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Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher’s own biases as part of the research process.
The World Health Organization has defined health inequality as differences in health status or in the distribution of health determinants between different population groups (29, 77). Disparities in health status and health care would be easy to ignore were they not so well documented. Health inequality exists because of race and ethnicity, which intersect with other social determinants of health. The purpose of this article is to advance fourth-generation health disparities research, framed by public health critical race praxis, to help develop multilevel interventions designed to achieve health equity. Although our focus is on racial and ethnic disparities in the U.S. context, we recognize that socioeconomic disparities are a contributing but not the sole cause of these racial and ethnic health disparities. We also recognize that although it is beyond the scope of the paper to address global health disparities, many of the core concepts are relevant to a global context.
The existence of compelling DNA evidence to show all humans are indeed one race biologically (1) has done little to eliminate the social presumption of race, which perpetuates discrimination and contributes to health disparities among racial and ethnic minority populations (21, 76). The 2006–2008 American Community Survey revealed that 38.6% of the U.S. population identified their race as nonwhite, black or African American (12.3%), nonwhite, Hispanic or Latino (15.1%), or non-white other (remaining 11.2%) (64). The U.S. Census Bureau (62) projects that by 2050 racial and ethnic minority groups will account for almost half the U.S. population. These statistics are based on the social presumption that individuals in the United States can be readily categorized into definable races despite ample DNA evidence to the contrary that all humans are one race biologically (1). Classification based on race reveals, however, that the overall health of the nation is inextricably intertwined with the health of racial and ethnic minority populations and that discrimination contributes to health disparities affecting these groups (76). As the U.S. demographic shifts away from a white majority, the differential health status between whites and minority groups constitutes a critical challenge for public health professionals.
In this article, we focus our discussion on the two largest minority groups, African Americans/blacks and Latinos/Hispanics,1 with the understanding that health disparities are caused by common factors faced by all minority groups. We acknowledge that American Indian, Alaska Native, Asian, Native Hawaiian, Pacific Islander populations, and other racial/ethnic groups have also experienced systematic discrimination related to health as a consequence of their race/ethnicity and may face unique challenges in health care that cannot be adequately covered here.
Although health disparities have been evident throughout our nation’s history, federal efforts to address those disparities have waxed and waned. The first federal efforts to address health disparities have their genesis in the Negro Health Movement (1915–1951) and led the U.S. Public Health Service to establish the Office of Negro Health Work (51, 52). More than 30 years later, in 1985, Margaret Heckler, Secretary of the U.S. Department of Health and Human Services (DHHS), released the Secretary’s Task Force Report on Black and Minority Health, which documented excess deaths from cancer, cardiovascular diseases, chemical dependency, diabetes, homicide, unintentional injuries, and infant mortality experienced by minority populations (66) and focused attention on significant gaps in health status between minorities and whites. The report also uncovered decades of neglect in seeking solutions and thrust minority health back onto the national agenda.
The Task Force Report galvanized the DHHS to establish the Office of Minority Health (OMH) in 1986 and charged this agency with the responsibility to implement the report’s recommendations (59). In 1988, the Centers for Disease Control and Prevention (CDC) created the Office of the Associate Director for Minority Health, which became the CDC’s Office of Minority Health in 2002. In 2005, the CDC strengthened its commitment to promote health and quality of life and to eliminate health disparities for vulnerable populations by forming the Office of Minority Health and Health Disparities (OMHD) (12). Similarly, the Director of the National Institutes of Health (NIH) established the Office of Research on Minority Health (ORMH) in 1990 (18, 41, 59). In 2000, the ORMH became the National Center on Minority Health and Health Disparities (NCMHD) within the NIH, which supports and coordinates health disparities research and promotes programs that increase the number of underrepresented minority students and students from health disparity groups in the biomedical and behavioral research workforce (18).
The passage of the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) (65) marks the beginning of a new chapter in American society, bringing the United States one step closer to universal access to health care. The Act authorized the transition of NCMHD to become the National Institute on Minority Health and Health Disparities, expanding its mission to planning, coordinating, reviewing, and evaluating all minority health and health disparities research activities conducted and supported by the NIH institutes and centers (42, p. 1). The Act mandates that insurers provide coverage for preventive services with no copayments or deductibles. The Act authorizes and supports increased efforts by the CDC’s Task Force on Community Preventive Services to evaluate and recommend prioritization of evidence-based and population-based programs, policies, and interventions that improve health and prevent disease. The Act also expands the efforts of the U.S. Preventive Services Task Force—an independent panel of internists, family physicians, pediatricians, gynecologists/obstetricians, nurses, and behavior specialists that reviews the effectiveness of preventive services and publishes recommendations for clinical preventive services (17). The Act encourages better coordination between these two task forces (72).
Specific to health equity, this legislation transfers the Office of Minority Health to the Office of the Secretary of Health and Human Services, headed by the Deputy Assistant Secretary for Minority Health, and provides funding for new initiatives, including grants for Creating Healthier Communities (community transformation grants), Promoting the Community Health Workforce, and Health Professions Training for Diversity (65).
The Act also supports the goals of Healthy People, the U.S. government’s strategic management tool first published in 1979, which identifies preventable threats to health and sets the nation’s agenda for the prevention of disease and reduction of mortality. The first iteration of health objectives for racial and ethnic minority populations was initiated in Healthy People 2000 (67). The elimination of health disparities became an objective in Healthy People 2010 (68). Healthy People 2020 (71) seeks to (a) eliminate preventable disease, disability, injury, and premature death; (b) achieve health equity, eliminate disparities, and improve the health of all groups; (c) create social and physical environments that promote good health for all; and (d) promote healthy development and healthy behaviors across every stage of life. These goals, coupled with an explicit endorsement of an ecological mindfulness and an acknowledgment of social determinants of health, mandate a broadening of current approaches to eliminating health disparities. Healthy People 2020 provides an action model that aligns these approaches and articulates a feedback loop as the nation monitors its progress toward achievement of the goals (71) (see Figure 1).
Although there has been significant improvements in health status of the U.S. population as a whole, closer examination of epidemiologic trends exposes a troubling truth: Racial and ethnic minority populations lag behind their white peers with respect to morbidity and mortality across a broad spectrum of mostly preventable conditions and diseases. According to the most reliable data from the National Center for Health Statistics (39, 63), white females continue to have the longest life expectancy (80.7 years) followed by black females (77.0 years) (Asian American women may have the longest life expectancy; however, data-collection methods for these and other populations vary widely and cannot be used in direct comparisons). Although the difference in life expectancy between white and black populations has decreased steadily from a difference of 7.1 years in 1989 to 4.8 years in 2007 (63), the U.S. Census Bureau predicts that a gap will continue to exist and estimates life expectancy for whites in 2020 to be 80.0 years compared with 76.1 years for blacks (62).
Much of the gap in life expectancy between whites and blacks is tied to the incidence of chronic diseases, which are a suitable focus for reducing disparities (16, 26). “Between 2002 and 2030, the mortality rate for all chronic diseases (e.g., heart disease, cancer, type 2 diabetes) is expected to increase by almost 20% worldwide” (26, p. S25). If we examine both existing racial and ethnic disparities in these diseases today, as well as the disproportionate obesity rates, which place minorities at high risk for chronic disease (22), we can project the continuing presence of disparities well into coming decades. Therefore, we must examine the prevalence of diseases themselves but also consider the actual causes of disease burden.
In 2004, the CDC published “Actual Causes of Death in the United States. 2000” (40), which identified tobacco (435,000 deaths; 18.1% of total U.S. deaths) and poor diet and physical inactivity (400,000 deaths; 16.6% of total U.S. deaths) as the leading contributors to loss of life. “These findings, along with escalating health care costs and aging populations, argued persuasively that the need to establish a more preventive orientation in the U.S. health care and public health systems has become more urgent” (40, p. 1238). The inclusion of a prevention focus in the Patient Protection and Affordable Care Act (72) sets the stage for new actions to achieve health equity. Nonetheless, the success of any future prevention program is dependent on the validity of historical and present research on obesity (69) and tobacco (70) and the acknowledgment that health disparities exist in certain populations.
In 2008, we (60) adapted Kilbourne’s (36) three phases of health care disparity research framework to address disparities in nonclinical settings. We proposed three generations of health disparities research as an organizing principle from which to examine the status of such research in non-clinical settings (60) (see Figure 2). First-generation research focuses on detection, identification, and documentation of disparities, including identifying vulnerable populations (36, 60). Second-generation research determines causal relationships that underlie health disparities. Whereas Kilbourne (36) focused heavily on understanding causality in the context of health care disparities, we (60) broadened that focus to include the social determinants that underlie disparities in health status and unequal access to health care. Third-generation research, which provides solutions for eliminating health disparities, mirrors what Kilbourne (36) describes as the third phase in health care disparities research. This research includes examples such as the CDC’s Racial and Ethnic Approaches to Community Health Across the U.S. (REACH 2010) projects (11). Below, we discuss obesity and tobacco use separately in terms of first- and second-generation research and together in terms of third-generation research. We conclude with a proposal to extend our research efforts to a fourth-generation approach.
Using data from the National Health and Nutrition Examination Survey (NHANES), Flegal and colleagues (22) report that the “prevalence of obesity in the US is high, exceeding 30% in most age and sex groups” (p. 238). Examination of the data by race and gender highlights the racial and ethnic differences. For example, according to the authors, non-Hispanic white men had an age-adjusted obesity prevalence of 31.9% compared with 37.3% for non-Hispanic black men. The racial disparity was more pronounced among women: The age-adjusted obesity prevalence among non-Hispanic white women was 33.0% compared with 49.6% among non-Hispanic black women (22). Although our ability to detect the obesity epidemic is extensive, the etiology of obesity is complex and our ability to eliminate it is far more limited.
