facilities post-consolidation. The post-consolidation group was significantly older, had higher mean injury severity score, and decreased hospital-free days. The post-consolidation group also saw an increase in ICU admission and surgical intervention. While there were no significant differences in ICU-free days or ventilator days, patients in the post-consolidation group with the highest level of activation who required both surgical intervention and ICU admission experienced decreased mortality. Conclusion: The consolidation of trauma services to a single level 1 trauma center in a rural Appalachian health system led to higher trauma volume and acuity, but most importantly decreased mortality for the most severely injured trauma patients. [ABSTRACT FROM AUTHOR]

This commentary thinks with Desiree Fields' 'Digital Experiments with Landed Property' across the urban–rural continuum. I offer provisional observations on rural property experiments emerging in Central Appalachia in the context of climate change. By way of conclusion, I suggest how scholars might engage and extend Fields' important provocations to deepen understandings of the shifting nature of land and property relations in the rural USA and the stakes thereof for rising authoritarian populism and political possibilities otherwise. [ABSTRACT FROM AUTHOR]

Sexual assault nurse examiners are crucial care providers in cases of sexual assault. However, it is not clear whether sexual assault nurse examiner availability differs throughout the 13 states that comprise the Appalachian region of the United States. Therefore, this cross-sectional analysis identified sexual assault nurse examiner availability in 13 states and determined differences in availability by both county-level Appalachian status and county-level rurality status. Data were downloaded from 2 public sexual assault nurse examiner registries for the included 13 states. Descriptive statistics of sexual assault nurse examiner certification type and availability by state were calculated. In addition, bivariate analyses of sexual assault nurse examiner availability by rurality and by Appalachian status were performed using 2-sample z-tests for equality of proportions. State-level sexual assault nurse examiner availability ranged from 0.34 to 0.86 sexual assault nurse examiners per 100,000 residents. Sexual assault nurse examiner availability in these 13 states did not differ by Appalachian status. However, rural areas had significantly lower sexual assault nurse examiner availability than urban areas in these 13 states. These data support previous literature on the need for stronger sexual assault nurse examiner programs in rural areas in the United States. Future research should take sexual assault prevalence into account to determine whether local sexual assault nurse examiner access needs, as well as appropriate support for sexual assault nurse examiners, are being met throughout Appalachian states. [ABSTRACT FROM AUTHOR]

The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level (P <.001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables (P >.05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population. [ABSTRACT FROM AUTHOR]

Eastern North America was constructed over several Wilson cycles, culminating in the breakup of Pangea. Previous seismological imaging lacked the resolution to depict precisely how ancient tectonic boundaries manifest throughout the lithosphere, how continental breakup modified the plate, or how ongoing mantle dynamics shapes the continental margin. We present a high‐resolution, plate‐scale seismic tomography model of the eastern US by combining an unprecedented suite of complementary data sets in a Bayesian framework. These data provide detailed resolution from crust to asthenosphere, identifying the base of the lithosphere and mid‐lithospheric discontinuities. The plate thins in steps that align with ancient orogens. The lithospheric step at the Appalachian front is associated with cells of mantle upwellings, likely edge‐driven convection, that erode the base of the plate and shape modern Appalachian topography. Low‐velocity structures in the lithospheric‐mantle align with the Grenville front and may be remnants of Rodinia assembly. Plain Language Summary: Eastern North America was constructed through several cycles of supercontinent assembly and breakup. The North American tectonic plate contains scars of this billion‐year history, but previous seismological imaging lacked the resolution to identify leftover structures that elucidate past processes or shed light on contemporary ones. We have produced a high‐resolution 3‐D seismological image of the eastern North American plate. Our imaging method combines numerous complementary data sets, which together provide resolution from the surface to beneath the plate. The plate is thickest where it is oldest, in the continental interior. It thins progressively eastward in steps that align well with geologically defined boundaries, and is thinnest next to the Atlantic ocean. A sharp step in plate thickness beneath the Appalachian Mountains provokes small convection cells, as cold plate drops off and hotter material ascends to replace it, pushing up the Appalachian mountains. We find a well‐preserved "fossil" of a collision zone, deep within the plate, likely left over from a billion‐year old supercontinent formation. The most recent supercontinent breakup, which led to Atlantic opening, has left a legacy of thin and heavily modified plate east of the Appalachians. Key Points: We present the highest resolution map to date of lithospheric properties from craton to margin in the eastern USSteep lithospheric steps drive edge‐driven convection along the margin and influence modern topographyGeologic boundaries correspond to plate‐spanning changes in seismic properties, including a possible continental suture [ABSTRACT FROM AUTHOR]

