Postsouthern cartographies: capital, land and place from 'The Moviegoer' to 'A man in full'

This thesis takes a historical-geographical materialist approach to the capitalist production and literary representation of "place" in the American South between the 1960s and 1990s. Part 1 provides literary-historical and theoretical context. Chapter 1 considers how the Agrarians and their literary critical acolytes defined the "sense of place" of "Southern literature." However, the chapter also recovers an aspect of Agrarianism suppressed by later Southern literary critics: the critique of modern (finance) capitalist abstraction expressed through the Agrarians' "proprietary ideal." Drawing also on postmodern theory, Chapter 2 theorises a postsouthern literary theory of place. Part 2 analyses the "postsouthern turn" in novels by Robert Penn Warren, Walker Percy and Richard Ford. Chapter 3 argues that, in A Place to Come to (1977), Warren interrogates his earlier Agrarian aesthetics of place. In Percy's The Moviegoer (1961), land speculator Binx Bolling constructs a rhetorical contrast between "the South" and "the North" to repress his fear that capitalist development is destroying New Orleans and its environs. Chapters 4 to 6 argue that, in A Piece of My Heart (1976), The Sportswriter (1986) and Independence Day (1995), Ford has offered the most sustained and sophisticated critique of the Southern literary critical "sense of place." Part 3 focuses uses upon recent literary representations of Atlanta. Chapter 7 provides a contextual assessment of Atlanta's "non-place" in "Southern literature" and its development as a postsouthern "international city." Chapter 8 considers the representational politics of "creative destruction" in Anne Rivers Siddons' Peachtree Road (1988). Chapter 9 considers the role of land speculation, global capital flows and finance capitalist abstraction in Tom Wolfe's A Man in Full (1998). The final chapter demonstrates how Toni Cade Bambara's novel about the Atlanta Child Murders, Those Bones Are Not My Child (1999), indicts capitalist abstraction through a grotesque body politics of place

Postsouthern cartographies: capital, land and place from 'The Moviegoer' to 'A man in full'

This thesis takes a historical-geographical materialist approach to the capitalist production and literary representation of "place" in the American South between the 1960s and 1990s. Part 1 provides literary-historical and theoretical context. Chapter 1 considers how the Agrarians and their literary critical acolytes defined the "sense of place" of "Southern literature." However, the chapter also recovers an aspect of Agrarianism suppressed by later Southern literary critics: the critique of modern (finance) capitalist abstraction expressed through the Agrarians' "proprietary ideal." Drawing also on postmodern theory, Chapter 2 theorises a postsouthern literary theory of place. Part 2 analyses the "postsouthern turn" in novels by Robert Penn Warren, Walker Percy and Richard Ford. Chapter 3 argues that, in A Place to Come to (1977), Warren interrogates his earlier Agrarian aesthetics of place. In Percy's The Moviegoer (1961), land speculator Binx Bolling constructs a rhetorical contrast between "the South" and "the North" to repress his fear that capitalist development is destroying New Orleans and its environs. Chapters 4 to 6 argue that, in A Piece of My Heart (1976), The Sportswriter (1986) and Independence Day (1995), Ford has offered the most sustained and sophisticated critique of the Southern literary critical "sense of place." Part 3 focuses uses upon recent literary representations of Atlanta. Chapter 7 provides a contextual assessment of Atlanta's "non-place" in "Southern literature" and its development as a postsouthern "international city." Chapter 8 considers the representational politics of "creative destruction" in Anne Rivers Siddons' Peachtree Road (1988). Chapter 9 considers the role of land speculation, global capital flows and finance capitalist abstraction in Tom Wolfe's A Man in Full (1998). The final chapter demonstrates how Toni Cade Bambara's novel about the Atlanta Child Murders, Those Bones Are Not My Child (1999), indicts capitalist abstraction through a grotesque body politics of place

Influence of statistical methods and reference dates on describing temperature change in Alaska

