Contemporary America Research Articles

The association of timing of coronary artery bypass grafting for non-ST-elevation myocardial infarction and clinical outcomes in the contemporary United States.

In contrast to the timing of coronary angiography and percutaneous coronary intervention, the optimal timing of coronary artery bypass grafting (CABG) in non-ST-elevation myocardial infarction (NSTEMI) has not been determined. Therefore, we compared in-hospital outcomes according to different time intervals to CABG surgery in a contemporary NSTEMI population in the USA. We identified all NSTEMI hospitalizations from 2016 to 2020 where revascularization was performed with CABG. We excluded NSTEMI with high-risk features using prespecified criteria. CABG was stratified into ≤24 h, 24-72 h, 72-120 h, and >120 h from admission. Outcomes of interest included in-hospital mortality, perioperative complications, length of stay (LOS), and hospital cost. A total of 147 170 NSTEMI hospitalizations where CABG was performed were assessed. A greater percentage of females, Blacks, and Hispanics experienced delays to CABG surgery. No difference in in-hospital mortality was observed, but CABG at 72-120 h and at >120 h was associated with higher odds of non-home discharge and acute kidney injury compared with CABG at ≤24 h from admission. In addition to these differences, CABG at >120 h was associated with higher odds of gastrointestinal hemorrhage and need for blood transfusion. All 3 groups with CABG delayed >24 h had longer LOS and hospital-associated costs compared with hospitalizations where CABG was performed at ≤24 h. CABG delays in patients with NSTEMI are more frequently experienced by women and minority populations and are associated with an increased burden of complications and healthcare cost.

Comprehensive appraisal of pregnancy and neonatal outcomes in singleton pregnancies conceived via invitro fertilization in the USA (2016-2021).

We set out to compare adverse pregnancy and neonatal outcomes in singleton gestations conceived via invitro fertilization (IVF) to those conceived spontaneously. Retrospective, population-based cohort using the CDC Natality Live Birth database (2016-2021). All singleton births were stratified into two groups: those conceived via IVF, and those conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes was compared between the two groups using Pearson's chi-square test with Bonferroni adjustments. Multivariate logistic regression was used to adjust outcomes for potential confounders. Singleton live births conceived by IVF comprised 0.86 % of the cohort (179,987 of 20,930,668). Baseline characteristics varied significantly between the groups. After adjusting for confounding variables, pregnancies conceived via IVF were associated with an increased risk of several adverse pregnancy and neonatal outcomes compared to those conceived spontaneously. The maternal adverse outcomes with the highest risk in IVF pregnancies included maternal transfusion, unplanned hysterectomy, and maternal intensive care unit admission. Increased rates of hypertensive disorder of pregnancy, preterm birth (delivery <37weeks of gestation), and cesarean delivery were also noted. The highest risk neonatal adverse outcomes associated with IVF included immediate and prolonged ventilation, neonatal seizures, and neonatal intensive care unit admissions, among others. Based on this large contemporary United States cohort, the risk of several adverse pregnancy and neonatal outcomes is increased in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Obstetricians should be conscious of these associations while caring for and counseling pregnancies conceived via IVF.

The Abolition of Democracy

Democracy seems shaky in the contemporary United States. In recent polls, an overwhelming 70 percent of Americans say that democracy is under threat, in crisis, and at risk of failing. Conventional wisdom tends to lay the blame for those findings—and the underlying fragility of democracy in America—at the feet of discrete political actors or at growing “polarization” in the electorate. But in The Abolition of Man, C. S. Lewis gives us reason to look deeper—at the difficult relationship, in practice, between modern democracy and enduring values. This essay shows how Lewis helps us better understand the crisis of democracy in America (including the crisis of faith in democracy in America) today.

“There Is a Corpse in the Room”: On Political Guilt and Reparation of the Past

AbstractPolitical theory scholarship tends to resist guilt, and especially collective guilt, as a framework for thinking about wrongs committed in the past or still enduring. The voices and experiences of those wronged, however, often imply that they are attributing guilt, and they are attributing it to a collectivity. I follow their lead and think through the potential of political guilt in motivating reparation and redress. Drawing on insights that Karl Jaspers fails to fully develop, I appropriate his notion of political guilt as situation, and read it as something that is contested among victims, perpetrators, and bystanders. Through contestation political guilt creates political spaces for reckoning with the past, and can be instrumental in making space for marginalized voices. I apply my framework to race relations in the contemporary United States, but guilt could be a catalyst to rethink postcolonial relations as well.