This paper is an aesthetic analysis of the practice of serpent handling by Christians in the Appalachian region of the United States. The purpose of this analysis is to understand serpent handling's aesthetic relationship to the Pentecostal tradition and exposit the implications of this relationship for the practice's legal status. The first section examines the history and defining characteristics of serpent handling and introduces the controversial problem of whether the practice can be categorized within the Pentecostal movement. The second section argues that serpent handling can be understood as belonging within the broader global Pentecostal tradition through engagement with the Pentecostal aesthetics of Nimi Wariboko. The final section concludes that if serpent handling is legible according to the aesthetic norms of Pentecostalism, a now broadly tolerated religious tradition in the United States, then this necessitates a wholesale reconsideration of antiserpent handling legislation. [ABSTRACT FROM AUTHOR]

We characterized concentrations of trihalomethanes (THMs), a measure of disinfection byproducts (DBPs), in tap water samples collected from households with utility-supplied water in two rural counties in Appalachian Virginia, and assessed associations with pH, free chlorine, and metal ions which can impact THM formation. Free chlorine concentrations in all samples (n = 27 homes) complied with EPA drinking water guidelines, though 7% (n = 2) of first draw samples and 11% (n = 3) of 5-min flushed-tap water samples exceeded the US Safe Drinking Water Act (SDWA) maximum contaminant level (MCL) for THM (80 ppb). Regression analyses showed that free chlorine and pH were positively associated with the formation of THM levels above SDWA MCLs (OR = 1.04, p = 0.97 and OR = 1.74, p = 0.79, respectively), while temperature was negatively associated (OR = 0.78, p = 0.38). Of the eight utilities serving study households, samples from water served by three different utilities exceeded the EPA MCL for THM. Overall, these findings do not indicate substantial exposures to DBPs for rural households with utility- supplied water in this region of southwest Virginia. However, given the observed variability in THM concentrations between and across utilities, and established adverse health impacts associated with chronic and acute DBP exposure, more research on DBPs in rural Central Appalachia is warranted. [ABSTRACT FROM AUTHOR]

Same-gender couples face unique sexual minority stressors that significantly impact individual and relationship health. This impact may be even greater among same-gender couples living in regions where there are pervasive social and legal biases that affect the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, two-spirit (LGBTQIA2S+) community (e.g., south central Appalachia). Brief relationship interventions, like the relationship checkup, are effective at improving relationship health and can be widely disseminated due to the brief and flexible nature of the program. Yet, this program was developed for different-gender couples and, as a result, may lack specific intervention for the unique stressors of same-gender couples. While many skills delivered in relationship interventions, including the relationship checkup, are applicable to all couples, untailored interventions for same-gender couples may result in less impactful outcomes. The present study examined whether the relationship checkup, in its original, unadapted format, is as effective for same-gender couples as it is for different-gender couples. Using a subsample from the larger relationship checkup study (N = 656 couples), the present sample included 64 committed couples (same-gender = 32; different-gender = 32). We used propensity score matching to match different-gender participants to the same-gender participants based on racial minority status, poverty status, marital status, and parenting status. Results revealed that same-gender couples presented similarly to different-gender couples on baseline relationship functioning and changed similarly on all relationship functioning outcomes through 1-month postintervention. Same-gender couples also reported similar degrees of satisfaction with and perceived helpfulness of the relationship checkup. The relationship checkup appears to be equally effective and acceptable for same-gender and different-gender couples. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to explore postpartum individuals' experiences and perceptions of breastfeeding and International Board Certified Lactation Consultants' (IBCLC) knowledge and perceptions of maternity care practices and perceived barriers to breastfeeding among their patient populations in Appalachia. Methods: Semistructured interviewswere conductedwith seven IBCLCs and seven postpartum individuals. Interviews were recorded and transcribed. Thematic analysis was conducted to determine emergent themes and subthemes related to knowledge/perceptions, experiences, and barriers to breastfeeding among postpartum individuals, aswell as emergent themes associated with the knowledge and perceptions of maternity care practices, easy-/difficult-to-implement Baby-Friendly Hospital Initiative maternity care practices, and perceived barriers to breastfeeding among IBCLCs. Results: Postpartum individuals recruited from an Appalachian obstetrics/gynecology clinicwere aware of the benefits of breastfeeding, but their infant feeding journeys were more stressful than they expected, and they had limited access to lactation support and breastfeeding education/information. IBCLCs identified the benefits of the Baby-Friendlymaternity care practices but mentioned some risks, especially when there is a lack of communication and coordination among providers. Environmental and informational barriers were identified by both postpartum individuals and IBCLCs as breastfeeding challenges potentially amenable to change. Conclusions: To support postpartum mothers in the Appalachian region, environmental barriers (eg, lack of lactation support) and informational barriers (eg, lack of prenatal education) need to be addressed. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. Methods: A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. Results: In two out of the three regression models, predictors such as traveling ≥10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled ≥10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. Conclusions: This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia. [ABSTRACT FROM AUTHOR]