The disproportionate burden of obesity among African Americans and Latinos compared with the white population is disturbing and not well understood. Socioeconomic status, environment, and lifestyle factors such as physical inactivity and diet have been identified as contributing factors (15, 45). Paeratakul et al. (45) predict that the absence of evidence-based studies and interventions for minority populations will perpetuate the problem (15, 45). Unfortunately, the reductionist nature of randomized controlled trials (RCTs) as the gold standard for scientific evidence (5) has advanced our mechanistic and biomedical understanding of obesity at the expense of understanding social and environmental determinants of the obesity epidemic. The result is an acceleration of surgical and pharmaceutical interventions (13) to the neglect of observational research on the social, policy, and environmental interventions for obesity.
Tobacco use, predominately cigarette smoking, continues to be the leading cause of preventable morbidity and mortality in the United States. Cigarette smoking is recognized as the cause of multiple cancers, heart disease, stroke, complications in pregnancy, and chronic obstructive pulmonary disease (37, 43, 70) and is responsible for greater than 443,000 annual deaths among adults (10). In 2008, 20.6% (~46 million) of U.S. adults were smokers, resulting in $96 billion in medical costs and $97 billion in lost productivity annually in the United States (2, 9). Thus tobacco use has remained an important challenge facing the public health, medical, and policy communities (10, 43).
Looking closely at current data, the smoking prevalence in 2008 was higher among men (23.1%) than among women (18.3%). Among racial/ethnic groups, Asians had the lowest prevalence (9.9%), followed by Hispanics (15.8%), non-Hispanic blacks (21.3%), and non-Hispanic whites (22.0%). American Indians/Alaska Natives had the highest prevalence of current smoking compared with any other racial or ethnic group (32.4%) (10).
Smoking cessation campaigns and health education efforts have contributed to a substantial decline in the smoking rates over the past 40 years, although the decline has remained unchanged at ~20% among adults 18 years and older during the past five years, according to the CDC (10). Unfortunately, progress has also stalled in reducing smoking rates among young persons and minorities (2, 10).
Tobacco use is a multilevel problem that is influenced by a number of factors (43), including socioeconomic correlates such as race and ethnicity, gender, level of education, occupation, and income and wealth, as well as other individual-level factors that affect tobacco use, including age of smoking onset, adverse childhood experiences, and self-esteem (3, 9, 70).
Environmental factors include familial, social, cultural, economic, historical, political, and media influences (43). For example, the presence of smoking peers, siblings, and parents, as well as norms established at home, can influence uptake (70, 75). Moreover, the use of higher tar-yield brands has been associated with nicotine dependence among black smokers (43, 48, 49). Other environmental factors identified as contributors to disparities in tobacco use include targeted tobacco advertising and promotion, including billboards and advertisements in media that appeal to racial/ethnic minorities, and cultivation of a prosmoking environment (27, 32).
With a focus on development and implementation of interventions, third-generation research is necessary before distilled knowledge can be implemented in standards of practice (61). Although the nascent status of third-generation research is apparent in the lack of evidence for solutions to address the obesity epidemic and tobacco use among racial and ethnic minorities, we examined the CDC’s Guide to Community Preventive Services, which reports results of greater than 200 interventions, to determine what works when addressing obesity- and tobacco-related disparities (56):
In Table 1, we concentrate on obesity and tobacco use prevention, previously discussed as examples in first- and second-generation research in health disparities.
The criteria for inclusion of interventions in the Guide to Community Preventive Services systematic review are biased toward RCT research, the gold standard for NIH-funded research. As such, the underrepresentation of racial and ethnic minority populations in RCT research has yielded a color-blind evidence base, with few, if any, studies that explicitly cite evidence of effectiveness with minority communities. Research is urgently needed that builds the evidence base of effective and culturally appropriate interventions for racial and ethnic minority populations. To address this need, we call for strong third-generation research that explicitly includes racial and ethnic minorities in RCT studies to build the evidence base. Additionally, we proposed that this research rest on three pillars: (a) transdisciplinary research, (b) community engagement, and (c) translational research (60).
Despite our call for more third-generation research to build the evidence base, using this type of research to address the elimination of racial and ethnic health disparities is inherently limited. Typically, third-generation research is composed largely of categorical interventions focused on a specific disease outcome. In this research, race is often treated superficially, either as a demographic variable or as a proxy for culture, but rarely understood in its more complex linkage to racism and structural determinants of health (e.g., poverty, institutional factors, policy factors). Moreover, many third-generation research interventions have functioned within what Resnicow & Braithwaite (53) refer to as the “surface structure” dimension of intervention development and implementation: “the extent to which interventions fit within the culture, experience, and behavioral patterns of the audience” (p. 518, emphasis in original). However, race and racism are far less frequently the explicit focus of RCT research. In fact, we argue that such color blindness, which does not address issues of racism, has contributed to the knowledge gap in the Guide on Community Preventive Services with regard to evidence-based interventions that target racial and ethnic minority populations. Furthermore, even in third-generation research, interventions that focused heavily on individual behaviors have failed to address in a meaningful way the broader structural determinants of health. Although the strength of many third-generation studies was their increasing focus on community engagement and transdisciplinary research, there remained too few strong translations of research results into interventions that targeted racial and ethnic populations. In hindsight, despite our proposal for third-generation research, we realize that such research, while aimed at providing solutions, still falls short of being capable of truly achieving health equity.
Today, we believe that third-generation research is necessary but not sufficient to eliminate disparities and to move toward health equity. Transformational thinking beyond our standard research paradigms is needed (16). Therefore, we propose the health equity action research trajectory (HEART) as a platform for fourth-generation research (see Figure 3). The proposed HEART paradigm is anchored by the three pillars of our generation-based model of health disparities research (detect, understand, and provide solutions) but adopts key bioethics principles of justice to facilitate action to eliminate health disparities. For example, HEART proposes research that takes action by (a) utilizing public health critical race praxis (PHCR) as our conceptual framework (25), (b) addressing structural determinants of health through comprehensive multilevel interventions, (c) utilizing comprehensive evaluation, and (d ) necessitating explicit attention to self-reflection by the researcher.
W.E.B. DuBois, noted African American sociologist, declared, “the problem of the twentieth century is the problem of the color line” (20, p. XV). Thomas echoed, “The ‘color line’ is not fixed but ripples through time, finding expression at distinct stages of our development as a nation” (58, p. 1046). Race and racism are persistent themes throughout our history and must not be limited by focusing primarily on the black experience, owing to the historical institution of slavery. Today, there is an increasingly racialized focus on the experience of Latinos, owing to polarization of public opinion regarding immigration into the United States.
Although some (14, 28) argue that we should abandon the concept of race for the purpose of surveillance and instead use ethnicity as the classification schema for public health research and practice, we believe that the shift away from race to ethnic group minimizes the health impact of racism for populations subjected to social prejudice because of their skin color and facial features. Much of the public health literature to date has not effectively engaged the complex and persistent impact of racism. To a large extent, research utilizes race as a demographic variable without fully grappling with race and racism in contemporary society. Sophisticated research tools have been developed to measure the impact of racism and discrimination; however, these tools have not been widely adopted.
Ford & Airhihenbuwa (25) make a convincing argument that critical race theory (CRT) is a transdisciplinary approach that offers much to health disparities research. For example, race consciousness is defined as “the explicit acknowledgment of the workings of race and racism in social contexts or in one’s personal life and color blindness as positing that nonracial factors explain racial phenomena” (24, p. s31). Additionally, CRT integrates Gilmore’s definition of racism, “the state-sanctioned and/or extralegal production and exploitation of group differentiated vulnerability to premature death” (31, p. 247). Today, the overt demonstrations of racism exist in the margins of our society, but it is still possible for racism to be made visible to all, as seen in the beating deaths of individuals from protected classes (e.g., racial/ethnic minorities) and passage of hate crime laws. However, racism also plays out more in what is termed as ordinariness, where it is a more subtle part of daily life (24). By incorporating this concept of racism, researchers can better examine the impact of routine exposure to racism on health behaviors and health status. Moreover, adopting race consciousness and beginning the research process from the perspective of racial and ethnic minorities, which Ford & Airhihenbuwa (24) called “centering in the margins” rather than from perspectives of majority white researchers, would essentially shift the entire research process toward a different level of engagement around race and racism, demanding that the researchers examine their own lived experiences and the interaction of race, power, and class. Thus, the research endeavor would aim for praxis, where “knowledge gained from theory, research, personal experiences and practice inform one another” (24, p. s31). In summary, we concur with the assertion that
Critical Race Theory can contribute…a comprehensive framework for connecting these research endeavors, a vocabulary for advancing understandings of racial constructs and phenomena, critical analyses of knowledge production processes, and praxis that building on community-based participatory approaches linking research, practice and communities. (24, p. s32)
We propose adoption of Ford & Airhihenbuwa’s PHCR praxis (25) as the framework for fourth-generation research in health disparities. They state that “public health critical race praxis assists public health researchers to carryout health equity research with fidelity to CRT” (25, p. 1390). Both CRT and PHCR praxis go beyond simply documenting, understanding, and proposing solutions to health disparities toward action aimed at eliminating health disparities. PHCR is based on four focuses and ten principles (see Table 2 for definition of principles). The four focuses are (a) contemporary racial relations, guided by the principles of the primacy of race, race as a social construct, the ordinariness of racism, and structural determinism; (b) knowledge production, guided by the social construction of knowledge, critical approaches, and voice; (c) conceptualization and measurement, guided by race as a social construct and intersectionality; and (d ) action, guided by critical approaches, voice, intersectionality, and disciplinary self-critique (25). According to the authors, race consciousness is at the heart of working through the four focuses and is also informed by theory, qualitative data, and unlike much current research, personal self-reflection.