Black Women Reporting and Seeking Help for Sexual Assault: A Call for Action

Black women in America have historically been victims of oppression, racism, and sexual assault. This victimization can be traced as far back as the forced immigration to America in Jamestown, Virginia in 1619. Forced travel bondage on slave ships highlights the institutionalized pattern, not only of their suffering from repeated rape, but also logs their victimized sufferings in silence that they had to endure then and continue to endure in 21st century contemporary America. Black women have been socialized intergenerationally to respond in a specific manner similar to the female slaves who endured rape from ship crew members during their long voyage to the Americas. Even after slavery was legally abolished in 1865, Black women continued to endure victimizations not only due to their gender, but also due to discrimination, classism, perceptions regarding their sexuality, racism, and fear. These intersectional factors cause Black women to have become unique experiences at the hands of rapists. Thus, Black women have unique experiences as victims of rape than other individuals who are also rape victims. Any discussion of Black women and rape must be placed in a sociohistorical framework. The purpose of this article is to revisit historical underpinnings about the rape of Black women in a socialized manner that continues to hinder a silent, nonactive role, and in some instances denial of being a victim of rape. The aim is to sensitize, stimulate, and motivate action by increasing social work classroom discussions about the topic, increasing research in the area of rape of Black women utilizing an intersectional approach reviewing factors that are unique to Black women, and providing more information as a resource to enhance community awareness. Effective intervention strategies are also delineated.

Responsibility and Restitution in the Freedman's Bank Crisis

The Freedman's Savings Bank, founded in 1865, was established with the express purpose of providing safe banking access for newly freed black Americans. Despite a charter dedicated to low-risk banking, the boot-strap mythology expounded by Congress was undermined by rampant fraud. Nine years after its founding, the Bank folded, swallowing 1.2 million dollars in deposits (approximately 29.6 million today) spread among roughly 61,000 individuals. The Freedman's Bank offers policy makers and social justice advocates an under-explored opportunity. Despite the near universal recognition that the fault for the institution's collapse lies with Federal mismanagement, a majority of the deposits were never compensated. Both the power to restitute and the culpability rest with the same party. Further, the record keeping of the bank ensures reasonably clean lines of inheritance for compensation. Combined these factors make a return of Freedman's Savings deposits politically viable in the rhetoric of contemporary America. This article provides the historical and data research necessary to arm policy makers in the restitution of the victim's deposits. It is not the intention of this policy to supplant the more ambitious effort of reparations, but instead to build a rhetorical position squarely within the liberalist market tradition, which also mitigates harm.

Mooring Christian Nationalism: How Religious Institutions, Participation, and Beliefs Inform Christian Nationalism

ABSTRACT Christian nationalism has been linked to a variety of political and social outcomes in the contemporary United States, however little research has investigated factors that give rise to it. Most scholars examining Christian nationalism contend that it is unmoored from extant social institutions, and even oppositional to institutional Christianity. This claim is associated with earlier research arguing for the declining influence of denominations, and particularly mainline Protestantism. In contrast, social movement theory views Christian nationalism as an ideological outgrowth of religious organizations, structured by exclusivist religious beliefs, and reenforced through religious participation. Using data from the General Social Survey (GSS) this investigation examines how religious and political factors inform subscription to Christian nationalism and explores how religious and political commitments are connected. In general, the findings support the expectations of the social movement perspective. Christian nationalism is strongly predicted by ties to sectarian Protestantism, religious participation, and fundamentalist beliefs, and it is not embraced by secular and non-Christian Americans.

Making salient ethics arguments about vaccine mandates: A California case study.

Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies-and to attributes of the communities they aim to govern-can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in policy, they should attend to these kinds of empirical considerations. This paper focuses on the most common and contentious vaccine mandate reform in the contemporary United States: the elimination of nonmedical exemptions (NMEs) to school and daycare vaccine mandates. It highlights, in particular, debates about California's Senate Bill 277 (SB277), which was the first successful recent effort to eliminate NMEs in that country. We use media, secondary sources, and original interviews with policymakers and activists to identify and evaluate three ethics arguments offered by critics of SB277: parental freedom, informed consent, and children's rights to care and education. We then turn to one ethics argument often offered by advocates of SB277: harm prevention. We note, however, that three arguments for mandates that are common in the immunization ethics literature-fairness/free-riding, children's rights to vaccination, and utilitarianism-did not play a role in debates about SB277.

When My Brown Got Colored

Abstract This essay is a testimonial of the author’s experiences, memories, and reflections about becoming a person/woman of color, discovering, and unearthing the meanings of racialization, white privilege, and white supremacy in the contemporary United States. The author gives voice to her new migrant experience as a Brown woman from India, positioning her reflections and learnings amidst the history and politics of colonialism and capitalist development, linking it to contemporary neoliberal academia in the United States. By sharing some events and encounters in her relatively short stint in Charlottesville, Virginia, between 2016 and 2019, the author reviews her attempts to critically analyze concepts like women of color, diversity, colorism, privilege, invisibility, and othering. The article further connects some of the author’s experiences of racialization in view of the growing politics of casteism and Brahmanical supremacy in India, locating and reassessing herself in the midst of Trump’s hardened propagation of white privilege in the United States and Modi’s Hindutva, both emanating a politics rooted in racialization, exploitation, and marginalization of the other.