Quantifying temperature trends across multiple decades in Alaska is an essential component for informing policy on climate change in the region. However, Alaska's climate is governed by a complex set of drivers operating at various spatial and temporal scales, which we posit should result in a sensitivity of trend estimates to the selection of reference start and end dates as well as the choice of statistical methods employed for quantifying temperature change. As such, this study attempts to address three questions: (1) How sensitive are temperature trend estimates in Alaska to reference start dates? (2) To what degree do methods vary with respect to estimating temperature change in Alaska? and (3) How do different reference start dates and statistical methods respond to climatic events that impact Alaska's temperature? To answer these questions, we examine the use of five methods for quantifying temperature trends at 10 weather stations in Alaska and compare multiple reference start dates from 1958 to 1993 while using a single reference end date of 2003. The results from this analysis demonstrate that, with some methods, the discrepancy in temperature trend estimates between consecutive start dates can be larger than the overall temperature change reported for the second half of the 20th century. Second, different methods capture different climatic patterns, thus influencing temperature trend estimates. Third, temperature trend estimation varies more significantly when a reference start date is defined by an extreme temperature. These findings emphasize that sensitivity analyses should be an essential component in estimating multidecadal temperature trends and that comparing estimates derived from different methods should be performed with caution. Furthermore, the ability to describe temperature change using current methods may be compromised given the increase in temperature extremes in contemporary climate change

The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study

BACKGROUND: Work-related neck and upper limb pain has mainly been studied in specific occupational groups, and little is known about its impact in the general population. The objectives of this study were to estimate the prevalence and population impact of work-related neck and upper limb pain. METHODS: A cross-sectional survey was conducted of 10 000 adults in North Staffordshire, UK, in which there is a common local manual industry. The primary outcome measure was presence or absence of neck and upper limb pain. Participants were asked to give details of up to five recent jobs, and to report exposure to six work activities involving the neck or upper limbs. Psychosocial measures included job control, demand and support. Odds ratios (ORs) and population attributable fractions were calculated for these risk factors. RESULTS: The age-standardized one-month period prevalence of neck and upper limb pain was 44%. There were significant independent associations between neck and upper limb pain and: repeated lifting of heavy objects (OR = 1.4); prolonged bending of neck (OR = 2.0); working with arms at/above shoulder height (OR = 1.3); little job control (OR = 1.6); and little supervisor support (OR = 1.3). The population attributable fractions were 0.24 (24%) for exposure to work activities and 0.12 (12%) for exposure to psychosocial factors. CONCLUSION: Neck and upper limb pain is associated with both physical and psychosocial factors in the work environment. Inferences of cause-and-effect from cross-sectional studies must be made with caution; nonetheless, our findings suggest that modification of the work environment might prevent up to one in three of cases of neck and upper limb pain in the general population, depending on current exposures to occupational risk

Tai Chi for osteopenic women: design and rationale of a pragmatic randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Post-menopausal osteopenic women are at increased risk for skeletal fractures. Current osteopenia treatment guidelines include exercise, however, optimal exercise regimens for attenuating bone mineral density (BMD) loss, or for addressing other fracture-related risk factors (e.g. poor balance, decreased muscle strength) are not well-defined. Tai Chi is an increasingly popular weight bearing mind-body exercise that has been reported to positively impact BMD dynamics and improve postural control, however, current evidence is inconclusive. This study will determine the effectiveness of Tai Chi in reducing rates of bone turnover in post-menopausal osteopenic women, compared with standard care, and will preliminarily explore biomechanical processes that might inform how Tai Chi impacts BMD and associated fracture risks.</p> <p>Methods/Design</p> <p>A total of 86 post-menopausal women, aged 45-70y, T-score of the hip and/or spine -1.0 and -2.5, have been recruited from primary care clinics of a large healthcare system based in Boston. They have been randomized to a group-based 9-month Tai Chi program plus standard care or to standard care only. A unique aspect of this trial is its pragmatic design, which allows participants randomized to Tai Chi to choose from a pre-screened list of community-based Tai Chi programs. Interviewers masked to participants' treatment group assess outcomes at baseline and 3 and 9 months after randomization. Primary outcomes are serum markers of bone resorption (C-terminal cross linking telopeptide of type I collagen), bone formation (osteocalcin), and BMD of the lumbar spine and proximal femur (dual-energy X-ray absorptiometry). Secondary outcomes include health-related quality-of-life, exercise behavior, and psychological well-being. In addition, kinetic and kinematic characterization of gait, standing, and rising from a chair are assessed in subset of participants (n = 16) to explore the feasibility of modeling skeletal mechanical loads and postural control as mediators of fracture risk.</p> <p>Discussion</p> <p>Results of this study will provide preliminary evidence regarding the value of Tai Chi as an intervention for decreasing fracture risk in osteopenic women. They will also inform the feasibility, value and potential limitations related to the use of pragmatic designs for the study of Tai Chi and related mind-body exercise. If the results are positive, this will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.</p> <p>Trial registration</p> <p>This trial is registered in Clinical Trials.gov, with the ID number of NCT01039012.</p