Adopting PHCR praxis as the framework for fourth-generation research goes against a growing consensus that the United States is now a postracial society, as evidenced by the election of President Barack H. Obama. Nevertheless, in the context of the continuing tragedy of racial and ethnic health disparities, we believe that only by directly confronting race and racism can we truly eliminate health disparities and achieve health equity.
Although significant second-generation research has aimed to understand the linkage between structural determinants and health status of racial and ethnic minority populations, the challenge of addressing those determinants in interventions is daunting. In their book, Vlahov et al. (73) critique categorical interventions, which focus on a specific disease outcome and frequently focus more on intrapersonal and interpersonal levels for interventions than on broader social, economic, cultural, and environmental determinants. Vlahov et al. (73) argue that these interventions fit the current paradigm, which allows for assessment of effectiveness of a specific intervention on a specific outcome. With the launch of Healthy People 2020, we welcome the inclusion of social determinants of health (http://www.healthypeople.gov) and agree that social, economic, cultural, and environmental factors are vitally important as targets for interventions. However, we believe that Ford & Airhihenbuwa (25) go further with structural determinism, which calls attention to the underlying dynamic power structure that perpetuates inequities. Therefore, we utilize their term, structural determinism, which explicitly demands that we address racism. Consequently, to a large extent, we have yet to realize the promise of integrating our increasing understanding of structural determinants of health with comprehensive interventions that address multiple levels simultaneously.
A comprehensive intervention focuses on multiple outcomes as well as multiple levels of the socioecological model (71, 73). Such interventions are at the heart of fourth-generation research and are responsive to the Healthy People 2020 action model aimed at achieving health equity. From the PHCR perspective, four key principles should inform intervention research: the primacy of racialization, structural determinism, critical approaches, and intersectionality.
In fourth-generation research, guided by PHCR, it is essential to remember that the goal is ultimately to take action to eliminate health disparities. In that context, the voice of community members is an absolute necessity. Fourth-generation research is deeply rooted in community and the racialized context of the populations who reside within them. Community-engaged research considers the actions that communities can take to promote health and represents a fundamental shift in emphasis from an individualistic biomedical model of health to a public health focus on populations in community-based settings.
The emergence of community-based participatory research (CBPR) (33) has represented a fundamental change from a sole focus on the individual as an autonomous being to a complex understanding of how health and behavior are shaped by the environment. Although CBPR is a valuable tool, it is only one means of community engagement. Community engagement is essential to fully understand and grapple with the impact of the ordinariness of racism on community members’ lives, to expand our understanding of race and racism as well as the intersectionality of other factors such as gender on their lives, and to engage community members fully as partners in action.
In the inaugural issue of the Journal of Mixed Methods Research, Tashakkori & Creswell (55) globally defined mixed methods research as utilizing both qualitative and quantitative strategies to collect and analyze data, to integrate findings, and to draw conclusions in a single study. The central tenet of the definition is the integration of the combined analyses of the data. We concur with the definition set forth by the authors and further embrace the extended definition proposed by Johnson et al. (34):
Mixed methods research is an intellectual and practical synthesis based on qualitative and quantitative research; it is the third methodological or research paradigm (along with qualitative and quantitative research). It recognizes the importance of traditional quantitative and qualitative research, but also offers a powerful third paradigm choice that often will provide the most informative, complete, balanced, and useful research results. (34, p. 129)
To this end, fourth-generation research demands a sophisticated mixed methods approach that can evaluate comprehensive, multilevel interventions. The mixed methods research paradigm is inherently rigorous and sensitive to the PHCR praxis principles of voice and the social construction of knowledge. More important, at its core, mixed methods research is grounded in and embraces the principles of intersectionality and critical approaches in the development and conduct of scientific investigations. As a result, this paradigm fits well with moving toward a fourth-generation of health disparities research.
Vlahov et al. (73) also caution that as we move toward more comprehensive, multilevel interventions, we face new challenges. They describe the challenges faced when making inferences from comprehensive interventions in which the interactions among the levels of intervention themselves, as well as with the social context, make it more difficult to tease out specific inferences of impact. The use of multilevel modeling in research is often an attempt by investigators to address more than one factor and more than one level other than individual behavior. Multilevel models allow for simultaneous examination of two levels of data (e.g., individual and neighborhood) and examination of the effects of one factor at one level while controlling for potential confounders at another level or interaction of factors at different levels. Yet, as with most models, impact is limited. As a result, we suggest that these new challenges require new methods informed by PHCR principles of structural determinism, critical approaches, intersectionality, disciplinary self-critique, and race as a social construct. The PHCR praxis demands that race and racism remain explicitly at the forefront of the analysis. Ford & Airhihenbuwa (25) clearly state their caution and concern regarding fidelity to critical race theory:
[W]hile it is entirely appropriate to apply most public health theories in a formulaic fashion, similar ‘application’ of Critical Race Theory would constitute a gross violation of its critical approach. CRT is praxis, not a standard theory. Its constituent constructs cannot be used merely to quantify relations between raced risk factors and individual-level health outcomes. (25, p. 1397, emphasis in original)
There has been much focus in recent years on enhancing the cultural competence of health professionals. This focus on cultural competence contributes to the use of attendance at workshops as evidence of competence. Our concern is that the proliferation of cultural competence workshops and guides may create an artificial sense of efficacy with regard to engaging people of different racial and ethnic backgrounds (44).
We have to move beyond the mere synthesis and application of awareness, knowledge, and sensitivity gained from a discrete end point like a cultural competence workshop (46) to the belief that one can be committed to self-reflection and critique over one’s life span (4, 7). We describe this process as cultural confidence. Cultural confidence is a lifelong process based on the individual’s self-reflection about their personal biases and prejudices. We define a culturally confident person as someone who is flexible and humble enough to admit ignorance and is willing to be uncomfortable addressing complex racialized issues. This new approach is guided by race consciousness, the social construct of race, intersectionality, critical approaches, and disciplinary self-critique, which demand continual discussion and reflection about race and racism. This approach also demands that our professional preparation programs revamp their training to address race and racism more explicitly. To do so will require that academicians and researchers are also willing to engage in these same processes and that their capacity to work effectively with racial and ethnic minority communities is strengthened.
The Healthy Black Family Project (HBFP) is a third-generation research example of translating an RCT into a community-based, culturally appropriate health-promotion and disease-prevention program (60). The goal of the HBFP was to translate the lifestyle interventions found to be effective in the Diabetes Prevention Project (19) into a culturally appropriate program in a low-income, black community. For example, the HBFP sought to lower the common risk factors for type-2 diabetes and hypertension by providing physical activity classes such as African dance, body toning, walking, and yoga; providing nutrition classes; and engaging members in other research activities, including community forums on research (23, 60).
When HBFP was being developed in 2006, we lacked a strong framework that allowed us to address race and racism explicitly and their associated complex structural determinants. Now, with the creation of the 2010 PHCR praxis framework, we propose to look at HBFP with fresh and provocative eyes. In Table 2, we illustrate the principles of PHCR in the context of the HBFP. In hindsight, we recognize that we had actually addressed some of the PHCR principles but had not done so in the systematic manner that Ford & Airhihenbuwa (24, 25) proposed. Additionally, in Table 2, we present new interventions to move HBFP to a fourth-generation research study.
We have articulated an ambitious agenda for fourth-generation research. Critics could argue that it is unattainable, too costly, too time-consuming, and too idealistic. The danger is to assume that (a) racism is not relevant in the scientific pursuit of solutions for the elimination of health disparities, (b) some populations will always suffer premature illness and death by virtue of their culture-bound lifestyle choices, and thus (c) the elimination of disparities is impossible and health equity unachievable in a free-market society.
The opportunity is to recognize health disparities as an ethical issue of justice because specific groups were subjected to systematic racial discrimination and denied the basic benefits of society, a violation of the social contract (6). As Powers & Faden (50) state,
One critical moral function of public health…is to monitor the health of those who are experiencing systematic disadvantage as a function of group membership, to be vigilant for evidence of inequities relative to those in privileged social groups and to intervene to reduce those inequalities. (p. 88)
Because this situation places health disparities in a category of injustices deemed morally problematic (35), it demands achieving what we have thus far failed to do adequately, such as critically examine racism and race in a meaningful way and develop interventions that allow us to take direct action to eliminate health disparities.
There is an emerging consensus within the NIH, best articulated by John Ruffin (54), Director of the National Institute on Minority Health and Health Disparities:
[W]e can no longer be victims of inaction. Our role as scientists is to provide the knowledge and perspectives for effective practice and policies…. We have a moral obligation in our society to do what is necessary to improve health, and the health disparities research community should be in the vanguard of that movement. (p. s9)
Utilizing the framework of PHCR praxis, the health equity action research trajectory provides a transformational approach for action aimed at achieving the Healthy People 2020 goal of health equity for all.
This research was supported by the National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities (PG60MD000207, S.B. Thomas, PI) and the NIH Office of the Director (7RC2MD004766, S.C. Quinn, PI). In addition, Drs. J. Butler, C.S. Fryer and M.A. Garza are all recipients of Mentored Career Development Awards (K01) from the NIH, National Cancer Institute. Additional financial support was provided by the Robert Wood Johnson Foundation, the Pittsburgh Foundation, the DSF Charitable Foundation, the Highmark Foundation, and Dr. Judith Davenport. We graciously thank our community participants in the Healthy Black Family Project and the black barbershop and beauty salon network, Health Advocates In-Reach and Research who shared their knowledge, expertise, and insight over a decade of work. Finally, we thank Dr. Janey Whalen for her superb review and feedback on early drafts of the manuscript.
1These terms are used interchangeably throughout this review.
The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.