The Butch/Femme Couple: Reproducing Patriarchal Marriage in Loving Her (1974) by Ann Allen Shockley

The historical objective of feminist movements, whatever their trends, has been the end of gender and patriarchal inequality in the society. In spite of the progress that these feminist battles have achieved, the traditional model persists in contemporary America, at least this is what is pictured in Ann A. Shockley’s Loving Her (1974), the fiction which focuses attention in this work. In this novel, as a lesbian couple represented by Terry and Renay stubbornly challenges traditional gender and patriarchal forces in order to enjoy their sexual life, the reader discovers many signs of these forces on this relationship. In this study, which is conducted under the angle of feminism and queer theory, our aim is to show that this lesbian couple in which Terry plays the role of the Butch while Renay represents the Femme is nothing but the reproduction of the patriarchal system of couple.

Operationalizing cultural adaptation to climate change: contemporary examples from United States agriculture.

It has been proposed that climate adaptation research can benefit from an evolutionary approach. But related empirical research is lacking. We advance the evolutionary study of climate adaptation with two case studies from contemporary United States agriculture. First, we define 'cultural adaptation to climate change' as a mechanistic process of population-level cultural change. We argue this definition enables rigorous comparisons, yields testable hypotheses from mathematical theory and distinguishes adaptive change, non-adaptive change and desirable policy outcomes. Next, we develop an operational approach to identify 'cultural adaptation to climate change' based on established empirical criteria. We apply this approach to data on crop choices and the use of cover crops between 2008 and 2021 from the United States. We find evidence that crop choices are adapting to local trends in two separate climate variables in some regions of the USA. But evidence suggests that cover cropping may be adapting more to the economic environment than climatic conditions. Further research is needed to characterize the process of cultural adaptation, particularly the routes and mechanisms of cultural transmission. Furthermore, climate adaptation policy could benefit from research on factors that differentiate regions exhibiting adaptive trends in crop choice from those that do not. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

Cycles of Debt and Punishment: A Symposium on Prisons of Debt: The Afterlives of Incarcerated Fathers

In the contemporary United States, millions of fathers cycle through the criminal justice and child support systems—cycles that create new forms of debt and disadvantage. This symposium discusses those cycles and their effects on fathers and their families. Through comments on Lynne Haney's book, Prisons of Debt: The Afterlives of Incarcerated Fathers, the authors analyze the criminalization of child support and the ways it complicates reentry after prison. They engage Haney's arguments about the causes and consequences of prisons of debt and her empirical material on men's struggles as indebted fathers—or, as Michael Mitchell put it, the book's insistence on “getting proximate to human suffering.”

Seeing Red and Blue: Assessing How Americans Understand Geographic Polarization, Secession, and the Value of Federalism

Abstract This article examines how public perceptions about the divide between blue and red states shape attitudes about secession in the United States. Through a nationally representative survey of the adult American population, I measure how individuals perceive political differences between states, and demonstrate that as perceptions of political differences increase, so too does support for secession. Measured through multiple questions and an experimental design, these findings demonstrate a previously underexplored dynamic of the country’s partisan divisions. Both Democrats and Republicans are more likely to support secession as their awareness of the “red” and “blue” divide increases—an attitude that is statistically independent from other beliefs that motivate partisan animosity in the contemporary United States, such as populism, racial resentment, affective polarization, and ideology. While talk of an impending “civil war” may be exaggerated, the widespread prevalence of secessionist beliefs shows that the legitimacy of the country’s federal bargain is challenged by political nationalization.

Systemic Hypocrisy in United States Foreign Policy

Why is contemporary United States foreign policy systemically hypocritical? This essay offers a legal realist perspective, which considers human rights and democracy-oriented narratives as morally appealing meta-discourses that are subject to reframing, weaponisation, and instrumentalisation by a wide variety of contending political actors in pursuit of concrete material or policy objectives. The perspective of legal realism is used in the case of post-Cold War United States foreign policy to understand how normative discourses are used across various geographies of geopolitical contestations in which state-initiated violence and death are prevalent. This commentary suggests that in pursuit of its geostrategic and economic objectives, the United States government’s human rights rhetoric abroad did not match the actual consequences of its domestic and foreign policies, thereby showing systemic hypocrisy.