Small mammals are important, albeit often overlooked, fauna in wetland restoration projects. However, it is essential to evaluate factors that influence small mammal community metrics in restored wetlands to maximize wetland restoration effectiveness. Previous studies found that vegetation differed as restored wetlands aged and that wetland age may play a role in the presence of amphibians and birds. Therefore, we assessed whether wetland age influenced small mammals. We also evaluated 17 environmental factors in restored wetlands that could influence small mammal communities in these wetlands. To assess and evaluate the effects of age and environmental factors on the small mammal community, we appraised 14 restored wetlands in West Virginia, USA, in the summers of 2020 and 2021 for small mammal community metrics, specifically relative abundance, diversity, richness, and evenness. We captured six species of small mammals: deer mice (Peromyscus maniculatus), white-footed mice (Peromyscus leucopus), meadow voles (Microtus pennsylvanicus), meadow jumping mice (Zapus hudsonius), northern short-tailed shrews (Blarina brevicauda), and eastern chipmunks (Tamias striatus). We found that the relative abundance of deer mice, white-footed mice, and meadow voles decreased with wetland age. However, both species diversity and evenness increased with wetland age. Wetland size influenced the relative abundance of white-footed mice, meadow jumping mice, and all small mammals combined. Although the relative abundance of white-footed mice and total small mammals decreased with wetland size, the relative abundance of meadow jumping mice increased with wetland size. Wetland managers should consider wetland age and size when designing wetlands to facilitate small mammal communities. [ABSTRACT FROM AUTHOR]

This case study examines young children’s access to fresh local produce in childcare settings in rural Appalachia. In-depth, semi-structured interviews with childcare center directors participating in farm to early care and education programming were conducted in the spring of 2023. Centering the per­spective of childcare directors, this research explores why farm to school programming is diffi­cult to implement. It specifically addresses the bar­riers preventing early childcare centers from pro­viding access to fresh and local produce to enrolled children. Eight primary obstacles to implementing farm to early care and education programming were identified: lack of staff; too wide a variety of tasks for directors; the “extra” work that fresh pro­duce requires; lack of knowledge about how to grow food; lack of required kitchen equipment; need for additional funding; unclear or out-of-date regulations about food safety; and a lack of paren­tal time. Limitations of the research include the specific geographic location of the study and the long-lasting implications of the COVID-19 pan­demic. Recommendations drawn from this case study include improving communication between childcare centers and regulatory agencies; creative use of alternative gardening practices; participating in a regional food hub; and improved funding.

