Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons™

Open Access. Powered by Scholars. Published by Universities.®

Arts and Humanities

Institution
Keyword
Publication Year
Publication
Publication Type
File Type

Articles 3361 - 3390 of 13260

Full-Text Articles in Medicine and Health Sciences

From Case Study As Symptom To Case Study As Sinthome: Engaging Lacan And Irigaray On "Thinking In Cases" As Psychoanalytic Pedagogy, Erica Freeman Aug 2020

From Case Study As Symptom To Case Study As Sinthome: Engaging Lacan And Irigaray On "Thinking In Cases" As Psychoanalytic Pedagogy, Erica Freeman

Electronic Theses and Dissertations

This dissertation accomplishes two goals. First, this dissertation articulates a Lacanian account of the epistemological and historical presuppositions of the psychoanalytic case study genre, while engaging reflexively with extant Foucauldian scholarship on this genre as well as feminist psychoanalyst Luce Irigaray’s criticisms of Lacan. Irigaray’s critique is engaged in order to tarry with its implications for a Lacanian approach to the psychoanalytic case study genre. Second, this dissertation critically examines the significance of Lacan’s (re)reading, in Seminar V, of Joan Riviere’s (1929) “Womanliness as Masquerade” in the midst of his oral teachings on the psychoanalytic concepts of castration and …


Special Issue – July 2021 The Impact Of Inequity & Health Disparities On The Human Experience, Patient Experience Journal Aug 2020

Special Issue – July 2021 The Impact Of Inequity & Health Disparities On The Human Experience, Patient Experience Journal

Patient Experience Journal

Patient Experience Journal (PXJ) is excited to announce the call for submissions for its July 2021 special issue on the impact of racial inequality, health disparities, and discrimination on the human experience. The world now finds itself in the grips of a global pandemic that is taking its toll on communities socially and economically, placing strain on healthcare workers and revealing the very systemic weaknesses and inherent biases that have been resting just beneath the surface of our society for years. The challenge of disparity and inequity is not unique to healthcare, but in the era of COVID-19, what many …


Ada News - 08/03/2020, American Dental Association, Publishing Division Aug 2020

Ada News - 08/03/2020, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.


The History Of Early Modern Medicine In New Spain, El Primero Sueño, And Poet Sor Juana Inés De La Cruz, Daniel Hughes Aug 2020

The History Of Early Modern Medicine In New Spain, El Primero Sueño, And Poet Sor Juana Inés De La Cruz, Daniel Hughes

Grand Valley Journal of History

This essay analyzes poetry and other writing by Sor Juana Inés de la Cruz in the context of themes from Greco-Roman antiquity and the historical development of medicine in seventeenth century New Spain, now Mexico. Sor Juana’s El Primero Sueño, a Spanish language poetic silva, exhibits copious references to writers from classical antiquity, including Aristotle and Ovid. Establishing a context steeped in ideas from Greco-Roman antiquity, Sor Juana invokes the medical and philosophical legacy of foundational physician Galen of Pergamon. She also expands upon his ideas into the human anatomical realm, reflecting the increased early modern prominence of …


A Unique Type Of Loneliness: Infertility In Nineteenth-Century America, Abigail Butler Aug 2020

A Unique Type Of Loneliness: Infertility In Nineteenth-Century America, Abigail Butler

Theses and Dissertations from 2020

Many diaries and letters written by nineteenth-century Americans display the aching for parenthood and pain of loss due to miscarriage. Though some women felt joy or relief when they recognized they had miscarried or were not pregnant, infertility negatively affected the everyday lives of many men and women in the nineteenth century. Infertility not only disturbed their personal beliefs of family and their role in society, but could cause marital discord, feeling outcast from society, and could lead to other health problems. Women in slavery faced even more serious consequences that included being sold away from their family and/or receiving …


The Aids Virus And The Galvanization Of The Lgbtq Movement For Equality, Michael Ernest Wachowski Aug 2020

The Aids Virus And The Galvanization Of The Lgbtq Movement For Equality, Michael Ernest Wachowski

