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Sir Charles Brett
Solicitor and journalist who became Northern Ireland's premier architectural historian
Saturday 24 December 2005
Charles Edward Bainbridge Brett, solicitor, architectural historian, writer and public administrator: born Holywood, Co Down 30 October 1928; Partner, L'Estrange & Brett, Solicitors 1954-94, Consultant 1994-98; Chairman, Ulster Architectural Heritage Society 1968-78, President 1979-2005; CBE 1981; Kt 1990; Vice-Chairman, Arts Council of Northern Ireland 1994-98; married 1953 Joyce Worley (three sons); died Belfast 19 December 2005.
A key moment in Charles Brett's life occurred in 1956 when, at the age of 27, he was invited to join the Northern Ireland committee of the National Trust. Innocently enquiring what books he should read to fit himself for the task, he was told there were none to be had - an assertion he later found to be "substantially true". In that instant a resolve was formed in his mind to make good the deficiency himself, a resolve he carried out with the utmost thoroughness and virtuosity.
He wasted no time in getting to grips with the enterprise. People going about their business in Belfast's city centre during the late 1950s might have wondered at the occupation of a tall, fair-haired young man with a notebook and pencil, and the attention he seemed to be bestowing on buildings which everyone else either took for granted or mildly disparaged, according to the fashion of the day. In this manner - noting, recording and appreciating - Brett's great work as Northern Ireland's premier architectural historian got under way.
He started, as he said himself, just in the nick of time, as the Victorian city with its Georgian underlay fell victim to the rage for redevelopment which overtook the whole of the United Kingdom in the 1960s; and then to the additional, local depredations of "politically motivated" arsonists and bombers, once "the Troubles" had taken root. Brett's Buildings of Belfast, 1700-1914 when it was published by Weidenfeld & Nicolson in 1967, already contained much to lament, including Charles Lanyon's School for the Deaf and Dumb, and the old Lunatic Asylum on the Falls Road, demolished, as Brett has it, in 1924, "by the lunatics of Belfast".
There were three main strands to Charles Brett's working life at the time. In 1950, he had joined the family firm of solicitors, L'Estrange and Brett, and his initial architectural scrutiny of Belfast was carried out during his lunch hour. He was also a keen member of the rocky Northern Ireland Labour Party, a would-be non-sectarian organisation caught between clashing factions, and destined to fade out of Northern Irish politics (though not before Brett had successfully chaired it for a number of years). By opting for socialism, rather than Unionism, he was subscribing to a view of the world not readily attributable to someone of his background (though among his ancestors, it's true, were those of a similarly radical, anti-Unionist and even anti-clerical cast of mind).
He was born in 1928 in Holywood, Co Down, into a prominent legal family, and educated in England, at Rugby and Oxford, where he read History at New College, Oxford and was president of the Poetry Society. Then he spent a year in Paris, working as a broadcaster and journalist, and savouring the mildly bohemian pleasures of an unencumbered life abroad, before returning in 1950 to Ireland and all its provocations. Belfast, however - which he'd lumbered in his mind with a dismal backwaterish quality - he found bristling with an indigenous camaraderie and vitality. The worlds of the arts, and of trade unionism, gave him an outlet for all his gregarious, cultural and reformist tendencies.
As for the other kind of Unionism: as he says in his autobiography-cum-family-history, Long Shadows Cast Before (1978), in the face of Unionist smugness and self-satisfaction, and in view of the overbearing way the one-party state was run, there was nothing for it but to "stand outside and bung bricks at them: a duty that I performed to the best of my ability, and with relish, for the next 20 years".
In that assertion, you catch the unmistakable tones of the independent-minded, witty and forthright campaigner for social justice and improvement in every area of life with which he came in contact: someone whose raison d'être was to uphold the values of reason, tolerance and civilisation, even if it meant (as a Labour activist) getting up on a cart, or climbing the Custom House steps (Belfast's version of Speakers' Corner) to cry up the necessity for change before a sometimes unenthralled audience. He did this in order not to shirk any aspect of the socialist agenda; but (he says) "I was more at home in a committee room than on the back of . . . a lorry".
Committee rooms come into the picture, in abundance. The year 1967 saw the founding of the Ulster Architectural Heritage Society, mostly at the instigation of Charles Brett - an organisation he was still serving, as President, at the time of his death. Chairman of Hearth Housing Association, of the Northern Ireland Housing Executive, Vice-Chairman of the Arts Council of Northern Ireland. . . the list is formidable.
But the preservation of Ulster's dwindling store of architectural treasures became Brett's most cherished preoccupation, "the modest but delightful buildings with which previous generations have endowed the towns, villages and countryside"; and to the listing and evaluation of these he brought a poet's eye and a solicitor's discipline, allied to a kind of benign despotism which came into play whenever he considered that others were dragging their heels.
The last part of the 20th century was not, he noted wryly, an auspicious era for a Northern Irish conservationist. His own solicitors' office, in one of Belfast's few remaining Georgian terraces, suffered severe damage from a massive car-bomb which exploded nearby in 1972; and Brett himself was quickly among the teams of helpers, "filthy and often bleeding from scratches made by slivers of broken glass", who worked day and night to clear up the mess. The office continued in use (it is still there, under different ownership), and during the subsequent bomb scares which plagued the city, causing mass evacuation of workplaces, Brett would carry his papers out to a traffic bollard near the City Hall - a makeshift solicitor's desk.