domain: medical


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domain: economics


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A senior SIT official said same weapon was used to shoot Gauri Lankesh, rationalists Govind Pansare and M M Kalburgi.
Bengaluru: Parashuram Waghmare, the last of the six suspects arrested in connection with the killing of journalist-activist Gauri Lankesh, was her assassin, the SIT probing the sensational case said today.
A senior official in the Special Investigation Team also said the same weapon was used to shoot Gauri Lankesh, rationalists Govind Pansare and M M Kalburgi.
"Waghmare shot Lankesh and the forensic report has confirmed that (rationalists) Govind Pansare, M M Kalburgi and Lankesh were murdered with the same weapon," a senior officer in the SIT told news agency PTI wishing not to be named. He, however, said the weapon was yet to be traced.
Forensic examination can lead to such a conclusion when the hammer of a gun has left identical marks at the rear of a bullet even if the weapon itself has not been found.
The official said the organisation, composed of people drawn from Hindu right groups, had around 60 members spread across at least five states but had no name. "We discovered that this gang has a network in Madhya Pradesh, Gujarat, Maharashtra, Goa and Karnataka. We did not find their Uttar Pradesh connection so far," the official said.
He said though it recruited people from hardline Hindutva organisations like Maharashtra-based Hindu Jagruti Samiti and Sanatan Sanstha, these outfits may not be directly responsible for the killings. Both organisations had denied their role in the killing of the three.
Sujith Kumar alias Praveen used to recruit people for the gang, the official said, adding it was following his interrogation that the network was busted.
The SIT, he said, suspected three more people were present when Gauri Lankesh was shot dead at the entrance of her Bengaluru residence on September 5, 2017.
Speculation was rife that Parshuram Waghmare, whose physical appearance matched that of the man whose image was caught on the CCTV camera at Gauri Lankesh's home on the day of the killing, was her assassin. The officer said the gang meticulously planned its operations before executing them.
The entire process of reconnaissance, identifying the weaknesses of the targets and their elimination would take anywhere between six months and a year. "The gang had almost reached the last phase of killing Prof K S Bhagawan (Kannada writer) when we nabbed them," the officer said.
The Karnataka police had uncovered the plot to kill Bhagwan recently, and it was during the interrogation of the four arrested accused that they grew suspicious about their involvement in Gauri Lankesh's killing.
Bhagwan had often angered the right-wing outfits with his writing and utterances against Hindu Gods.
The SIT had recently recovered a diary from the suspects which contained a hit list of targets. The name of film and theatre personality Girish Karnad figured in the list, the officer said, adding the Jnanpith awardee's surveillance was in the "last phase". Other than Bhagvan and Karnad, former minister and literateur B T Lalitha Naik, rationalist C S Dwarakanath and pontiff Veerabhadra Channamalla Swamy of Nidumamidi Mutt were also on the hit list. All of them have been quite vocal in criticising the Hindu right.
Kalburgi, a Sahitya Akademi Award winner and a doughty campaigner against superstition in Hinduism, was shot dead in August 2015 at his home in Karnataka's Dharwad district.
In February the same year, Govind Pansare, a Left politician and rationalist, was shot at and fatally injured by unidentified assailants in Kolhapur in Maharashtra.

domain: law


text:
Britney Spears could finally be ready to open up to her fans — in fact, rumors are swirling that she's considering sharing her side of the story with the one and only Oprah Winfrey. Imagine? After her interview with Prince Harry and Meghan Markle, it's clear that Oprah's the one to trust.
In a report from Entertainment Tonight, Britney is apparently feeling especially grateful for the overwhelming support from fans and fellow industry stars — like Miley Cyrus or Kim Kardashian — after the release of Hulu's documentary, Framing Britney Spears, with the New York Times.
Related | The Astrology of Oprah
"Britney has considered speaking out about her past, mostly because she doesn't feel others should tell her story," a source told ET. "She's always hated doing interviews but if she ever takes that step, Oprah would most likely be her first choice. At this point, there is no plan in the works for her to do an interview but when she does, there will be steps Britney would need to take before speaking out."
Though nothing has legally changed for the 39-year-old pop star in regards to her conservatorship, the support through messages on social media has reportedly made Britney feel far more understood.
I need that Britney interview like yesterday Oprah is the only one I trust.— Kate (@KateBDoll) March 13, 2021
Now that Oprah has taken down the Monarchy, the next logical step is taking down Britney Spears' father— Chris cross, big apple sauce 🗽 (@iamChrisVolpe) March 18, 2021
Now, fans are begging for a Britney interview with Oprah... "like yesterday," as one Twitter user notes. "No one touches [Oprah] as an interview," writes another. And "now that Oprah has taken down the Monarchy," a fan suggests, "the next logical step is taking down Britney Spears' father."
Photo via Getty
- Who Is Mimi Zhu Socialist Writer Who Created Comrade Britney ... ›
- Britney Spears' Ex-Husband Jason Alexander Helped Storm the ... ›
- Britney Spears' Social Media Manager Addresses Instagram ... ›
- Britney Spears Said She Was "Embarrassed" By "Framing Britney Spears" Documentary - PAPER ›

domain: entertainment


text:
AYC supports sailboat racing on Anchor Bay for all skill levelsAYC is a sailboat racing club. We sail in Anchor Bay on northern Lake St. Clair. In association with the Anchor Bay Yacht-Racing Association (ABYRA), we manage our Tuesday Night Twilight Race Series, and also sponsor several Invitational races. On most Tuesday evenings, between May and September, you will find several classes of yachts having a go around the buoys. We feature handicap fleets for a wide range of boats, including Spinnaker, Asymmetric Spinnaker (Mackinac Race Cruising Class rules), and Jib & Main racers. One-design classes can also be accommodated. We are also a member of the Detroit Regional Yacht-Racing Association.
Top Gun Series Racing
AYC offers a variety of sailing events. If you are interested in participating in these events or wish to assist in the management of any of the events, please talk to any AYC Board member or the Race chairman. Please note that class representation is based on the number of boats registered. Typically, there is a minimum of five yachts required to constitute having a separate class and a separate start for any of the events listed.
Race results for each Race and the Series are posted on YachtScore. Click the button below to be redirected to the official results page
St. Elmo's Night Race 2023
This spirited race has sometimes been called the AYC Night Race and has become one of the more popular races in the North end of the lake. The course consists of a race from the Clinton River Buoy “CR” to the Saint Clair Light and back again. Depending on the conditions, the Saint Elmo’s can demand a great deal of night sailing ability. This race also counts toward the AYC season standings.
AYC Memorial Trophy Race
This is a fun race open to ALL club members. The race honors deceased members and V.C. Michael Malesko who died in office. This race also counts towards the AYC season standings.