Graduate Theses

The LGBTQ community was greatly altered by the AIDS crisis and the organizations that were founded in the 1980s. AIDS would become associated with those of the gay community during the early years of the crisis. The government and leading health officials perpetuated the public’s ignorance about the relativity new disease leading to more misunderstandings and mishandlings of the HIV/AIDS crisis. The disease did not discriminate among people, however, and quickly spread throughout many of the communities in the U.S. Organizations with roots in the LGBTQ community established themselves during the 1980s to deal with not only the AIDS crisis, …


Clusters Of Individuals Experiences Form A Continuum Of Persistent Non-Symbolic Experiences In Adults, Jeffery A. Martin Aug 2020

Clusters Of Individuals Experiences Form A Continuum Of Persistent Non-Symbolic Experiences In Adults, Jeffery A. Martin

CONSCIOUSNESS: Ideas and Research for the Twenty-First Century

Persistent forms of nondual awareness, enlightenment, mystical experience, and so forth (Persistent Non-Symbolic Experience) have been reported since antiquity. Though sporadic research has been performed on these experiences, the scientific literature has yet to report a large-scale cognitive psychology study of this population. Method: Assessment of the subjective experience of 319 adult participants reporting persistent non-symbolic experience was undertaken using 6-12 hour semi-structured interviews and evaluated using grounded theory and thematic analysis. Results: Five core, consistent categories of change were uncovered: sense-of-self, cognition, affect, perception, and memory. Participants’ reports formed phenomenological groups in which the types of change …


Resilience In Nonmetropolitan Nebraska: Capacity To Overcome Disasters And Hardships, 2020 Nebraska Rural Poll Results, Rebecca Vogt, Cheryl Burkhart-Kriesel, Brad Lubben, L.J. Mcelravy, Timothy Meyer, Steve Schulz, Jason L. Weigle Aug 2020

Resilience In Nonmetropolitan Nebraska: Capacity To Overcome Disasters And Hardships, 2020 Nebraska Rural Poll Results, Rebecca Vogt, Cheryl Burkhart-Kriesel, Brad Lubben, L.J. Mcelravy, Timothy Meyer, Steve Schulz, Jason L. Weigle

Rural Futures Institute: Publications

The definition of resilience is the capacity to recover quickly from difficulties. Synonyms include toughness, perseverance and grit. Last spring’s severe weather events and this year’s ongoing COVID-19 pandemic are likely testing the resilience of rural Nebraskans. Given that, how do rural Nebraskans rate their communities on dimensions that measure their resiliency? How confident are they that the federal government or local emergency management authorities can contain infectious disease outbreaks? How do they rate their ability to help their community handle adversities? How prepared are rural Nebraskans to deal with financial emergencies? This paper provides a detailed analysis of these …


University Crime Alerts: Do They Contribute To Institutional Betrayal And Rape Myths?, Alexis A. Adams-Clark, Carly P. Smith, Prachi H. Bhuptani, Jennifer J. Freyd Aug 2020

University Crime Alerts: Do They Contribute To Institutional Betrayal And Rape Myths?, Alexis A. Adams-Clark, Carly P. Smith, Prachi H. Bhuptani, Jennifer J. Freyd

Dignity: A Journal of Analysis of Exploitation and Violence

Universities are mandated by the Clery Act (20 USC § 1092(f)) to publicize the occurrence of certain campus crimes. Many universities rely on “Crime Alert” emails to quickly and effectively communicate when a crime has occurred. However, communications of sexual crimes are often narrow (e.g., limited to stranger-perpetrated crimes) and misleading (e.g., containing safety tips that are not applicable to most types of sexual violence). The current paper presents the results of two studies that test the effects of reading crime alert emails on subsequent endorsement of rape myths and institutional betrayal. In Study 1, participants read a typical crime …