With so much destruction taking place, the necessity to conserve what remained became even more urgent. Throughout the entire period of disruption, Charles Brett - who'd made himself into a connoisseur of the cobweb fanlight and the fluted wooden column - went on providing invaluable guides to the existing building heritage of the north. These culminated in the splendidly produced, vividly informative trio of volumes, Buildings of County Antrim (1996), Buildings of County Armagh (1999), and Buildings of North County Down (2002), in which scholarship and idiosyncrasy combine to make a sparkling effect.
Going his own way, with elegance and aplomb, Brett stood in his lifetime as an antidote to the madness, complacency and inertia which bedevilled his birthplace; and if his impatience with diehards and ditherers alike sometimes got people's backs up, the vast and eclectic nature of his circle of friends is a testament to his kindness, generosity, originality and verve. He was a delight to know.
Patricia Craig
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Arts, Entertainment & Media
May Tue 29, 2012
It may seem a small thing compared with the momentous issues that we face these days, yet the goal of 250 issues (corresponding to more than 20 years on the newsstands) reached by Nathan Never, the star of the sci-fi series of the same name published by the Italian publishing company Sergio Bonelli Editore, deserves to be celebrated, and for several reasons.First of all, this is the nth extraordinary success of the high quality craftsmanship that is the real strength of Italian small and medium-sized enterprises, of which Bonelli has always been, in his sector, a more than worthy representative. To understand the magnitude of his success, which could elude those not familiar with the area, suffice it to say that apart from Bonelli (who also published Dylan Dog and Martin Mystère) there is no other comic book series in the world that were born in the digital age that is so long-lived. There are series of longer duration, but they were all created, and are living on the income of the fame acquired when there was less competition from other media, and partly due to adult readers (oh, yes!), who often remain faithful through the decades to their youthful passion, as fans of Tex (another Bonelli product) know well, in the face of those who think that comics are only for kids.To be able to withstand the competition of the Internet and video games, for some time Bonelli has focused on high quality, not only of the drawing, which in some cases actually rises to level of real art, but also and especially of the plots, which are not limited to amazing their readers with special effects, but aim to create an entire world, and a believable world as well, not only in the sense of internal consistency, but also one with coherence with the real world (to the extent compatible with fantasy, of course). This requires a continuous and almost monstrous task of documentation by the authors, both historically and in the case of Nathan, in relation to science fiction literature, of which the "band of Sardinians" (Antonio Serra, Michele Medda and Bepi Vigna) have a truly encyclopedic knowledge that flows continuously into the series (always being revisited creatively, of course), which has, in time, reached a level of complexity that one might define a real saga, rivaling the most famous sagas of film and literature.
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Asked for a view, got it. Great staff, clean room and bathrooms, quiet hotel. Very close to the city centre, about 5 minutes walking so it was an ideal spot as you could enjoy the calm canals at night or hit the busier streets 5 mins away.
Enjoyed it.
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Top Definition
The act of doing a woman doggy style after you did a couple lines off her ass cheeks.
Billy did a couple lines off Cindy's ass then did her doggy style, what a dusty cowboy.
by Rev Phallus February 16, 2011
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Choosing simplicity with Liberté Greek.
Crafted using traditional Greek methods, the yogurt is strained according to the principles of old-time cheesecloth draining, which gives it an incredibly rich and creamy texture and one that's absolutely free of fat. No fat at all!
Requiring three times more milk than a regular yogurt, our Greek yogurt also contains twice the protein of any other regular yogurt. It's an excellent source of energy and the perfect choice for a low-fat diet.
In its simplest form, plain, it contains only two ingredients; fresh skim milk and bacterial cultures. Otherwise, having the fruit at the bottom allows to appreciate both the quality of the yogurt and the real fruit pieces. And in any case, none of our Greek yogurts contain preservatives, additives, artificial coloring or gelatine.
Strawberry & Peach and passion fruit 0%
Strawberry & Raspberry 0%
Blueberry 0%
Plain 0%
Vanilla 0%
Strawberry 0%
Vanilla Bean 5%
Plain 0% Lactose free
Black Cherry 2%
Lemon 2%
Strawberry & Banana 2%
Vanilla 0% lactose free
Coconut 2%
Lime 2%
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Vanilla 2%
Strawberry 2%
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Raspberry 5%
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Costco - Vanilla 0%
Costco - Greek 0%
What bacterial cultures do you use?
Bought for the first timer yesterday Liberte Yogurt( plain)
I don't usually buy Yogurt, glad i did. I tried this morning.Quite surprised how good it tasted on its own, i wont be adding any flavoring.I like that little taste of tartness, how delicious it tastes,now added to my list of weekly groceries.
Better late than never to discover something that good and healthy also Thank you..
What are the names of the active bacterial cultures that would be in your greek yogurt?


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What Every Groom Needs to Know: The Most Important Year in a Man's Life - eBook
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CBDReader App for iPod/iPad/iPhone
Using your iPad, you can download the CBDReader App directly from Apple's App Store.
Open the App Store, type 'CBDReader' into the search bar and press 'Search'.