domain: hobby


The Mudcat Café TM
Thread #142469 Message #3290973
Posted By: Stringsinger
15-Jan-12 - 01:37 PM
Thread Name: Why didn't MacColl like Dylan?
Subject: RE: Why didn't MacColl like Dylan?
I think we can infer that McColl found pop music to be a form of musical imperialism, although he may never have stated this publicly.
Pop music, whether Dylan or the Beatles is a form of musical marketing and their popularity tends to eclipse other forms of music on a mass public level. This is true with pop music in general. To declare any form of pop music as traditional folk music is specious.
That doesn't make it bad, it just makes it different.
Ewan may have declared himself a communist with a small c which is quite different than the Stalin model in the Soviet Union. I have heard him admire Castro in Cuba and from what I know of Cuba, things are not terrible there which makes the US policy toward Cuba somewhat ridiculous.
Having known Peggy for many years and Ewan casually as a result, I can see why in his way of thinking that Dylan would represent in his mind a misrepresentation of what traditional folk music is.
I see Dylan as a pop star and there is nothing wrong with this provided he doesn't become representative of traditional folk music or folk singers.
I see Dylan and the Beatles as a form of music cult and as a result, a non-objective critical appraisal of their output is considered by some to be sacrilegious.
I don't think this is true for traditional folk music because some of it is very good and some not so. Here, it is necessary to define terms. Good in what way? Etc.
To say that Ewan appreciated Dylan in his role as a folk singer doesn't make sense.


text:
Discover How You Can Arrange For a Vacation in Orlando
Do you have intentions of going to Orlando for a vacation and it is your first time? It is perfectly a great move but you should to evaluate yourself to establish what you really need to plan for. In a general sense, you can’t get up one morning and you choose to go for an excursion. It requires one to have some planning prior to the big day. This will upgrade a smooth change in your visit and simultaneously it will assist you with keeping off from disillusionments. You cannot imagine going to a place and it is your first time and you experience some hiccups that will make you hate the trip. For this reason, if you want your vacation to be a memorable one, it will be imperative to make sure that you have exceptional plans for the occasion and you won’t regret it. It will be prudent to work on your budget.
Contingent upon your desired days to spend in Orlando, it will be judicious to have an impressive financial plan that will actually be able to cover every one of your necessities. You should make certain of where you expect to invest your valuable time while in Orlando. Consequently, you can actually take a look at additional insights regarding various inns and hotels that offers accomodation. This will empower you to do the suitable appointments on time. You will require a specialist to help you in arranging for the trip to Orlando since it can end up being a difficult errand in the event that you do it all alone.
You can read more here in this site regarding the arrangements that you ought to undertake if you are planning to go for Orlando vacation. Essentially, Orlando is perhaps one of the best place that you can at any point consider visiting.
There are so many amazing sites that you can be able to visit and enjoy. From this homepage, you will be able to discover some of the places that you can be able to enjoy. You most certainly should get in touch with the best tour organizers for them to have the option to have great plans for your benefit. Once you seek consultation from them, this company will be in a position to offer the best kind of services. You will be able to enjoy this service and this product from this great company because they so much focus on satisfying their clients. You can also read more about it from this site for the best hotels where you can have the option to spend your days. All this information will enable you to make sober decisions regarding your trip to Orlando.

domain: travel


text:
I’ve always learned so much from my mom, but there’s been some special lessons she has taught me as I’ve watched her navigate the steps of writing and publishing a book. When my grandmother died in my early 20s, Mom inherited a box of old photos, letters, diaries and newspaper articles that my great aunt Hallie had saved. That tattered box started a twenty five year journey to write a book about Hallie’s life and what enabled her to live with an attitude of gratefulness and an ability to say, “Wonderful, Wonderful” even when life was far from perfect. Today, I am sharing a few things I am learning from my Author Mom (and sharing how you can order her brand new book).
This post includes affiliate links.
Things I am Learning from my Author Mom
Visit the Past, but Don’t Stay There
The past is a great place to visit but a terrible place to live. I have watched Mom do family research my entire adult life and discover some amazing treasures. She has done detailed research on the life of my great Aunt Hallie, studied letters, city directories, and family pictures. Along the way, there have been fascinating discoveries – some emotionally heavy. Mom continues to remind me that when we find out details about family history illness, death or heartaches, remember that those pains have already been dealt with. It may be sad at the time you learn the details but remember that if we choose to stay there, we lose the joy of the present.
Don’t Worry About the Future
The opposite is also true. If we live each day worried about the future, then we miss out on the joys of the present. Mom does a good job reminding me by her example that tomorrow will take care of itself. This is a recurring theme reflected in her book and personal life. Sure, there will be problems in the future, but there will also be amazing experiences and mountaintops that you can never imagine. Some of the stories that Mom uncovered were a good reminder to me that we need to hold on to joy even though we don’t know what tomorrow will bring.
You’re Never too Old to Finish a Dream
Mom dreamed of becoming a published author from her young elementary days, but the actual book had to wait till 2021. Along the way, she wrote poems, Bible School curriculums, camp programs, articles for various publications like Upper Room, SBC Life, and Campus Life, but she still dreamed of writing a book.
Mom took a break from college so she could raise us kids, live life, and support their church ministries. But at the age of 50, Mom walked acrosss the platform with her college English degreee. and now in 2021, she is officially a published author. You’re never too old to finish a dream – no matter what age you are.
Every Day is an Adventure
You know that life is never boring or predictable when you are with Ritchie Hale. When you read Treasures of the Tattered Box, you get to experience many of these adventures that she went on with my grandparents in their later years. As they got older and their health started to fail, Mom would often help them into the car and head off on another ‘adventure’. Sometimes it would involve something amazing, and other adventures would be something quite ordinary, but each outing would be far from boring.
Stay Calm in the Storm
When life turns upside down, the best person in the world to call is Mom. She is the most calm person in every storm – addressing the drama or chaos in a step by step approach. After the emergency is under control, that’s when it’s time to process and deal with the emotions.
I’m so proud of Mom for having a dream to write a book and then doing the hard work to bring this dream to reality. You can learn more about her book journey on her website – Another Ritch Publication.
About the book
Ritchie was fourteen years old when she first met her great aunt Hallie and fully expected her to be a frumpy old lady. She was wrong. Thirty years later an old tattered box bound together with frayed twine containing treasures and keepsakes, would lead Ritchie on a twenty-five year journey, often accompanied by her mother-in-law. They would visit six states and journey nearly fifteen thousand miles.
Earlier this month, we celebrated the release of Mom’s Book with a few table decorations and her first book signing. It’s been an amazing process as we watched Mom follow this dream and get the book published.
Have you read this book yet? If not, what are you waiting for! Order today on Amazon.com!

domain: library


text:
When trying to discover the perfect vet practice to care for your animals, you should guarantee the vets and vet hospital deliver complete service. The below list of veterinary amenities should be a minimum offered by your next pet clinic.
– Wellness Care And Immunization
Prevent illness if possible. The effort and time spent in health programs have rewards for both owners and pets. You can also visit https://allpetanimalhospital.com/ to find best Babylon animal hospital.
Wellness applications should be made specifically for all your pets from your vet and comprise comprehensive physical examination, oral evaluation, internal parasite testing, heart disease, and flea control, vaccination program, neuter, and spay program and dedicated blood tests for all life span.
– Dental Care
Fixed professional cleaning is essential in keeping up the teeth. Life expectancy was demonstrated to grow 3-5 years using regular dental cleaning. The Modern and the secure ultrasonic and hand scaling ought to be used to clean each tooth carefully, above and below the gum line.
The general operation should be among the vet clinic services offered to comprise spays, neuters, expansion removals, hernia repairs, hematoma repairs as well as other.
Electronic vascular monitoring, through blood testing, oxygen saturation screens and intensive postoperative surgery care have to be a part of this support.