Writer and director Elaine McMillion Sheldon begins her latest documentary, King Coal , with a funeral rite. A multigenerational, multiracial procession of people in black clothing walks slowly up a country road. All is quiet except for the sound of insects and a steady drum. Who are these mourners? Sheldon lets the mystery linger. But we learn eventually that the solemn rite is for a king—King Coal—or perhaps for the past he represents. [ABSTRACT FROM AUTHOR]

Following the 2016 elections, several feminist groups emerged in the U.S. in response to the election of President Trump. This manuscript focuses on a feminist assembly located in marginal and conservative Appalachia. Grounded in reflexivity, we employ affective solidarity to better understand feminist organizing in a post‐Trump rural Appalachian town. Based on a collaborative ethnography, including the National Organization of Women's local chapter members, conducted between 2016 and 2022, we analyze how political engagement has been initiated by an affective response—vulnerability, misery, rage, passion, and hope. By organizing open houses, marches, and voter guides, this group's outreach strives to inform and engage community members in dialogs around women's rights to improve gender equality in West Virginia, a state historically characterized by a conservative, heteronormative, patriarchal, and anti‐abortion mentality. We show how the dissonance between Trump's glorification of these ideologies and our affective responses served as a mechanism for feminist solidarity. This paper uses Butlerian principles to explore how vulnerability and resistance shape a feminist social movement held together by affective solidarity. We argue that responses to threats prompted by the Trump Presidency have been critical to the resurgence of our feminist agency and political engagement where conservative and masculine ideologies impose control over vulnerable populations. This paper advances the knowledge of vulnerability and agency and contributes to the literature on assemblies for political resistance. [ABSTRACT FROM AUTHOR]

The fauna of Diplura, the two-pronged bristletails (Hexapoda), of the southern Appalachians has received little focused systematic attention. Existing literature suggests the fauna to comprise around a dozen species. Based on a broader DNA barcode-based survey of high elevation litter arthropods in the region, we suggest the fauna to be much richer, with automated species delimitation methods hypothesising as many as 35 species, most highly restricted to single or closely proximate localities. Such a result should not be very surprising for such small, flightless arthropods, although it remains to be seen if other markers or morphology support such high diversity. The region still remains sparsely sampled for these more cryptic elements of the arthropod fauna and much larger numbers of species undoubtedly remain to be discovered. [ABSTRACT FROM AUTHOR]

Photovoice is an increasingly popular research method across disciplines due to its flexibility and capacity for generating rich data. This article argues that while its practical virtues are abundant, the theoretical contributions of photovoice to qualitative research are just as important. We argue that photographs can act as boundary objects that enable collective sensemaking at multiple stages of a research study. This is fulfilled through a case study of gas extraction and distribution networks and their social consequences in West Virginia, a state in the United States deeply entrenched geographically and culturally in natural resource extraction. Ultimately, this case study demonstrates that photovoice as a process and photographs as artifacts are sites for rich collaborative interpretation and provides a model of how to operationalize photos in multiple stages of research so that study designs are centered around participant experiences. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the accuracy of indexing for "Appalachian Region"[Mesh]. Researchers performed a search in PubMed for articles published in 2019 using "Appalachian Region"[Mesh] or "Appalachia" or "Appalachian" in the title or abstract. Only 17.88% of the articles retrieved by the search were about Appalachia according to the ARC definition. Most articles retrieved appeared because they were indexed with state terms that were included as part of the mesh term. Database indexing and searching transparency is of growing importance as indexers rely increasingly on automated systems to catalog information and publications. [ABSTRACT FROM AUTHOR]

Red spruce (Picea rubens) is the keystone species of the red spruce–northern hardwood forest, a unique high-elevation plant community that supports high biodiversity in the Central Appalachian mountains. These forests were drastically reduced by the Industrial Logging Era of the late 1800s and early 1900s, and the few remaining patches of this forest type remain in a degraded and fragmented state. Efforts to restore this ecosystem in West Virginia have been ongoing for over a decade and include red spruce plantings on old-field agricultural sites and on legacy coal mines. This project seeks to examine restoration outcomes for vegetation and soils along a 10 year chronosequence of planting sites. Significant differences in seedling height were observed for each year examined with old-fields exhibiting higher early (Year 1) heights, while legacy mines were significantly taller in Years 7 and 10. Annual growth rates did not differ between the two planting treatments. Soil chemical differences between treatments may have influenced seedling response. Although comparison of soil characteristics from the reforested sites to those from relatively undisturbed reference red spruce stands exhibited some statistical similarities, it was clear that mining and agricultural practices altered the soil environment greatly. As such, additional research to further examine practices that could improve soil health on these disturbed lands is recommended. [ABSTRACT FROM AUTHOR]