Click 'install' on the CBDReader app or click the name to view more details.
You will be prompted to enter your Apple ID Password.
When the app is finished downloading, the CBDReader icon will appear on your homescreen.
Log in with your CBD account and all the eBooks you've purchased on the Christianbook.com website will be automatically added to your device.
Have questions about eBooks? Check out our eBook FAQs.
Product Information
|Format: DRM Protected ePub
Vendor: Zondervan
Publication Date: 2013
Availability: In Stock
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What Every Bride Needs to Know: The Most Important Year in a Woman's LifeSusan DeVries, Bobbie WolgemuthZondervan / 2012 / Trade Paperback$11.49 Retail:
$14.99Save 23% ($3.50)Availability: In StockCBD Stock No: WW313564
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What Every Bride Needs to Know: The Most Important Year in a Woman's Life - eBookSusan DeVries, Bobbie WolgemuthZondervan / 2013 / ePub$9.99Availability: In StockCBD Stock No: WW30262EB
The Most Important Year in a Woman's Life/The Most Important Year in a Man's Life: What Every Bride Needs to Know / What Every Groom Needs to Know Audiobook [Download]Robert Wolgemuth, Mark DeVries, Susan DeVriesZondervan / 2008 / Audio Download$19.99Availability: In StockCBD Stock No: WWDA13310-CP
What Every Groom Needs to Know: The Most Important Year in a Man's LifeRobert Wolgemuth, Mark DeVriesZondervan / 2012 / Trade Paperback$11.99 Retail:
$14.99Save 20% ($3.00)Availability: In StockCBD Stock No: WW313595
Publisher's Description
This is your guide to all the things that happen after I do.
The advice in this book to grooms is pretty simple. You dont need to become an expert on women. Only one woman. Learn the secrets to loving and cherishing her. Take an honest look at your family of origin: its unwritten codes, how it has shaped you, and the ways it affects your relationship with your wife. Learn how to speak each others language and appreciate the qualities each of you brings to your marriage.
Robert Wolgemuth and Mark DeVries offer a solid, approachable look at improving communication skills, secrets for a great sex life, budgeting basics, dealing with in-laws, navigating tough times, and much more. Above all, youll cultivate a spiritual unity that draws the two of you closer to each other as you draw closer to God.
Make this first year together as husband and wife what it was meant to be: the most important year in your life.
Author Bio
Robert Wolgemuth graduated from Taylor University (Biblical Literature) and received an honorary doctorate (LhD) from the same university in 2005. He is the author or coauthor of over twenty books, including Men of the Bible, The Most Important Year in a Mans/Womans Life, and the notes to the Dads Bible. See website: http://robertwolgemuth.com
Mark DeVries is pastor of youth and families at First Presbyterian Church in Nashville, Tennessee, where he has served for the past seventeen years. In addition to authoring several books, including Family-Based Youth Ministry and True Love Waits, he is founder of Youth Ministry Architects (www.ymarchitects.com), a strategic-planning service for churches facing transitions in their youth ministries. He and his wife, Susan, live in Nashville.
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Reducing youth disengagement: a survey of councils
5 June 2015
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Councils comment on new education Bill
4 June 2015
Cllr David Simmonds, Chairman of the LGA's Children and Young People Board, says hundreds of schools, often in disadvantaged areas, are being turned around thanks to the intervention of local councils.
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3 April 2015
Two in five council areas could still have more primary pupils ready to start school than places for them by September 2016, council leaders warn.
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Predatory men suspected of grooming children for sex could be stopped immediately if a new type of banning order was introduced by the new government, local government leaders say.
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25 March 2015
Cllr Izzi Seccombe, Chair of the Local Government Association's Community Wellbeing Board, responds to the Health Committee report published today on obesity, diet and physical activity.
We support councils in helping the children, young people and families in their areas achieve the best possible outcomes.
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More on WWE Introducing Sin Cara, Meaning of His Name, Brand Speculation
by Amish Patel - February 25, 2011
– When Sin Cara (Mistico) was introduced at WWE's press conference in Mexico yesterday, he came out in a Mistico style mask before taking it off to reveal his new WWE mask. Sin Cara reportedly means "Faceless."
WWE has setup a Facebook page for him at facebook.com/WWESinCara and a Twitter account is being setup. WWE will begin airing clips from the press conference on this week's TV and Monday's RAW. Mistico's signing with WWE is being covered my all the media in Mexico as it's considered a big deal.
Sin spoke at the press conference and said he doesn't know which brand he will end up on but said he is ready when called and proud to be working for the greatest promotion in the world. Lucha Libre journalist Kris Zellner expects Cara to end up on the SmackDown brand with Rey Mysterio and Alberto Del Rio.
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It is almost a truism that marketing has become highly technology-intensive. A nearly ubiquitous component of any marketing technology portfolio is email marketing. In fact, there is a high probability your company is already using some form of it, even though you might not be aware of it. A related component is marketing automation. Customers often talk of these in the same breath. In this article, we will look at this distinction in some detail and also summarize what marketers should know when evaluating these technologies.
Jul 14, 2006
Sony Pictures Home Entertainment and GUBA, an online multimedia entertainment site, have announced the immediate availability of more than 100 feature-length movies from Sony Pictures on the GUBA Premium online video service.