Memory And Stereotypes For Lesbian/Gay Characters, Amber Rose Williams Aug 2020

Memory And Stereotypes For Lesbian/Gay Characters, Amber Rose Williams

UNLV Theses, Dissertations, Professional Papers, and Capstones

Stereotype-consistency bias refers to the idea that people tend to remember stereotypical information about others better than non-stereotypical information (Fyock & Stangor, 1994). Limited research has examined how people may use stereotype-consistency bias when recalling information about LGBT characters in narratives (Bellezza & Bower, 1981; Clark & Woll, 1981; McGann & Goodwin, 2007; Snyder & Uranowitz, 1978). This line of research suggests that, instead of genuinely remembering stereotypical information better, participants tended to guess stereotypical answers to questions they do not know. In contrast to those studies, the experiment I conducted for this thesis suggests that heterosexual young adults tend …


Reproductive Health In The Philippines: Poverty, Religiosity, And Navigating Reproductive Choices, Allison Goncena Aug 2020

Reproductive Health In The Philippines: Poverty, Religiosity, And Navigating Reproductive Choices, Allison Goncena

International Studies (MA) Theses

This dissertation centers the Philippines as a case study in which quantitative and qualitative data from empirical studies, science journal articles, social science texts, and interviews are cross-examined to ascertain two main areas of interest. The first incentive is to identify and analyze the Catholic Church’s resources in perpetuating moral male-dominant rhetoric that have delayed efforts supporting reproductive health intended to aid low-income women concerning their sexual and reproductive health. The second incentive is to detect how low-income women’s thoughts and behaviors in making reproductive decisions are resonant or not of the Church’s moral rectitude over SRH through their demonstrations …


Sexual Violence, Traumatic Memory, And Speculative Fiction As Action, Kate Rose Aug 2020

Sexual Violence, Traumatic Memory, And Speculative Fiction As Action, Kate Rose

Dignity: A Journal of Analysis of Exploitation and Violence

Starhawk’s speculative novel City of Refuge (2015) depicts rape trauma and its consequences in a dystopian society that is the logical conclusion of patriarchy. French psychiatrist Muriel Salmona’s research on how traumatic memory contributes to inequality and how reconstructing narrative can heal survivors places her similarly at the intersection of story and activism. City of Refuge is a literary experiment focused on survivors of institutionalized sexual assault, while Salmona’s work maps consequences of traumatic memory linked to childhood sexual violence. The basic tenet of narrative medicine that life experience affects mental and physical health coincides with Salmona’s critique of how …


So Others May Live: The Price Of Healthcare In Combat, Robert Del Toro Aug 2020

So Others May Live: The Price Of Healthcare In Combat, Robert Del Toro

War, Diplomacy, and Society (MA) Theses

“Medics carried more responsibilities than dry feet, salt tablets, syphilis, and puncture wounds,” U.S. Army Medic Ben Sherman stated after reflecting on his tour in Vietnam. On the battlefields of North Africa, Italy, France, and Vietnam, the medics of the U.S. Army Medical Department faced the difficult duty of preserving life while death surrounded them. Their patients were not strangers but, men they had grown close to, they were comrades and family. Analyzing the memoirs and letters of forward medical personnel from the Second World War and the Vietnam War, this thesis analyzes how a medic’s care went beyond the …


A Three Article Study Examining Sexual And Gender Minority Competency Of Health Service Providers, Corrine N. Wilsey Aug 2020

A Three Article Study Examining Sexual And Gender Minority Competency Of Health Service Providers, Corrine N. Wilsey

Health Services Research Dissertations

Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and more medical conditions. These disparities are exacerbated by the fact that SGM individuals face issues such as accessing health insurance, social support programs, and health service providers who are knowledgeable about SGM health issues. Certain health service provider governing organizations (i.e., the American Psychological Association, the Association of American Medical Colleges, and the Gay and Lesbian Medical Association) have recognized the need for guidelines regarding SGM care in recent years and published guidelines for health service providers regarding …


Minority Counselor Multicultural Competence In The Current Sociopolitical Climate, Kathleen Brown Aug 2020

Minority Counselor Multicultural Competence In The Current Sociopolitical Climate, Kathleen Brown

Counseling & Human Services Theses & Dissertations

A key component of professional orientation in the field of mental health is the ability to provide counseling that is culturally competent. Counselor preparatory education, ethical codes, professional organizations and regulating bodies recognize cultural competence as a cornerstone of clinical practice. It is especially important during a time in which cultural and racial minorities combat a tumultuous sociopolitical climate. American society has seen an exponential rise in anxiety, depression, and helplessness secondary to the 2016 Presidential Election. For minority counselors, providing multiculturally competent counseling in the face of extreme oppression, and during a period of apparent resurgence in overt systemic …