Purpose: Mutations in Topoisomerase I–binding RS protein (TOPORS) have been previously documented and have been described to result in pathological autosomal dominant retinitis pigmentosa (adRP). In our study, we describe the various genotypes and clinical/phenotypic manifestations of TOPORS-related mutations of our unique patient population in Rural Appalachia. Methods: The medical records of 416 patients with inherited retinal disease at the West Virginia University Eye Institute who had undergone genetic testing between the years of 2015–2022 were reviewed. Patients found to have pathologic RP and mutations related to TOPORS were then analyzed. Results: In total, 7 patients (ages 12–70) were identified amongst three unique families. All patients were female in our study. The average follow-up period was 7.7 years. A mother (70 yr) and daughter (51 yr) had a novel heterozygous nonsense point mutation in TOPORS c.2431C > T, p.Gln811X (Exon 3) that led to premature termination of the desired protein resulting in early onset vision loss, cataract formation, and visual field restriction. The mother developed a full-thickness macular hole which was successfully repaired. Five other patients were found to have previously described TOPORS mutations. Visual field loss was progressive with age in both cohorts. Conclusions: Seven patients at our institution were identified to have mutations in TOPORS resulting in autosomal dominant retinitis pigmentosa. Two patients were found to have novel truncating mutations in the TOPORS gene resulting in profound night blindness and visual field loss, recurrent macular edema, and in one individual, epiretinal membrane formation leading to a macular hole which was able to be successfully repaired. [ABSTRACT FROM AUTHOR]

Saturated hydraulic conductivity (Ksat) is a hydrologic flux parameter commonly used to determine water movement through the saturated soil zone. Understanding the influences of land-use-specific Ksat on the model estimation error of water balance components is necessary to advance model predictive certainties and land management practices. An exploratory modeling approach was developed in the physically based Soil and Water Assessment Tool (SWAT) framework to investigate the effects of spatially distributed observed Ksat on local water balance components using three digital elevation model (DEM) resolution scenarios (30 m, 10 m, and 1 m). All three DEM scenarios showed satisfactory model performance during calibration (R2 > 0.74, NSE > 0.72, and PBIAS ≤ ±13%) and validation (R2 > 0.71, NSE > 0.70, and PBIAS ≤ ±6%). Results showed that the 1 m DEM scenario provided more realistic streamflow results (0.315 m3/s) relative to the observed streamflow (0.292 m3/s). Uncertainty analysis indicated that observed Ksat forcings and DEM resolution significantly influence predictions of lateral flow, groundwater flow, and percolation flow. Specifically, the observed Ksat has a more significant impact on model predictive confidence than DEM resolution. Results emphasize the potential uncertainty of using observed Ksat for hydrological modeling and demonstrate the importance of finer-resolution spatial data (i.e., 1 m DEM) applied in smaller watersheds. [ABSTRACT FROM AUTHOR]

Kentucky is one of the largest coal-producing states; surface coal mining has led to changes in natural land cover, soil loss, and water quality. This study explored relationships between actively mined and reclaimed areas, vegetation change, and water quality parameters. The study site evaluated 58 watersheds with Landsat-derived variables (reclamation age and percentage of mining, reclaimed forest, and reclaimed woods) as well as topographic variables (such as elevation, slope, drainage density, and infiltration). Water samples were collected in spring (n = 9), summer (n = 14), and fall (n = 58) 2017 to study changes in water quality variables (SO42−, alkalinity, conductivity, Ca2+, Mg2+, Mn2+, Al3+, and Fe2+, Fe3+) in response to changes in land cover. Pearson correlation analyses indicated that conductivity has strong to very strong relationships with water quality variables related to coal mining (except Al3+, Fe2+, Fe3+, Mn2+, elevation, slope, and drainage density) and land cover variables. In addition, separate regression analyses were performed, with conductivity values based on samples collected in the fall. First, conductivity responses to mining percentage, reclamation age and topographic variables were examined (adjusted R2 = 0.818, p < 0.01). Next, vegetation cover change parameters were added to the same model, which yielded slightly improved R2 (adjusted R2 = 0.826, p < 0.01). Finally, reclamation age and mining percentages were used to explain the quantity of reclaimed forested areas as a percentage of watersheds. The model was significant (p < 0.01), with an adjusted R2 value of 0.641. Results suggest that the quantity (area as a percentage) of reclaimed forests may be a predictor of the mining percentage and reclamation age. This study indicated that conductivity is a predictable water quality indicator that is highly associated with Coal-Mine-Related Stream Chemistry in areas where agriculture and urban development are limited. Water quality is not suitable for various purposes due to the presence of contaminants, especially in mined sites. These findings may help the scientific community and key state and federal agencies improve their understanding of water quality attributes in watersheds affected by coal mining, as well as refine land reclamation practices more effectively while such practices are in action. [ABSTRACT FROM AUTHOR]