The launch makes GUBA the first video sharing community to distribute Sony Pictures movies online. Among the diverse slate of more than 100 titles that will be available for digital downloading at GUBA.com are Spider-Man 2, Underworld: Evolution, Memoirs of a Geisha, Hitch and the classic Bridge on the River Kwai. SPHE will steadily increase the number of films available for Internet sales over the coming months, with an expected 500 films, including day and date releases, being offered to consumers within a year.
GUBA users can purchase films as of today on a download-to-own basis. New releases are priced at $19.99 and catalog titles will retail from $9.99. All video content can be downloaded and played on compatible home computers. Some titles will also be available for rental on a Video-on-Demand (VOD) basis.
GUBA's service uses Digital Rights Management (DRM) copyright protection software developed by Microsoft. Only devices with current Windows Media technology can play Sony's content. This includes most Windows PCs. The Sony Pictures Home Entertainment content is only available to users in the US due to international copyright ownership restrictions Purchased videos are owned in perpetuity but cannot be burned to DVD due to current restrictions of the DRM software.
(www.guba.com; www.sonypictrures.com)


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Smith Optics 2011/12 WE TRAVEL Episode 02 Powder | snowboard
A Snowboarding video by snowboardermbm - 3,817 views
For this episode we sent our team far out into the backcountry. You will see sprays, kicker building, first tries, slams and rock-paper-scissor for starters. To shoot this episode our team riders went from Hasliberg, Suisse to Kaunertal and Arlberg in Austria all the way to the USA. The riders in order of appearance are Gian Simmen, Stefano Munari, Fabian Fassnacht, David Bertschinger Karg, Phips Gruber, Aaron Holtermann, Matthias Vogt and Mario Käppeli. Enjoy the video!
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Moon Georgia
By Jim Morekis
Seventh Edition, October 2013
Pages: 460
Price: 19.99
Price: 9.99
Savannah native Jim Morekis offers an insider's view of Georgia, whether it's playing a round of golf on Jekyll Island or hiking up the Appalachian Trail. Morekis provides unique trip ideas for all interests, including Mountains to Marsh (as well as Musical Georgia, President's Tour, and Literary Georgia). Packed with information on dining, transportation, and accommodations, Moon Georgia has options for a wide range of travel budgets. From taking the CNN Studio Tour in Atlanta to whitewater rafting down the Chattooga River to visiting the Golden Isles, Moon Georgia gives travelers the tools they need to create a more personal and memorable experience.
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HOBBY LOBBY, the craft store which challenged the Affordable Care Act's requirement and refused to pay for abortifacient drugs as part of its employee health package, has once again celebrated the Christmas holiday by placing a full-page advertisement in newspapers around the country. Their latest message was designed in-house by an employee in Hobby Lobby's art department. The advertisement, which I spotted in the Detroit News, ran on Christmas in 460 publications across the country. This y … [Read more...]
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July 1, 2014 by
Among all the hysterics following yesterday's Supreme Court ruling in favor of Hobby Lobby, it's Hillary Clinton's response that is most troubling.The potential Democratic candidate for the 2016 presidential election finds it "deeply disturbing" that craft chain Hobby Lobby and other "closely-held" for-profit companies do not have to provide contraceptives to their employees if doing so violates their religious beliefs.During a Facebook Live interview at the Aspen Ideas Festival in … [Read more...]


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First, watch this stunning video of Felix Baumgartner leaping from the edge of Earth on Sunday in a carefully orchestrated attempt to beat several skydiving records:
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(Dan Rosenstrauch/Bay Area News Group)
Five delicious noshes for that picnic basket
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(Photo by Darren Carroll/Getty Images)
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Ice-T's wife Nicole "Coco" Austin is seen in Miami Beach, Florida on June 27, 2010.
Is she a retired stripper? Me thinks so.
lol @ spelling police.
Center of gravity…
I just threw up in my mouth. What a heifer Nasty big. I would not screw that with my dogs dick!.
Wow. Someone seems to do or wear anything to get attention…I don't think she if fat though, just the small bikini makes her look that way.
Someone needs to drop a few LB's, quite a few in fact.
She might think she's the hottest woman on earth, but to be honest, she looks like Jessica Rabbit, but faker, she also looks like a hippo and those implants look disgusting, her legs are like turkey legs and I've never seen breasts like those 'BREASTS'. Gosh, she needs a reality check.
I am all for a woman who works out and takes care of her body, but really CoCo? Something just doesn't look quite right…..
somebody call an ambulance i just puked up my entire stomach.
ohhhhh yeahhhh
Looks like a manatee squeezed into a child's bikini
Work it baby.
she has greate shap of body god has given too much time to shap her figure
i'd bang her!
She´s gourgeous!, her body is a masterpiece of female beauty!. A galore of pleasure to see this pictures.
She´s gorgeous!, her body is a masterpiece of female beauty!. A galore of pleasure to see this pictures.
why didnt she just go nude? shes letting it all hang out in the open anyway…
That shit is nasty!!!!!!!!!!!!!!!!! I barfed! Why is she so blehhhhhhhhh
she is a disgust
Damn! That's gross!