Hello, I’M Fat: Finding Myself In A Hulu Original, Mac Clark Aug 2020

Hello, I’M Fat: Finding Myself In A Hulu Original, Mac Clark

Student Works

My first relationship happened when I was 18. We matched on Tinder and spent the following month doing everything people in relationships do, just without the label. This casual mindset was not my choice, and neither was the constant feeling of disappointment. I yearned to be respected; I knew it wasn’t right for him to sleep through our dates nor return my texts for days at a time. I wanted a real relationship, one where I wouldn’t have to beg for clarity, but as a fat, young woman, I believed this lesser form of relationship was my only option, so …


Rejection Sensitivity And The Intent To Seek Medical Help Among Gender Minority Individuals, Kellyann Garthe Aug 2020

Rejection Sensitivity And The Intent To Seek Medical Help Among Gender Minority Individuals, Kellyann Garthe

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: As members of a marginalized and socially devalued group, gender minority (GM) individuals regularly experience rejection in healthcare experiences. These rejecting experiences lead to barriers to healthcare access and health disparities. Consequently, GM individuals’ may develop anxious and avoidant attitudes toward their healthcare needs. When considering healthcare, an individual’s inherent attitude informs their intent to seek medical help (ISMH), defined as the attitude that influences one’s decision to seek medical help. When an individual has a hyper-sensitive reaction to perceived rejection, this is termed rejection sensitivity (RS).

Purpose: The purpose of the study was to determine if the independent …


Catholic Family Ties: Sustaining And Supporting Hiv-Positive Canadian Gay Men’S Faith, Mental Health, And Wellbeing, Renato M. Liboro Jul 2020

Catholic Family Ties: Sustaining And Supporting Hiv-Positive Canadian Gay Men’S Faith, Mental Health, And Wellbeing, Renato M. Liboro

Psychology Faculty Research

Research has documented that sexual minorities and people living with HIV/AIDS have successfully used religious coping to help them overcome life challenges related to their sexual orientation and HIV status, including religious struggles surrounding their faith brought about by stigma and discrimination that have historically been promoted by organized religion. Research has also documented how sexual minorities and people living with HIV/AIDS have utilized family support as a vital resource for effectively coping with life challenges associated with homophobia, heterosexism, and HIV stigma, which have historically been perpetuated in certain family and faith dynamics. The aim of the community-engaged, qualitative …


Creatively Exploring Self: Applying Organic Inquiry, A Transpersonal And Intuitive Methodology, Larisa J. Bardsley Phd Jul 2020

Creatively Exploring Self: Applying Organic Inquiry, A Transpersonal And Intuitive Methodology, Larisa J. Bardsley Phd

The Qualitative Report

This article explores the merit of using Organic Inquiry, a qualitative research approach that is most effectively applied to areas of psychological and spiritual growth. Organic Inquiry is a research approach where the psyche of the researcher becomes the instrument of the research, working in partnership with the experiences of participants and guided by liminal and spiritual influences. Organic Inquiry is presented as a unique methodology that can incorporate other non-traditional research methods, including intuitive, autoethnographic and creative techniques. The validity and application of Organic Inquiry, as well as its strengths and limitations are discussed in the light of the …


Impacts Of The Covid-19 Pandemic On Black Americans With Diabetes, Ted Studt Jul 2020

Impacts Of The Covid-19 Pandemic On Black Americans With Diabetes, Ted Studt

Biology Summer Fellows

The COVID-19 pandemic has impacted all Americans in varying ways, but it has hit the American Black population particularly hard. It also impacts immunocompromised individuals, especially those with conditions that involve damage to or hindering of the cardiovascular or respiratory systems. I found myself asking several questions – how much did this affect individuals who suffer from such conditions, especially those who are Black Americans; how much does systemic racism play in the current pandemic; what could be done about all this; and so on. Since I myself have lived with type I diabetes for almost two decades at the …


The Health Wagon Partners With The Virginia Department Of Health To Provide Covid-19 Testing In Rural Southwest Virginia, Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, Nicole France, Sarah Hubbard Jul 2020

The Health Wagon Partners With The Virginia Department Of Health To Provide Covid-19 Testing In Rural Southwest Virginia, Tauna Gulley, Teresa Tyson, Ethan Collins, Rachel Helton, Paula Hill-Collins, Nicole France, Sarah Hubbard

Journal of Appalachian Health

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year.