Economics is everywhere, and over the last year we’ve seen it play out in purple on the roads of Belfast in the form of Glider Economics.
When the Department for Infrastructure and Translink embarked on the Glider project, what few people maybe realised was that it was the beginning of a major economic exercise to change consumer behavior and to ‘nudge’ us into making better decisions through a series of small and larger interventions.
Whilst this project created resistance in the early stages, it would be hard to argue that The Glider hasn’t been a success given the figures to back it up. Passenger numbers have increased by 30 percent in parts of Belfast in its first year meaning about 1.67 million fewer car journeys, reducing congestion and enhancing city air quality. Public transport usage is now at a 20-year high, with the Glider contributing to this.
So, what was the problem the Glider project set out to address and how did they go about it?
Firstly, a major problem is that Belfast is one of the worst cities in the UK for air pollution, making it very different from the rest of Northern Ireland, which has good air quality. Recently Belfast was deemed to have “dangerously high” levels of pollutants, with nitrogen oxide levels so high in some areas that they breached legal limits. Clearly this was contributing to making it less desirable for people to live in the city, and reducing the number of cars coming into Belfast was seen as a key way of addressing this.
Secondly, Belfast has a very considerable problem with congestion. Local motorists spent an average of 190 hours stuck in traffic last year, according to one report, making Belfast the second worst city in the UK after London. It was estimated that this cost £1,400 per driver in lost time.
There were a very wide range of routes down which the policy-makers and decision-makers in government could have gone down to try to address these problems and there are many examples around the world of policies that have been put in place to do.
Perhaps the best-known to us in this part of the world is the London congestion charge, which charges motorists in the UK capital to use road space during the working day , including peak commuting hours, in order to nudge them towards using public transport or to cycle. Without this charge, demand for road space would massively exceed supply, resulting in chronic congestion with a wide range of consequences.
In addition, London has introduced an Ultra Low Emissions Zone to help improve air quality. This effectively charge anyone without a low emissions vehicle for having their car within the zone 24-hours per day, seven days per week.
Another interesting example is in Paris which in 2016 started restricting vehicles in the city based on their number plate, with odd numbers banned on day and even the next. In doing so, they effectively took a leaf from Athens’s playbook during the 1990s.
With the Glider approach in Belfast, the policy makers have chosen not to go down the route of banning cars or putting an explicit financial charge on driving in the city. What they have done instead is nudged people to take their cars off the road at peak times at least. They have done this by radically rebalancing the relative attractiveness between driving and using public transport or cycling through a series of small and larger changes.
On the one hand, they have effectively increased the cost of taking the car; though the cost motorists pay in the Belfast is their time. Whilst public transport in the form of the Glider has become quicker, more convenient (e.g increased availability of park & ride), more comfortable and easier overall, driving into the city has become more difficult as a result of the changes to bus and car lanes.
Some of the things that have been done to make the Glider more attractive than driving include upping the quality of the journey as well as reducing the time it takes. This includes things like introducing pre-pay ticketing before getting on the Glider. It also includes increasing the number of doors to make boarding faster and less stressful. Onboard, there is now wifi and charging points for mobile phones.
Ultimately though, the frequency and reliability (i.e. predictable commute time) of the Glider as well as the speed with which it can cross the city in its dedicated bus lanes is the biggest seller. Reducing two car lanes to one to accommodate the Glider means that motorists for battling for half the road space than they previously were, and they are paying for this privilege with time.
In the Glider project, there are parallels with the approach of Downing Street’s infamous Nudge Unit which was the world’s first government institution that uses behavioural economics to examine and influence human behaviour, to ‘nudge’ us into making better decisions. Seemingly small, subtle and low-cost solutions, or nudges, have led to huge improvements across tax, healthcare, pensions, employment, crime reduction, energy conservation and economic growth.
The nudge, or a type of Glider Economic thinking, should become hardwired into policy making in Northern Ireland to help deliver a more efficient and effective public and private sector economy. We should be asking ourselves in the absence of water charges how we can nudge members of the public to make use of this important public service in a more sustainable way.


text:
LANVIN PRE-FALL 2016 COLLECTION
Chemena Kamali and Lucio Finale have taken over Lanvin, heading a new team of designers to ...
January 7, 2016
Chemena Kamali and Lucio Finale have taken over Lanvin, heading a new team of designers to temporarily replace Alber Elbaz, after a 14-year run. The pair will also design the Fall 2016 runway show until a new Creative Director has been appointed.
Kamali delivered a flamboyant, risky Lanvin Pre-Fall 2016 collection with a different aesthetic than the characteristic and familiar looks we have grown accustom.
“Our focus is on the Lanvin woman, who she was and who she could be,” Kamali said, “but the evolution of the house, as well. It’s about finding a balance between the fundamentals but also thinking of who that woman is today. How can you inject that dose of authenticity?”
The velvet pants of a suit were cut generously; the proportions of a herringbone overcoat were mannish; and a Japanese polyester jumpsuit erupted with bows. Shirts and dresses featuring plastrons trimmed with deep ruffles showed her background at Chloé. Patchwork in men’s necktie fabrics worked into appealing blouses and dresses, and furs.
Accessories were rich exposing the House’s iconography, employing the Lanvin mother-and-daughter logo medallion on some handbags and using Lanvin’s signature blue for bag linings and shoes soles. The collection features mixed metallic finishes and new hobo style bag.

domain: artistic


text:
I’m just going to say it out loud: Wake Up Girls did not leave a lasting impression on me. Yamakan’s (Yutaka Yamamoto) attempt at creating a great hit idol show failed. The social commentary on the “dark underside of the idol industry” ended up feeling creepy instead of insightful. The show (or at least the TV broadcast) was also occasionally plagued by some really bad animation, which made it kind of disappointing and unpleasant to watch as a whole.
That particular problem was highlighted even further by the fact that the prequel movie, which serves as an introduction to the TV series, looked pretty good, and it had a very impressive and climactic live performance scene. It also had a very solid story, and now that I think about it it’s probably my favourite introduction to an idol show. It’s sad, then, that the TV series failed to live up to the movie, but sometimes that happens, and it’s not like I (or anyone else I know) had any great expectations for the show.
The show did, however, surprise me pleasantly with its music. Tachiagare and 7 Girls War in particular are two songs that I like listening to as songs in their own right (in contrast to ), which is a feat that, for me, no other idol show aside from AKB0048 (and Macross Delta) has pulled off. I guess I also liked the character designs and characters in general in Wake Up Girls, but the only thing that really stuck with me was the music. So in my opinion the show did do at least something right.


text:
Testing of containers
According to the CSC and UIC regulations, the newly developed and made prototypes must be tested in compliance with the standard ISO 1496. Our own testing room of containers enables us to do all the tests by ourselves.
In order to be able to offer the market and the customers tested and functional products, our testing room enables us the following testing:
- testing of materials (toughness test),
- static and dynamic testing of constructions of container,
- dimension controls and measuring of products,
- testing of gas tightness,
- testing of container demolition,
- simulation of the container falls (“drop test”),
- functional testing of containers,
- and other testing adapted to the customers’ requirements.
This kind of development, production and testing enables us to launch an optimal and tested product on the market and the final buyer will use it carefree every day.

domain: design


With f representing the frequency of vibration (cycles
per second), V a v e r a g e as the average velocity of
be between 5 and 5000 CPS (or as limited by vibra-
tion transducer frequency response). Many calibra-
vibration (inches per second), and D as the peak-to-
tors are calibrated in terms of RMS velocity, whereas
peak displacement (inches), the equation reads:
the vibration meter is calibrated in terms of average
velocity. Assuming that sine-wave functions are being
used, the following simple conversion factors can
1-48. PRELIMINARY CONTROL SETTINGS
CHECK OF CIRCUITS. Before performing any meas-
Average inches/second = (0.90) (RMS
urements with the vibration meter, the following
steps should be taken:
= (1.11) (average
a. Turn the RANGE switch to the OFF position.
c. These examples may serve to clarify the use of
the conversion factors:
b. Leave the INPUT NETWORK and CHANNEL
selector switches in any position.
(1) Assume that a calibrator is used at a level of
0.5 RMS inches/second. To determine what the vibra-
c. The vibration transducer may be connected or
tion meter should read under this condition, use the
first formula given above:
d. Connect the meter ac power cord to 115 volts ac.
T u r n the OFF power switch to the on position.
Average V = (0.90) (RMS V) = (0.90) (0.5)
= 0.45 inches/second average
e. Perform the zero test by indexing the OPERA-
TION selector switch through the Vx1.0, Vx0.1,
(2) Alternatively, assume that it is desired to
Dx1.0, and Dx0.1 positions. A reading of not more
produce a vibration input corresponding to a full-
than two percent of full scale should be obtained,
s c a l e reading on the 0.5 inches/second average
indicating a noise level of less than two percent.
v e l o c i t y range of the vibration meter. Here the
problem is to determine the RMS velocity of the
f. Perform the calibrate signal test. Turn the OP-
shaker corresponding to this condition. This may be
ERATION selector switch to position C. Depress the
done using the second formula given above:
CALIBRATE SIGNAL control to operate. This con-
trol should adjust the meter indicator from one-third
RMS V = (1.11) (average V) = (1.11) (0.5)
to full scale. Set the meter indicator at 5 on the
= 0.555 inches/second RMS
lower scale and release the CALIBRATE SIGNAL
control, preparatory to step g .
1-44. OPERATING INSTRUCTIONS.
1-45. GENERAL. When using Vibration Meter Type
1-117 with a compatible vibration transducer for
The CALIBRATE SIGNAL control taps a por-
measuring purposes, install the equipment as de-
tion of the filament supply voltage. The volt-
age regulator for the power supply distorts the
sine wave; however, the resultant wave is
1-46. The vibration meter may be set up to indicate
suitable for setting the gain of the first half
the value of the peak-to-peak amplitude of the vibra-
of the amplifier.
tion. This reading will serve as a check against known
acceptable limits for the equipment being tested. For
g. Perform the sensitivity control test. Index the
production work, monitoring checks at key points are
CHANNEL selector switch to each of its four posi-
usually sufficient to establish product acceptability.
tions. At each position, it should be possible to obtain
a full scale reading on the output meter by adjusting
1-47. If further details pertaining to the nature of the
the applicable channel SENSITIVITY control.
vibration are needed, the average velocity may also
be read directly from the meter. When the vibration
1-49. MEASUREMENT PROCEDURE.
consists of a single frequency, the frequency of vibra-
tion may be calculated from the reading of displace-
a. Make preliminary circuit checks and adjust-
ment and velocity by the use of the following equation.