Why so many gays, flatties, and fatties knocking on this hottie? The litmus test is simple: does a straight man, such as myself, get the wood when looking at this woman in such attire? Um, quick check says yes, lumber present.
Beautiful? Yes. Sexy? Certainly. Good taste? No.
I am glad, though, that here is a real woman with 'real' woman curves who is catching the public eye. While your mileage may vary, I prefer a healthy woman over these 'stick figure' types that Hollywood sells as "perfect" women.
Still not my idea of perfection. I just don't care for blondes…
Come on she is beautiful i am not gay or bisexual but i think she is beautiful who ever doesn't like it, then don't watch the photos!!
are you Kiki from Bison N.Dakota?? jerry
Looks like a super stripper with way too much plastic surgery. I love woman, but the huge fake ass and titties is a bit overboard. She might pop if touched.
OMG :o
Oh my god we have them on the westcoast of fla wecall them manatee's, comon why show that??
oh my god we have them on the west coast of fla we call them Manatees' why do you put pic like this out their,, common roll it back in the water before it dies,, ice tea,, f–n loser
It Looks to me like her snatch ate the Front Of Her Bathing Suit
style is so hot and sexy i like this
I don't care about her weight…it's fine. But her breasts! They make her look gross. They say confidence is sexy, and I agree, but she looks confident here…and still disgusting.
From the top up, great, but from the waist down, would someone please call Jennie Craig on her PLEASE!!!! Thunder thighs from hell & needs to lose 20 lbs. of fat from her ass & thighs!!
Ok.. I think it is gross that she has on a bikini that is only fit for a porno and not public, obviously she doesn't respect herself, but i'm confused on why people are calling her a hippo, she looks like she's in great shape and her thighs are a little thick because of muscle not fat.
Hehehe, her boobs are giving her shade to her lower half of her body…
That is the grossest thing I have seen all day, and I always examine my bowel movements.
I don't know why, but this just looks so nasty to me..I mean seriously, if you got a body that's ok. But don't be exposing yourself like that. Like where is your self respect as a female. Females like her that give WOMEN like me a bad name.
WHAT !!!!! >.< WTF is goin on earth !!!!
(Who brought the panda to the beach ??!! )
hi ;)
Extremely thick, muscular and curvy-mostly naked woman. And? I personally wouldn't show so much, but I am not Coco. I am not going to hate on her, either. She is rich, confident, and happy with herself. Can all here that are cutting on her say that?
she is not naturally this way. i'm all for curvy women, i am one myself, but she certainly does not look like a 'real woman'. she has artificially enhanced her body to ridiculous proportions and it looks so wrong. i just find that all natural curvy women are far more attractive – this is just silly, and she's done that to herself. madness.
That is is just so nasty, cover up COCO, you ain't that great, you look like you bought the wrong size bathing suit, you'r just gross, nasty, nasty, nasty, GROSS!!!!!!!!!!!!
Too big and too nasty! Bigger isn't always better sometimes less is more.
Anyone saying eww is either gay or jelous. Coco is incredibly hot her curves are nothing but amazing.
I needed to thank you for this wonderful read!! I absolutely enjoyed every bit of it. I have you saved as a favorite to check out new stuff you post…
do you think she would look as good without implants?? Would guys think her body was good without implants??
Wow….she looks incredibly sexy! Any true heterosexual man would kill to hit that ass. Not to be so crude but it is true, that is what we really like. I used to be embaressed and wouldn't say to my friends openly that I liked thick curvy women like CoCo or Kim Kardashian or Nikki Minaj or Christina Hendricks (just giving examples so you understand) because I thought they would laugh at me and say I liked fat girls because theyd all talk about how hot Mila Kunis is or Meghan Fox & I would just sit there and nod agreeing like an idiot because I was afraid to be myself. Then somebody would bring up some girl from school or work that was exactly my type and theyd ask what I thought & I'd lie and say "eww shes fat, maybe if she lost weight" and theyd all look at me weird and say oh really? I think shes wicked hot, shes one of those girls that is a little thick that are so friggin hot & they'd all agree and think I didn't. So I'd sit there mad, stewing in my own mind unbeknownst to them that she is the exact girl I like and have liked since I saw her and now they think I'm the exact opposite of what I am b/c I was afraid of getting laughed at but now I'm being the odd one out which is the whole reason I lied to avoid being in that exact predicament. Thats happend a few more times throughout my life until I decided enough was enough, I like who and what I like and thats just how it is and who I am. Sure enough when I was open about liking curvy girls and not caring that much for thin skinny models who are gross, my friends didnt think I was weird or laugh at me at all. Matter of fact they all would come out here or there and say they knew exactly what I was talking about and how girls of that type are really sexy and that every guy likes that once in a while. The fact I was afraid and lied about it just showed before how ignorant & clueless I was about what other men thought and felt about women. I thought because skinny girls covered all of the magazines and runways, not to mention on the covers of playboy and female leads in movies that every guy liked that and that it was the complete norm for straight men. To like girls of any bigger size and you were a "chubby chaser"….but those fears were unwarranted and true straight guys will get it and agree, those who don't are either secretly gay & pretending to be straight and thats why they dont get what authentic straight men like or they were like me and lying to escape redicule OR they are one of those few out there with an actual fetish for skinny types. Aside from the 1950's, today is the best time to be somebody like me who likes thick women. The media has begun to embrace the trend with voluptuous women now being the ones on magazines, tv & movies (still not the runways but thats b/c most fashion designers & makeup artists for models & agents are usually gay men who tend to think skinny thin as a thread women are attractive because they have the same figure as a teenage boy). Society is beginning or has already begun to accept voluptuous women & women themselves have started to embrace