Book Review: Neoliberal Lives: Work, Politics, Nature, and Health in the Contemporary United States

Book Review: <i>Neoliberal Lives: Work, Politics, Nature, and Health in the Contemporary United States</i>

The needle and the damage done: Deaths of despair, economic precarity, and the white working-class

Economic insecurity has grown in the United States since the 1970s impacting all segments of the working-class, including previously insulated sub-groups such as non-Hispanic whites. Moreover, the white working-class has experienced a surge in socio-cultural isolation, and disengagement with societal institutions. This analysis focuses on the health consequences of these developments, with a particular emphasis on the rising “deaths of despair” (suicide, drug poisoning, alcohol related). These deaths have been increasing since the mid-1990s and, at least until recently, tended to be clustered amongst whites without a four-year college degree. Various competing explanations have been put forth, emphasizing distinct factors such as material conditions, socio-cultural dynamics, and accessibility to opioids. Using a series of linear models this analysis examines the county-level association between economic precarity, white working-class population size, opioid accessibility, and deaths of despair. Results affirm the net effect of each predictor and illuminate an interactive relationship between opioid accessibility and precarity, as well as an interactive relationship between all three predictors. By undertaking an interdisciplinary synthesis of existing research, this study contributes to the understanding of the social determinants of mortality while providing crucial insights into an ongoing crisis in contemporary America.

That Which They Will Not See: Climate Denial as a Vector of Epistemological Crisis in the Contemporary United States

ABSTRACT Climate denial continues as a cultural epistemology for anthropogenic climate change in the United States, despite worsening impacts. This article offers an ethnographic account of rural areas in three states in the southern US – Arizona, Louisiana, and Missouri – based on long-term participant observation and interview data. Engaging with the literature on agnotology, the social construction of ignorance, the argument is made that this literature as it pertains to climate denial does not go far enough in accounting for the persistence of the rejection of climate science. Theoretically drawing from anthropological work on the incommensurability of paradigms, the argument is based on a tripartite construction of denial as produced through an interaction of a cultural norm of radical empiricism, a political-media ecosystem funded by fossil fuel companies, and a cosmological schema derived from conservative white evangelicalism. The result of this process is an epistemological crisis in contemporary American society.

Sexual Fluidity: Implications for Population Research.

For the first time ever, national censuses have begun asking adults to report their sexual orientations. However, because such surveys provide only cross-sectional snapshots of populations, these data obscure one key complexity: that sexuality can be fluid, with sexual self-identification evolving over time. Drawing on unique, restricted-use data from the Population Assessment of Tobacco and Health, the current study documents the prevalence, correlates, and empirical consequences of sexual fluidity in the contemporary United States. Overall, about 1 in 11 American adults changed sexual identities over five annual surveys, including 6% of cisgender men, 11% of cisgender women, and 35% of gender minorities. Fluidity was particularly pronounced among young adults and among those who had ever identified as bisexual or "something else." Despite the frequency and patterning of sexual fluidity, accounting for fluidity did little to change observed patterns of disadvantage on three measures of sexual minority well-being: mental health, financial insecurity, and substance use. Given these facts, I argue that demographic research should foreground the complexities inherent in quantifying sexuality, focusing less on how many people "are" a given sexual orientation and more on the social dynamics that continue to produce sexual minority disadvantage.

Contextualizing drug use and pharmacological harm in the United States: a socio-historical overview

The purpose of this conceptual paper is to navigate through the socio-historical modulations in American tolerance for different psychoactive substances, and propose a theoretical synthesis formed by two vanguard philosophical doctrines, objectivism, and constructivism. Our approach is grounded on the analysis of social historical context and objective harms that have influenced drug use tolerance in the United States based on key historical events such as: heavy drinking at the dawn of nineteenth century, the establishment and repeal of prohibition, late nineteenth century opiate and cocaine tolerance followed by early twentieth century prohibition, post-prohibition drug concerns such as marijuana prohibition in the 1930s, heroin concerns and medical depressant use in the 1950s, poly-drug use in the 1960s, crack cocaine use in the 1980s, and finally modulations in tolerance for peyote use. Evidence supports the notion of drug harms reduction for the privileged, and criminalization of drug use by marginalized groups. Over long spans of history, however, more objectively harmful drugs are rejected, while drugs that can be used regularly without serous dysfunction are tolerated and normalized. We argue that a framework of social status and pharmacological harm can account for the vacillating policy responses that have emerged to different drugs at different times. Our approach informs the role of socio-cultural conflict in drug policy development and infuse the need for empirical research on the effect of socioeconomic positioning on attitudes of medicalization and legalization of marijuana and opioid policy in contemporary America.

Hundreds and hundreds

SummaryThis contribution to the special section “100s for Katie” attempts to communicate the depth and breadth of the hatred infecting contemporary America in one hundred words.