Listening To Voices In Appalachia: Gathering Wisdom From The Field About Substance-Abuse Recovery Ecosystems, Bruce Behringer Jul 2020

Listening To Voices In Appalachia: Gathering Wisdom From The Field About Substance-Abuse Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

New qualitative data collected through six regional community-based listening sessions and community meetings are presented that describe elements of the Appalachian Regional Commission’s Recovery Ecosystem Model. These data informed the Model, which was used in formulating the new ARC Recovery-to-Work initiative. Input was intentionally solicited from multiple sectors, including persons recovering from substance abuse disorder, treatment and recovery service providers, workforce development agencies, employers, and community advocacy groups.


Responding To Appalachian Voices: Steps In Developing Substance-Use Recovery Ecosystems, Bruce Behringer Jul 2020

Responding To Appalachian Voices: Steps In Developing Substance-Use Recovery Ecosystems, Bruce Behringer

Journal of Appalachian Health

A description is presented of the four-step process used by the Appalachian Regional Commission to develop a new Recovery to Work initiative. The Commission identified, defined, and described issues facing individuals who complete substance abuse disorder treatment and who seek reentry into the workforce. Key elements were identified for resources and supports to develop and maintain community-based substance abuse recovery ecosystems. The steps included conceptualization, data collection, analysis, and review to formulate recommendations for program and policy development. The full process of development was accomplished in twelve months.



Experiencing Cancer In Appalachian Kentucky, Melanie Mccomsey, David Ahern, Robin C. Vanderpool, Timothy W. Mullett, Ming-Yuan Chih, Meghan Johnson, Michele Ellison, Karen Onyeije, Bradford W. Hesse, Eliah Aronoff-Spencer Jul 2020

Experiencing Cancer In Appalachian Kentucky, Melanie Mccomsey, David Ahern, Robin C. Vanderpool, Timothy W. Mullett, Ming-Yuan Chih, Meghan Johnson, Michele Ellison, Karen Onyeije, Bradford W. Hesse, Eliah Aronoff-Spencer

Journal of Appalachian Health

Nothing tells the story of people working together better than a community quilt. A diversity of talents, colors, and materials brought together through skill and shared purpose. Perhaps never before have we as Americans needed a stronger reminder that many hands make short work of big problems. The work presented here by the L.A.U.N.C.H. Collaborative offers a new framework for health care that could be compared to a digital quilt, powered by community-based participatory design, with lived expertise and the newest advances in broadband-enabled connected health solutions. This work demonstrates the value and need to engage local communities and what …


Preface: Experiencing Cancer In Appalachian Kentucky, Michele Ellison, Robin C. Vanderpool Jul 2020

Preface: Experiencing Cancer In Appalachian Kentucky, Michele Ellison, Robin C. Vanderpool

Journal of Appalachian Health

Connected cancer care is of increasing importance in light of the COVID-19 pandemic. The Linking & Amplifying User-Centered Networks through Connected Health (L.A.U.N.C.H.) Collaborative in Appalachian Kentucky has pioneered a new roadmap for equipping communities with the transformative power of broadband to innovate around the future of cancer care and to better scale their ideas. The roadmap involves reaching across disciplines, including public health, anthropology, telecommunications, and user-centered design. The goal is to leverage connectivity and cancer communication research and practice to make a real difference for patients and families.