their own bodies and no longer are obsessed with hiding their curves and losing weight to be like the anorexic runway models who are not attractive at all. With leading actresses in the movies & TV like Scarlett Johanssen, Christina Hendricks, Salma Hayek & musicians like Nikki Minaj & whatever Kim Kardashian is famous for (sex tape? reality tv? being rich? who knows?) we now have women who look real or at least more real than the ones we had before. I'm glad to have our times being more accepting to looks, as well as diversity in sexuality & attractions. It isn't just about me having a thing for voluptuous women & being able to see them in movies & tv when before it was rare, it is about people accepting what they feel, WHO they ARE & NOT being afraid of how we look or what we feel. Not having to look in the mirror and be ashamed of what you look like or afraid to go outside because you don't fit societies picture of perfection you are expected….nay, demanded to be…it's about humanity accepting its own humanity and not trying to put on a mask and throw out this false perception of who & what we truly are and honestly feel. Nobody should be made to feel ashamed of what they look like, wether fat, short, tall or even skinny, or what race they are nor ever be ashamed of their sexual desires wether they are homosexual, bisexual, heterosexual, asexual and everything & fetish in between. Acceptance, Understanding, Tolerance, Equality, Enlightenment, Humanity…..these are the exemplars for our time and our society…NOT American society or British society or Japanese society, but for Human society, our people as a whole. Sure, it is probably far fetched of me to think of such goals as achievable in our lifetimes but one must at least have hope, our future, our tomarrow gives us hope and without hope we might as well give up already. I know this is a bit preachy just for a comment about CoCo in a bikini but one thing leads to another and thats how the world evolves….
These pics are nasty…in my opinion. I have a nice body and figure and cute face…not jealous of a female that looks like a tranny…SORRY
ooooooooooooooooooooooooh my god, can't believe it…
Elizabeth Olsen totally had a Marilyn Monroe moment. …
Summer is upon us and that could only mean one thing: Swimsuit season is finally here.
Caitlyn Jenner is giving thanks for the freedom to be herself on this very special Independence Day.


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There is a need for reliable and valid measures of cultural competence from the patient's perspective.
This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) item set.
Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using Cronbach alphas, and examined the validity of the measures using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis.
A random stratified sample (based on race/ethnicity and language) of 991 enrollees, less than 65 years old, from two Medicaid managed care plans in California and New York.
CAHPS CC item set after excluding screener items and ratings.
Confirmatory factor analysis (CFI= 0.98; TLI= 0.98; RMSEA= 0.06) provided support for a seven-factor structure: Doctor Communication-Positive Behaviors; Doctor Communication-Negative Behaviors; Doctor Communication-Health Promotion; Doctor Communication-Alternative Medicine; Shared Decision Making; Equitable Treatment; and Trust. Item--total correlations (corrected for item overlap) for the 7 scales exceeded 0.40. Exploratory factor analysis showed support for one additional factor: Access to Interpreter Services. Internal consistency reliability estimates ranged from 0.58 (Alternative Medicine) to 0.92 (Positive Behaviors), and was 0.70 or higher for four of the eight composites. All composites were positively and significantly associated with the overall doctor rating.
The CAHPS CC 26-item set demonstrates adequate measurement properties, and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient's perspective.
Among the strategies that have been advocated for reducing racial/ethnic differences in patient experiences is the provision of "culturally competent" care.1, 2 The National Quality Forum (NQF) (p. 2) recently defined cultural competency as the "ongoing capacity of healthcare systems, organizations, and professionals to provide for diverse patient populations high-quality care that is safe, patient and family centered, evidence based, and equitable."3
Based on the NQF definition, patient-centered care is one of the major elements of cultural competency. The Institute of Medicine (p. 3)4 defined patient-centered care as "care that is respectful and responsive to individual patient preferences, needs, and values…" McWhinney5 described patient-centered care as being able to see through the patient's eyes. Thus, the patient's perspective on the care that he or she receives is an essential barometer of culturally competence care.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) project has resulted in a set of standardized survey instruments that can be used to collect reliable information from patients about the care they have received. These evaluations provide important information about how well providers meet the needs of the people they serve.6 For example, the CAHPS Clinician and Group (C&G) Surveys assess patients' experiences with health care providers and staff in doctor's offices. The CAHPS C&G core survey contains 13 items measuring 3 domains of performance: timeliness of care, provider communication, and staff helpfulness. In addition it has one global rating for provider.7
CAHPS data have been used to assess racial/ethnic and language differences in patient experiences with care.8-12 However, there are concerns that the CAHPS instrument does not fully capture domains of care of particular relevance to diverse populations, such as trust, perceived discrimination, shared decision making, and access to language services.1 To address this gap, the CAHPS team developed an item set to assess aspects of cultural competency not adequately addressed in the existing CAHPS surveys, which could serve as a supplemental item set to the CAHPS Clinician & Group surveys. The purpose of this study is to evaluate the internal consistency reliability and validity of the CAHPS Cultural Competence (CC) item set. The psychometric analysis by survey language (English/Spanish) is reported elsewhere.13