American ginseng (Panax quinquefolius) is a slow-growing medicinal root native to eastern North America. Though it is possible to farm, wild ginseng can sell for twenty (or more) times as much as cultivated ginseng. Declining wild ginseng populations due to habitat loss and overharvesting has led to harvest restrictions, but strong demand for wild ginseng remains. One potential solution is "wild-simulated" ginseng, where ginseng is grown under conditions crafted to mimic a wild forest with the goal of producing roots that look wild. I contend, however, that despite the fact that wild-simulated ginseng grows in a habitat actively tended and monitored by humans, is nevertheless wild. I explore wildness as "productive unruliness" and show how wild-simulated ginseng actively crafts wildness through management to maintain if not add complexity, to foster unpredictability, or to facilitate stress. Furthermore, the habitat that wild-simulated ginseng growers are attempting to emulate—"wild" Appalachian woodlands dominated by an assemblage of "native" plants that pre-date the arrival of Europeans in the Americas—are themselves the product of human manipulation. In Appalachia, the boundaries between the wild and the cultivated are blurred. Wild-simulated ginseng is an example of how conservation goals can be achieved by crafting "wild" environments that are not untouched, pristine wildernesses. [ABSTRACT FROM AUTHOR]

IntroductionResidents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool (“talking card”) to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy.Materials and methodsWe collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion.ResultsAcross the three study phases, 692 individuals participated. Survey respondents positively identified with the card’s sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion.DiscussionTo reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings.

Abstract Eastern North America was constructed over several Wilson cycles, culminating in the breakup of Pangea. Previous seismological imaging lacked the resolution to depict precisely how ancient tectonic boundaries manifest throughout the lithosphere, how continental breakup modified the plate, or how ongoing mantle dynamics shapes the continental margin. We present a high‐resolution, plate‐scale seismic tomography model of the eastern US by combining an unprecedented suite of complementary data sets in a Bayesian framework. These data provide detailed resolution from crust to asthenosphere, identifying the base of the lithosphere and mid‐lithospheric discontinuities. The plate thins in steps that align with ancient orogens. The lithospheric step at the Appalachian front is associated with cells of mantle upwellings, likely edge‐driven convection, that erode the base of the plate and shape modern Appalachian topography. Low‐velocity structures in the lithospheric‐mantle align with the Grenville front and may be remnants of Rodinia assembly.

This paper employs approaches from religious studies and Appalachian studies to examine the history, influence, and future of a multifaceted ethos of extraction, particularly as it influences the coal industry, in the Appalachian region of the United States. While many studies of extraction and the coal industry focus on their economic and political dimensions, by examining a broader ethos of extraction, this paper highlights multiple religious influences, including the entanglements between religious communities and extraction-based industries, the powerful moral narratives that serve to interpret and justify extraction, and the dynamics involved in shaping local identities and perceptions of place that enable this ethos to influence post-coal transition efforts. The result is a broad survey of the influences and impacts of resource extraction in Appalachia that challenges many of the longstanding stereotypes that can still be commonly found deployed about the region. In examining these influences, the paper also describes how academic interpreters have helped to shape popular conceptions of the Appalachian region that ultimately support ongoing extractive practices. Building upon insights from grassroots, anti-extractive activist communities in the region, the paper concludes by suggesting some ways that academics might adopt restorative ethics and practices in their work to address the entanglements between extractive scholarship and exploitation and devise alternative paths for just futures.

Introduction: Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). Methods: We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. Results: We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. Conclusions: This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery. [ABSTRACT FROM AUTHOR]