text:
New York, NY — The Miss Universe Organization (MUO), which oversees the annual MISS UNIVERSE competition, is thrilled to announce that Olivia Culpo and Jeannie Mai will return to the Miss Universe stage to host the 72nd annual competition, joined by television host, presenter, actress, New York Times-bestselling author, entrepreneur, Emmy Award-winning journalist, and host of “Heal Squad,” Maria Menounos. This is only the second time in MOU history that the show will feature an all-female hosting team.
MISS UNIVERSE will take place in El Salvador on November 18th, 2023. The competition will be streamed on The Roku Channel and broadcast by Telemundo within the United States, and will be Executive Produced by Sergio Alfaro and his LA-based team at InventTV.
Menounos joins the program from her work in the entertainment world including Access Hollywood, Extra, E! News, The Today Show, and NBC Nightly News, as well as an actress in various tv shows and films. This is her first time hosting, but she has been a part of the MOU community since winning the title of Miss Teen Massachusetts in 1995.
She’s accompanied by Emmy Award winning TV host, producer and advocate Jeannie Mai, who hosted the show in 2011 and 2022, and actress and model Olivia Culpo. Mai hosted the show in 2011 and 2022, and can be seen co-hosting the CBS game show Raid The Cage this fall. Culpo has also hosted twice before, in 2022 and 2014, after winning Miss Universe and Miss USA in 2012. She was last seen on the screen this year in the semi-finals of Fox’s The Masked Singer.
The show will also feature two backstage correspondents: Filipina model, singer, television personality, and Miss Universe 2018 Catriona Gray; and Emmy Award winning TV host, actress, and producer Zuri Hall. Hall is currently a co-host of Access Hollywood and NBC’s American Ninja Warrior. Both Catriona and Zuri return after last appearing as the backstage correspondents at the 71st MISS UNIVERSE. Multi-platinum artist, EGOT recipient, songwriter, producer, and activist John Legend will perform live at the event as well.
For the Spanish-language telecast, Telemundo will feature renowned TV personalities Jacqueline Bracamontes and Danilo Carrera. Joining them are Andrea Meza, Carlos Adyan, and Julia Gama, who will be on site bringing viewers all the excitement with exclusive behind-the-scenes access and special coverage.
Paula Shugart, President of MOU and the program’s Executive Producer said, “I’m so glad to be working with such a talented, funny, and knowledgeable group of women presenters. Our hosts this year exemplify the best of the Miss Universe family, and this is going to be a fantastic show.”
The 71st Miss Universe finale, which was hosted by Culpo and Mai in January 2023, streamed for the first time on The Roku Channel. It became the most streamed live program on The Roku Channel on its broadcast date, reaching millions of streamers with the live and on-demand replay of the competition during its broadcast weekend.
The Roku Channel is free and easy to watch through Roku devices or TVs, and it’s also easily accessible online at TheRokuChannel.com, iOS and Android devices, Amazon Fire TVs, Samsung TVs and Google TVs, and other Android TV OS devices.

domain: celebrity


text:
Atwood’s name is tied to several genres and writing styles and her non-fiction and poetic work. But, two major themes run throughout the vast majority of her writing— feminism, and environmentalism. Margaret Atwood’s relationship with feminism, at least publicly, is a complicated one. Throughout her career, she has been unwilling to use the term to refer to her own work, although it is often used by others.
The Handmaid’s Tale Artwork
Margaret Atwood’s poems, short stories, and novels are often of interest to feminist literary critics and those seeking out feminist literature. When asked about her first novel, The Edible Woman, and if she considered it feminist, she replied, “I don’t consider it feminism; I just consider it social realism.”
Recently Atwood has faced social media backlash after trying to explain her views on feminism, especially in the current moment. She has argued that feminism is not defined as the “assumption that women are always right regardless of the context.” She asks when thinking about feminism, “Do we mean women are better than men? Do we mean all men should be pushed off a cliff? What do we mean? Because that word has meant all of those different things.”
Atwood recognizes the fact that “feminism,” as a term, is used as a catch-all. Much of the discussion around Atwood’s feminist, or not, writing centers around The Handmaid’s Tale. Since it has been thrust back into the public spotlight, Atwood has herself been asked countless times how she views the novel and what she personally believes about feminism.
Atwood has made clear that she personally aligns herself with feminism founded on equality between men and women. Still, she would not elaborate on a specific wave or part of the movement she was thinking of. She has stated explicitly that she does not believe “women are always right,” citing Theresa May, the former prime minister of the United Kingdom, as an example to prove her point.
Feminism in Margaret Atwood’s Novels
When looking for themes of feminism in her books and stories, readers often cite works like Alias Grace, The Handmaid’s Tale, The Edible Woman, The Blind Assassin, and The Penelopiad. The latter is one of the best examples. In it, Atwood reexamines the story of Odysseus, in Homer’s Odyssey, and tells a new story based around the original. Rather than focusing on Odysseus and his quest to return home, Atwood focuses on his wife, Penelope, the maids who Telemachus slaughters, and everything that Penelope had to deal with (such as an endless line of suitors) while Odysseus was lingering on his adventures.
Alias Grace is another wonderful example. In it, Atwood delves into the true story of the murders of Nancy Montgomery and Thomas Kinnear in the Canadian West. Grace, and a fellow servant, were accused of the crime. He was sentenced to hang and she got life in prison. Atwood fictionalizes the story in order to delve deeper into Grace’s innocence or guilt. There are numerous moments in this novel in which Atwood speaks about the perception of women, how they were and are treated, as well as the double standards that exist in every part of life.
Another interesting example is The Robber Bride. Like much of Atwood’s fiction, this novel focuses on female main characters, in this case, three of them. The novel uses flashbacks to explore their various relationships and their broader interactions with another woman, Zenia. Readers are required to pick through these various depictions of Zenia and try to come to a truth about who this woman is, something that is impossible through biased second-hand accounts.
Margaret Atwood and Environmentalism
Today, Margaret Atwood is known as much for her literary accomplishments as she is for her activism. She has spoken out over the last ten years regarding the present climate crisis and her “hope” that the world can return to a better path if humanity changes. Atwood sees these changes as ones that have to take place in all parts of life. Humans, she explained at Iowa State University, have to live better, eat cleaner, and make all-around better life choices. She has often touched on these topics in her novels, such as the apocalyptic series Maddaddam, which includes the novel Oryx & Crake.
When speaking about the future of earth in an interview in 2018, she stated that women would bear the brunt of dystopian climate change. She explained in a talk at the British Library in 2018 that it’s not about climate change but about “everything change.” Less food, fewer resources, less safe housing, all of it, Atwood says, will come back to women. “Supplies,” she went on, “will be unevenly distributed, even more than they are [now].” Thinking forward, Atwood believes that the present and coming climate crisis is going to lead to civil unrest and repression, something that always works against the interests of women. Atwood’s poetry is another place to look for examples of feminism.
Environmentalism in Margaret Atwood’s Novels
Oryx & Crake is one of the best examples of how Atwood has included her environmental advocacy in her novels. While The Handmaid’s Tale is certainly a near-future dystopia, it is far more focused on human relationships than nature. In Oryx and & Crake, Atwood creates an entire world that’s been destroyed through an environmental disaster. It is only as the novel progresses, and Atwood’s characters experience flashbacks that the reader understands what the world was like before.
Oryx & Crake is not the only novel that touches on a future where the climate crisis has gone unaddressed. Atwood’s most popular novel, The Handmaid’s Tale, is made possible through the environmental disasters that led to massive declines in fertility rates and toxic wastelands. Although the true extent of the destruction is never fully elaborated on, it’s made clear that the world is not as it used to be. It is a much more dangerous and deadly place.