Guided by Bethell et al.'s14 conceptual model of measuring health care quality among diverse populations and a comprehensive literature review on diverse populations in the U.S., we developed a framework for obtaining the patient's perspective on culturally competent care.1 In this framework, health care is experienced by the patient in the context of interactions with providers within the health care system. Therefore, there are three factors that affect the quality of care for diverse populations: patient factors, provider factors, and health care system factors. The framework focuses on the areas where the three factors overlap (Figure 1). The first two domains reflect interactions between the patient and the provider: 1) Patient-provider communication; 2) Respect for patient preferences/ shared decision-making. The other four domains include patient and provider interactions, but also include interactions with other staff and the health care system overall: 3) Experiences leading to trust or distrust; 4) Experiences of discrimination; 5) Health literacy strategies; and 6) Language services. These six domains are best measured by patient assessments as opposed to organizational or provider assessments. There are other domains of quality care that are important, such as Access (ability to get timely care) or Coordination of Care (between different providers and health care settings.) However, because these domains of quality care have been extensively examined as part of patient-centered care, we chose not to include them within the scope of this study. Furthermore health literacy was not included as one of the domains of CAHPS CC item set because it was the focus of a separate project (CAHPS Health Literacy item set).15
We summarize below our literature review on five of the cultural competence domains. We focused specifically on empirical studies that included diverse populations (African Americans, Hispanics/Latinos, Asians and Pacific Islanders, or American Indians). We also only included studies conducted in the United States, as the healthcare systems and experiences in other countries may be very different and thus, not generalizable to the US.
Communication in the medical interaction plays a central role in decisions about subsequent interventions, and can influence patient adherence, satisfaction with care, and health outcomes16. Some racial/ethnic groups and those of lower socioeconomic status are more likely to report poor communication with their physicians17,18 Providers' non-verbal and interpersonal communication behaviors have been found to be particularly important for diverse patient populations. For example, Hurtado et al.19 found that empathy and establishing rapport (as opposed to just providing health information) were more important to minority patients than to White patients. Similarly, African American, Hispanic, and Asian patients were found to rate the provider's display of "concern, courtesy, and respect" as the most important factor in the interaction.20, 21 Finally, studies have found that listening and spending adequate time are especially important for Asian22 and Hispanic patients.23
While the CAHPS C&G surveys include provider communication as a core measure, this measure focuses on the behavioral aspects rather than the content of communication. One important content area is communication about complementary and alternative medicine (CAM).1 CAM refers to diverse practices and products that are not currently considered part of conventional medicine.24 An estimated 26 percent of African Americans, 28 percent of Hispanics, 36 percent of non-Hispanic whites, and 43 percent of Asian Americans use CAM.25 It is important for patients to discuss their use of CAM with their medical practitioners. Some therapies, such as herbal or vitamin therapies, may cause adverse events or interfere with medical regimens. Furthermore, knowledge of patients' CAM practices can provide valuable insight into patients' values, lifestyles, and health beliefs, which may, in turn; assist practitioners in providing optimum care.26, 27 Yet, in a national survey of U.S. adults, 70 percent of patients who used CAM reported that their providers did not discuss CAM use with them.24, 28
Another content area of particular importance to diverse populations is communication about health promotion. Racial/ethnic minorities suffer disproportionately from chronic diseases, such as diabetes and heart disease.29 As such communication about diet and exercise are particularly important for prevention in promoting a healthy life style among diverse patient populations. Similarly, racism and discrimination places minorities at higher risk for depression and anxiety.30 Yet minorities are less likely to receive treatment for depression than Whites.31 Communication about stress and depression with diverse populations can help reduce disparities in care.
The Institute of Medicine encourages providers to respect patients' preferences and promote their active participation in clinical decision-making to the extent that patients' feel comfortable and are willing to take part.4 Patients may participate in their care in a variety of ways, which includes having meaningful dialogue about their preferences, knowing all the available options, and making final decisions about treatment.
A report by the Agency for Healthcare Research and Quality (p. 122)17 noted that "Blacks, Asians, Hispanics, and low income populations are more likely to feel disenfranchised in the decision-making process." Compared with Whites, African Americans and Asians were more likely to report under-involvement in the health care decision-making process (e.g. 22% of Whites, versus 27% of African Americans and 42% of Asians reported that they were "not as involved as they would like to have been"). Similarly, Hispanics were more likely than non-Hispanic Whites to report feeling disenfranchised (34% vs. 21%), and low-income populations were more likely than higher-income populations to report this (30% vs. 20%).18
Patient's trust is an important element of the health care encounter. Thom et al.32 found that patients with lower levels of trust were less likely to adhere to their physician's advice, and were more likely to report not receiving the services they requested or needed. Similarly, patients with lower levels of trust have reported lower levels of satisfaction with the patient-provider relationship.32
Several studies have observed lower levels of patient trust among racial and ethnic minorities.33-36 Using data from a national sample of adults, Hunt et al. (2005)33 reported that African Americans and Latinos were less trusting and less satisfied with their physicians than Whites. Similarly, LaVeist et al.36 found that African Americans were significantly more likely than Whites to report mistrust of the medical system, and those who reported greater mistrust of the medical care system were less satisfied with their care.