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

Abstract Background Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture. Objectives To evaluate the clinical effectiveness and safety of bisphosphonates [alendronic acid (Fosamax® and Fosamax® Once Weekly, Merck Sharp & Dohme Ltd), risedronic acid (Actonel® and Actonel Once a Week®, Warner Chilcott UK Ltd), ibandronic acid (Bonviva®, Roche Products Ltd) and zoledronic acid (Aclasta®, Novartis Pharmaceuticals UK Ltd)] for the prevention of fragility fracture and to assess their cost-effectiveness at varying levels of fracture risk. Data sources For the clinical effectiveness review, six electronic databases and two trial registries were searched: MEDLINE, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science and BIOSIS Previews, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform. Searches were limited by date from 2008 until September 2014. Review methods A systematic review and network meta-analysis (NMA) of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. Discrete event simulation was used to estimate lifetime costs and quality-adjusted life-years (QALYs) for each bisphosphonate treatment strategy and a strategy of no treatment for a simulated cohort of patients with heterogeneous characteristics. The model was populated with effectiveness evidence from the systematic review and NMA. All other parameters were estimated from published sources. A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Fracture risk was estimated from patient characteristics using the QFracture® (QFracture-2012 open source revision 38, Clinrisk Ltd, Leeds, UK) and FRAX® (web version 3.9, University of Sheffield, Sheffield, UK) tools. The relationship between fracture risk and incremental net benefit (INB) was estimated using non-parametric regression. Probabilistic sensitivity analysis (PSA) and scenario analyses were used to assess uncertainty. Results Forty-six randomised controlled trials (RCTs) were included in the clinical effectiveness systematic review, with 27 RCTs providing data for the fracture NMA and 35 RCTs providing data for the femoral neck bone mineral density (BMD) NMA. All treatments had beneficial effects on fractures versus placebo, with hazard ratios varying from 0.41 to 0.92 depending on treatment and fracture type. The effects on vertebral fractures and percentage change in BMD were statistically significant for all treatments. There was no evidence of a difference in effect on fractures between bisphosphonates. A statistically significant difference in the incidence of influenza-like symptoms was identified from the RCTs for zoledronic acid compared with placebo. Reviews of observational studies suggest that upper gastrointestinal symptoms are frequently reported in the first month of oral bisphosphonate treatment, but pooled analyses of placebo-controlled trials found no statistically significant difference. A strategy of no treatment was estimated to have the maximum INB for patients with a 10-year QFracture risk under 1.5%, whereas oral bisphosphonates provided maximum INB at higher levels of risk. However, the PSA suggested that there is considerable uncertainty regarding whether or not no treatment is the optimal strategy until the QFracture score is around 5.5%. In the model using FRAX, the mean INBs were positive for all oral bisphosphonate treatments across all risk categories. Intravenous bisphosphonates were estimated to have lower INBs than oral bisphosphonates across all levels of fracture risk when estimated using either QFracture or FRAX. Limitations We assumed that all treatment strategies are viable alternatives across the whole population. Conclusions Bisphosphonates are effective in preventing fragility fractures. However, the benefit-to-risk ratio in the lowest-risk patients may be debatable given the low absolute QALY gains and the potential for adverse events. We plan to extend the analysis to include non-bisphosphonate therapies. Study registration This study is registered as PROSPERO CRD42013006883. Funding The National Institute for Health Research Health Technology Assessment programme

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570