The Place of Punishment in Twenty-First-Century America: Understanding the Persistence of Mass Incarceration

This study analyzes prison admission and crime data to assess whether the penal system’s response to crime has continued to intensify since mass incarceration’s peak and whether the increasing use of prison in nonurban areas helps explain this trend. The findings show that penal intensity has continued to escalate despite falling crime rates and widespread efforts to reduce prison populations. Further, the justice system’s response to crime is most vigorous in nonurban, and especially rural, counties, where more felony arrests for all types of offenses result in a prison sentence. Although not new, this geographic difference has grown in recent years. While penal intensity thus varies notably within states, case outcomes also vary markedly across states. Comparative case studies of dynamics in a highly punitive state (Kentucky) and a less punitive state (Washington) show how formal law interacts with local dynamics not only by creating “statutory hammers” that are utilized by zealous prosecutors and judges but also by limiting the impact of aggressive prosecutorial practices on prison sentences.

Geographic disparity of outcome in patients with cancer over decades: The surveillance, epidemiology, and end results.

1574 Background: Improvements in prevention, early detection and therapy of cancer have decreased cancer related mortality yet health disparities continue to exist. We investigated the impact of such disparities in cancer survival. Methods: In the Surveillance, Epidemiology, and End Results, we identified 784,341 patients with cancer from 1990 to 2016 in Georgia; 68,493 in 1990-1999, 371,353 in 2000-2009, and 322,932 in 2010-2016. We assessed overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer given the dramatic improvement in patient outcomes in CML since 2000 compared to the consistently poor outcome in lung cancer. We assessed distance from each county to the one National Cancer Institute-designated cancer center (NCI-CC) in Georgia. Results: The 5-year OS of patients with any cancer was 55% with median OS 80 months; the 5-y OS of each county ranged from 33% to 82% (interquartile range[IQR], 51%-65%)(P < 0.001). The improvement of OS was minimal over decades: 5-year OS was 52%, 55%, and 55% in 1990-1999, 2000-2009, and 2010-2016, respectively; the median was 69 months, 80 months, not reached, respectively (P < 0.001). In patients with lung cancer and CML, the 5-year OS was 15% and 52% with the median of 9 months and 67 months, respectively. The geographic difference between counties was relatively small and constant over time in patients with lung cancer, represented by the width in the range and IQR: range 5%-17%, IQR 9%-13%, median 13% in 1990-1999; range 2%-24%, IQR 10%-14%, median 14% in 2000-2009; and range 4%-24%, IQR 12%-17%, median 17% in 2010-2016. However, the geographic difference was more prominent in patients with CML and widened after introduction of modern therapy: range 20%-42%, IQR 26%-34%, median 32% in 1990-1999; range 14%-83%, IQR 38%-64%, median 53% in 2000-2009; and range 14%-80%, IQR 40%-57%, median 57% in 2010-2016. Multivariate Cox regression showed age (hazard ratio[HR],1.040;95% confidence interval[CI],1.039-1.040;P < 0.001), median county income (HR,0.919;95% CI,0.916-0.921;P < 0.001), African American (HR,1.021;95% CI,1.210-1.227;P < 0.001), and distance to NCI-CC (each 100 kilometers) (HR,1.021;95% CI,1.017-1.025;P < 0.001) as predictive factors. Conclusions: The disparity of cancer care exists between geographic locations. The geographic difference of survival seems more prominent when highly effective therapies are available.

‘Candy is Now Flanders’

This article examines the various layered concepts of foreignness constructed by ‘t Historiael Journael, a travel account of the first Dutch envoy to Ceylon from 1602 to 1604. It focuses on a map of Ceylon included in the account and positions it in relation to other cartographic projects commissioned by leaders of the early Dutch Republic. It is argued that the Dutch conceived of religious and cartographic images as opposing types of representation and used the stylistic conventions and ideological concepts underpinning these different modes of picturing to construct divergent religious and political identities. It is also suggested that Johann Theodor De Bry’s popular India Orientalis, in which an abridged version of the travel account appears, smooths out the complex layers of political, religious and geographic difference constructed in the original text.

“Such Monsters Do Exist in Nature”: Mermaids, Tritons, and the Science of Wonder in Eighteenth-Century Europe

While a thick vein of scepticism marked Enlightenment thinkers’ studies, such investigations cannot be divorced from their concurrent quest to merge the wondrous and the rational. Perhaps nowhere is this more apparent than in philosophers’ investigations of merpeople. Examining European gentlemen’s debates over mermaids and tritons illuminate their willingness to embrace wonder in their larger quest to understand the origins of humankind. Naturalists utilized a wide range of methodologies to critically study these seemingly wondrous creatures and, in turn, assert the reality of merpeople as evidence of humanity’s aquatic roots. As with other creatures they encountered in their global travels, European philosophers utilized various theories—including those of racial, biological, taxonomical, and geographic difference—to understand merpeople’s place in the natural world. By the second half of the eighteenth century, certain thinkers integrated merpeople into their explanation of humanity’s origins, thus bringing this phenomenon full circle.

Abstract MP060: Contributors to the Geographic Disparity in Stroke Incidence in the United States: Results From the Reasons for Geographic and Racial Disparities in Stroke Cohort

Introduction: Geographic disparities in US stroke risk have recently been confirmed by REGARDS, but contributors to this are unknown. Higher prevalence of risk factors (RF) and lower socioeconomic status (SES) may contribute to this geographic disparity. For a RF/SES to contribute to this disparity it must both : 1) have a large geographic difference in prevalence, and 2) be powerfully associated with stroke risk. Methods: The 1,623 counties of residence of 24,863 REGARDS participants were placed in quartiles of Vital Statistics stroke mortality. Logistic regression assessed the geographic difference in prevalence of each RF/SES by quartile of stroke mortality. Proportional hazards was used to calculate HR stroke for each RF/SES. Mediation analysis then estimated the proportion of increased stroke incidence in counties with high stroke mortality explained by each RF/SES. Results: Higher county-level stroke mortality was significantly associated with low neighborhood SES (nSES), and more weakly associated with low education and presence of RFs (left column of table). Over 8-years follow-up there were 1,194 stroke events. Hypertension, diabetes and heart disease were all more strongly associated with higher stroke risk (HR ≥1.59) than nSES (HR = 1.21) (center column of table). The large differences in nSES between regions overcame the somewhat weaker association of nSES with stroke risk, since nSES was the largest single contributor to the geographic disparity in stroke incidence, accounting for 20.5% of the disparity (95% CI: 7.1 - 34.0) (right column in table). In multivariable analysis nSES, hypertension and diabetes collectively mediated27% of the geographic disparity (95% CI: 20.0% - 34.0%), but the association with county-level mortality remained significant (p = 0.006). Conclusion: Lower nSES played the largest role in explaining the county-level geographic disparity in stroke incidence in REGARDS, however, 73% of the excess risk of stroke incidence was not explained by any studied factors.