Preventive Care And Chronic Disease Management: Comparison Of Appalachian And Non-Appalachian Community Health Centers In The United States, Julie P. Marcinek, Alek Sripipatana, Sue C. Lin Jul 2020

Preventive Care And Chronic Disease Management: Comparison Of Appalachian And Non-Appalachian Community Health Centers In The United States, Julie P. Marcinek, Alek Sripipatana, Sue C. Lin

Journal of Appalachian Health

Introduction: The Appalachian region is often characterized by poor health outcomes and economic depression. Health centers (HCs) are community-based and patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary healthcare services in high need areas, including Appalachia, where economic, geographic, or cultural factors can hinder access to healthcare services.

Purpose: The study compares the clinical quality performance in preventive care and chronic disease management between Appalachian HCs and their non-Appalachian counterparts.

Methods: Using 2015 Uniform Data System (UDS) health center data, bivariate and multivariate linear regression analyses examine the association of Appalachian HC with performance on preventive and chronic care …


Parental Impact On Child Physical Activity And Sedentary Time In Appalachian North Carolina, Allison V. Farrell, Richard W. Christiana, Rebecca A. Battista, J. Joy James Jul 2020

Parental Impact On Child Physical Activity And Sedentary Time In Appalachian North Carolina, Allison V. Farrell, Richard W. Christiana, Rebecca A. Battista, J. Joy James

Journal of Appalachian Health

Introduction: Physical activity has positive health benefits across the lifespan including reduced rates of chronic disease. Despite having ample availability of outdoor space for physical activity in the Appalachian Mountain region, there are low rates of physical activity along with high rates of sedentary time and increased prevalence of overweight individuals across all age groups. Therefore, there is a need to understand the factors that influence family’s physical activity and sedentary time.

Purpose: To assess whether parental attitudes and behaviors influence children’s physical activity and sedentary time.

Methods: The current study was a secondary analysis of the baseline data from …


Geographic Variation In The Structure Of Kentucky’S Population Health Systems: An Urban, Rural, And Appalachian Comparison, Rachel Hogg-Graham, Angela Carman, Glen P. Mays, Pierre Martin Dominique Zephyr Jul 2020

Geographic Variation In The Structure Of Kentucky’S Population Health Systems: An Urban, Rural, And Appalachian Comparison, Rachel Hogg-Graham, Angela Carman, Glen P. Mays, Pierre Martin Dominique Zephyr

Journal of Appalachian Health

Introduction: Research examining geographic variation in the structure of population health systems is continuing to emerge, and most of the evidence that currently exists divides systems by urban and rural designation. Very little is understood about how being rural and Appalachian impacts population health system structure and strength.

Purpose: This study examines geographic differences in key characteristics of population health systems in urban, rural non-Appalachian, and rural Appalachian regions of Kentucky.

Methods: Data from a 2018 statewide survey of community networks was used to examine population health system characteristics. Descriptive statistics were generated to examine variation across geographic regions in …


Appalachian Regional Commission Recovery Ecosystem Background And Overview, Kostas Skordas, Andrew Howard Jul 2020

Appalachian Regional Commission Recovery Ecosystem Background And Overview, Kostas Skordas, Andrew Howard

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) has long addressed issues of substance abuse through funded community-based interventions, research, and sponsored conferences. Recently, the opioid crisis created a new urgency for cross-sector collaboration among various partners and funders dealing with this issue. This commentary provides an overview of recent efforts by the ARC to convene stakeholders to focus on assisting individuals with substance abuse disorder to access recovery services while pursuing education and training necessary to reenter the workforce and gain employment. Two papers have been prepared to describe this year-long effort. One paper focuses on the participatory methods used to gather …


Perspective On Substance-Abuse Recovery Ecosystem From The Appalachian Regional Commission Federal Co-Chair, Tim Thomas Jul 2020

Perspective On Substance-Abuse Recovery Ecosystem From The Appalachian Regional Commission Federal Co-Chair, Tim Thomas

Journal of Appalachian Health

The Appalachian Regional Commission (ARC) is a local, state, and federal partnership focused on economic development in the communities of the Appalachian Region. ARC Federal Co-Chairman Tim Thomas provides his perspective on how an economic development entity, such as ARC, can support efforts to address the Region’s drug crisis in a way that both saves lives and strengthens economic opportunity in communities throughout Appalachia.