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Description: Engineering of a multi-enzymatic reaction accelerator in vivo based on TALE
For years, prokaryotic cells have been widely applied in synthetic biology and bio-engineering as the host organism. However, lacking of in vivo compartmentation of the heterologous metabolic pathways, which results in a relevantly low concentration of substrate and enzyme, may cause a low production or productive efficacy, especially when producing through a complex multi-enzymatic cascade. In the current study, we developed a new method to accelerate a multi-enzymatic reaction by integration of a transcription activator-like effector (TALE)-based scaffold system into the bacteria chassis. In this system, we designed two different random DNA sequences as binding motifs, and then incorporated them into the plasmid. Meanwhile, the different TALE proteins, which could specifically target the corresponding binding motifs, were generated by the assembly of repeat-variable di-residue (RVD) part coding sequences. Subsequently, multi-enzymes were fused with these TALE proteins, which could efficiently guide the enzymes around the DNA scaffolds, to enrich the local enzyme concentration, and promote the rate of reaction. The effect of the TALE-based scaffold system were tested by the fragmented GFP study and validated by the heterologous production of ndole-3-acetic acid (IAA), is a plant hormone, through incorporating the TALE-fused tryptophan-2-mono-oxygenase (A.K.A. IAAM) and indoleacetimide hydrolase (A.K.A. IAAH) in E.coli. To the best of our knowledge, this is the first report using TALE system as scaffolds for the spatial organization of bacterial metabolism. This technique might provide a powerful way in synthesizing multi-enzymatic reaction programs in prokaryotic chassis for a wide range of application. Mo, its application might be extend to the eukaryotic biofactory as well.
Prokaryotic cells have been widely applied as the host cells in bio-engineering and relevant fields for years due to their great advantages in high-speed growth and high productivities against the Eukaryotic Cells. However, lacking of the compartmentation of the heterologous metabolic pathways, which result in a relevantly low concentration of substrate and enzyme, may cause a low production or productive efficacy, especially when producing through a complex multi-enzymatic cascade. For years, this problem has been bothering researchers in further enlarging the applications of prokaryotic cells in bio-engineering.
Hence, multiple manners have been designed to accelerate the multi-enzymatic reactions in prokaryotic cells by physically enriching the local concentration of enzymes and substrates in certain areas of the cell. In 2011, Camille et al. demonstrated a method to increase the hydrogen production of a heterogenous hydrogen-producing pathway in vivo with rationally designed RNA assemblies. More recently, similar methods were applied in vivo on acyl-ACP reductase (AAR) and aldehyde deformylating oxygenase (ADO) . Nevertheless, the limited corresponding ligadin as well as the fragility of RNA itself is challenging the expansibility and stability of such method, which may constrain its further application. Elsewhere, DNA and proteins have also been tried to be modified as scaffold for similar use [3-5] . Unfortunately, it is difficult for the DNA scaffold to assemble as single-stranded loop-stem structure to bind the ligadin in vivo. Meanwhile, the complex structure of the scaffold proteins made it inconvenient for prokaryotic biofactory to correctly fold them, thus limits the application. Therefore, both of these two scaffold methods remained limited to in vitro applications.
Given the importance of developing an in vivo scaffold system that is natural, highly-stable, expandable and simple, a large body of work sought to establish a new method that provokes efficient interaction among different biomacromolecules in vivo. Notably, the recent developed genome editing technique (such as ZFN, TALEN, CRISPER-CAS9), can exactly meet this requirement and come up with clues for new scaffold systems. Accordingly, a recent report applied CRISPER-CAS9 technique as a scaffold system that concentrates specific enzymes for metaplastic functions. However, since the binding between different dCas9-fused proteins and gRNA is relevantly nonspecific, the expandability of such method is still limited. TAL effector nuclease (TALEN) technique is based on the specific and direct combination between DNA and proteins, thus gives us a clue that the compartmentation of multi-enzymes can be achieved based on TALE fused enzymes and corresponding DNA scaffold.
TAL effector (TALE) is a family-III effector in Xanthomonas that helps when they infect various plant species . Different TALEs share a similar domain structure that enables them to bind the genome of the host cell and act as transcriptional effectors. 1.5 to 33.5 tandem repeats (TAL repeats), each of which can recognize one specific DNA base pair, were determined in the central DNA binding domain of the TALEs [8,9]. Each TAL repeat contains 33 to 35 highly conserved amino acids, among which, residues at positions 12 and 13 (also known as RVDs for repeat variable di-residues) confer DNA specificity. This structural characteristic allows the TAL effector being utilized in protein engineering applications. By physically fusing the TAL effector with the cleavage domain of FokI nucleases, TAL effector nucleases (TALENs) can be created. This nucleases were widely applied in Prokaryotic and Eukaryotic Cells. Other methods of engineering TAL effectors acting as transcriptional effectors were also reported.
Fig.1 (A) The basic structure of TAL effectors. (B) 3D structure of the TAL effector bond with DNA (Deng et al., 2012)
Using the DNA-binding characteristic of the TAL effector, we can generate a new method to increase the production of heterogenous multi-enzymatic reactions in Prokaryotic cells by rationally designed TALE proteins fused with specific enzymes and their corresponding DNA sequences (as known as Binding Motifs [BMs]). Here we used Escherichia coli as our chassis. A plasmid backbone was used as the scaffold for those BMs. The same plasmid was used to encode the fusion protein. Thus, enzymes fused with TALE proteins could be gathered around the DNA scaffolds, enrich the local enzyme concentration, and promote the rate of reaction.
Fig.2 A diagrammatic sketch showing the TALE-fused enzymes combine with the scaffold.
III.Improvement we made(CLICK)
A. BBa_I715019 and BBa_I715020
Two pairs of primers were designed to extend the use of these parts
1. Primers to add termination codons on BBa_I715019
In our project, we plan to fuse the N-terminal of GFP (A.K.A. GFP1) to the C-terminal of TALE1 protein (you may visit our wiki for more details). However, the sample of BBa_I715019 provided by the 2015 DNA distribution does not have a termination codon on its 3’ terminal to stop the translation. To fix this, we designed a pair of primers to add a termination codon on the 3’ terminal of BBa_I715019 to further extend its usage.
F-Prime: 5’- GAATTCGCGGCCGCTTCTAGAATGC-3’
R-Prime: 5’- GGACTAGTATTATTGTTTGTCTGCC-3’
2. Primers to remove the additional T base from the BBa_ I715020
When fusing the GFP2 with our TALE2/3, we found the additional T base on the 5’ terminal of the BBa_I715020 annoying because it may cause frameshift mutation if we just use the standard Bio-brick assembly to fuse two enzymes. And that mutation may disable the whole reporter gene.
In order to meet this challenge and make this part easier to use, we designed a pair of prime to remove that additional base and make this part easier to be used.
F-Prime: 5’- CGGAATTCGCGGCCGCTTCTAGAAAGAATGGAATCC-3’
R-Prime: 5’- GGACTAGTTTATTATTTGTATAGTTC -3
We tested the function of a split-GFP system built by these parts
In our project, after properly engineered those two parts, we fused them with the TAL effectors we designed and tested their function.
In our experiment, GFP1 was fused with TALE1, GFP2 was fused with TALE2; and SCAF2 (a scaffold where TALE protein can bind) was added into the plasmid. The plasmid was transformed into E.coli BL21(DE3) and cultured in LB with 30mg/ml Chloramphenicol to OD600=0.6, then inducted with 1mM IPTG overnight.
Fig. 1 Evaluation of the functions of split GFP. The green fluorescence (Ex: 488 nm; Em: 538 nm) of split GFP was detected after overnight culture of E.coli with or without GFP1/2 under the 1mM of IPTG induction. Relative fluorescence intensity was calculated with normalization of OD600 value. The relative fluorescence intensity of S2 control group was set arbitrarily at 1.0, and the levels of other groups were adjusted correspondingly. This experiment was run in three parallel reactions, and the data represent results obtained from at least three independent experiments. *0.01 < p < 0.05.
The results shows that the existence of GFP1 and GFP2 can observably increase the fluorescent intensity. Which then indicates that these two parts work as expected.
The second functional prototype of our project this year is about the IAA synthesis pathway. In this prototype, enzyme IAAM and IAAH are fused with different TAL effector so that they can be concentrated around the scaffold.
Among the registry, BBa_K515100 is the only one available with those two enzymes, but unfortunately, we noticed that this part is a device that contains not only the CDS of those two enzymes but also other parts, and neither of the CDS of those two enzyme were submitted to the registry (they were only registered as BBa_K515000 and K515001). Thus, several improvements were made based on the part K515100 to provide an available version of IAAM and IAAH.
Two pairs of primes were designed to decompose this device and gain the CDS of IAAM and IAAH
1. For IAAM
F-Prime: 5’- GGAATTCGCGGCCGCTTCTAGAGATGTTTGGACCGG-3’
R-Prime: 5’- GCGGCGGACTAGTCTTATTAGTCCCCCAGCG -3’
2. For IAAH
F-Prime: 5’- GGAATTCGCGGCCGCTTCTAGAGATGCGCGAAATG -3’
R-Prime: 5’- GCGGGCGGCGGACTAGTCTTATTAGCCTTTTAACAC -3’
Two new bio-bricks were designed based on this part using the primers above
C. Project improvement: ZJU_CHINA 2012
In the project of ZJU_CHINA 2012, the IAA producing pathway originates from Pseudomonas savastanoi was engineered into E.coli. They applied their RNA scaffold into that system in order to get a higher IAA productivity. Compared with strain without basic scaffold D0, IAA output with D0 resulted in a 1.4 fold increase (The result was permitted to be used by the team advisor of ZJU_CHINA 2012).
This year in our project, we made an improvement to that system by changing the RNA scaffold system into our TALE-based scaffold system.
The result showed a 3.2 fold increase for the TALE1-IAAM/TALE2-IAAH S2 system and a 2.5 fold increase for the TALE1-IAAM/TALE2-IAAH S3 system compared to strain without scaffold S2/S3.
Please visit our result and discussion page for details.
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domain: chemistry