According to the Institute of Medicine,37 discrimination is differential treatment based on race, ethnicity, gender or other individual attribute. Racial bias or discrimination in the practice and delivery of healthcare may be at least partly responsible for the observed racial and ethnic health disparities.38 Prior research has found that perceived discrimination is associated with various negative health outcomes. Perceived discrimination has also been found to have a negative effect on satisfaction with care.39-41 For example, a study of the California Health Interview survey found that patient perceptions of discrimination based on race or ethnicity were associated with lower ratings of health care quality.40 Similarly, Hausmann et al.41 found that perceived racism was associated with low patient ratings of provider warmth/respectfulness, and ease of communication. Finally, Weech-Maldonado et al. found that Medicaid beneficiaries in Florida who perceived discrimination based on race/ethnicity and insurance reported lower CAHPS scores.42
According to the 2000 census, approximately 47 million people in the U.S. speak a language other than English at home and over 21 million are Limited English Proficient (LEP)43 Previous research has shown that non-English patients have worse access to care 44-47 and report lower ratings of care than English-speaking patients.9, 10, 12, 48, 49
The limited supply of bilingual providers has led health care organizations to use interpreter services to bridge language gaps. When examining the impact of language services, it is important to distinguish between professional interpreters and ad-hoc interpreters. Ad-hoc interpreters are individuals whose primary job function is something other than interpretation and includes clinic staff as well as the patient's family members and friends.50 On the other hand, professional interpreters receive specialized training on medical interpretation and their main function is interpretation.50 This includes in-person interpretation, third party interpretation and remote, third party interpretation using technology (e.g. using telephone or video). Professional interpreters have been shown to reduce barriers to care among LEP patients.51, 52
The CAHPS CC was designed to assess five domains of cultural competence: Patient-provider communication; Respect for patient preferences/ shared decision-making; Experiences leading to trust or distrust; Experiences of discrimination; and Language services. The survey development involved five steps: 1) Evaluating existing CAHPS surveys to identify existing items that addressed the domains of interest; 2) Conducting a literature review in order to identify existing instruments or item sets that had been used in the past to collect data on cultural competency from the patient's perspective; 3) Placing a Federal Register notice with a call for measures; 4) Reviewing and adapting existing measures in the public domain; and 5) Writing additional survey items as needed for each of the proposed cultural competency domains.
Each of these steps was conducted collaboratively by members of the CAHPS Cultural Comparability Team, a sub-team of the CAHPS Consortium that includes health researchers experienced in survey development and testing, psychometrics, and translation and cultural adaptation of survey measures. The review of the literature and the various CAHPS surveys yielded over 90 survey items related to the domains of interest for the CAHPS CC. This included survey items that could be adapted from other CAHPS Surveys, such as the CAHPS In-Center Hemodialysis Survey and the CAHPS American Indian Survey, as well as various surveys that are in the public domain (for example, the National Health Interview Survey, the California Health Interview Survey, the Child Hospitalization Communication, Quality and Safety Survey, Hablamos Juntos, the Commonwealth Fund's Survey on Disparities in Quality of Healthcare, and the Primary Care Assessment Survey). Only one measure submission was received in response to the Federal Register Notice. The survey development team mapped each of the items that was identified through the literature and survey review to the domains of interest and adapted measures that best captured the domains of interest by rewording the items so that they would include a 12 –month reference period, the same language in referencing the provider as utilized in other CAHPS measures, and response options that were consistent with the other CAHPS measures.
The CAHPS CC item set was translated into Spanish using the Agency for Healthcare Research and Quality's (AHRQ) Guidelines for Translating CAHPS Surveys.53 First, two independent American Translators Association's (ATA) certified translators conducted two forward translations of the survey into Spanish. Translators were instructed to aim for a 6th grade reading level or lower. Second, a committee formed by the two translators and members of the CAHPS Cultural Comparability team reviewed the translations and reconciled the differences. The review committee had representation from different Spanish subgroups in the US, such as Mexican, Puerto Rican and South American.
Next we conducted 18 semi-structured cognitive interviews (9 in Spanish and 9 in English) with scripted probes in Los Angeles, Boston, and Chapel Hill, North Carolina. Recruitment for the cognitive testing was aimed at getting a mix of respondents in terms of age, race/ethnicity, gender, and level of education. Based on the findings of the cognitive interviews, the instrument was revised and a final 44-item set was available for field testing.
A field test of the CAHPS CC survey was conducted with a stratified random sample of 6,000 adult (18 years and older) enrollees of two Medicaid managed care plans, one in New York (3,200) and the other in California (2,800) in 2008. We chose New York and California for the field test given the diversity of their population. The stratified sample based on race/ethnicity and preferred language was drawn using the health plans' administrative data: 1,200 non-Hispanic White English speakers, 1,200 non-Hispanic Black English speakers, 900 Hispanic English speakers, 900 Hispanic Spanish speakers, 900 non-Hispanic Asian English speakers, and 900 non-Hispanic Asians with a preferred language other than English. Health plan enrollees 65 years and older were not included in the sample, since this population is generally dually eligible (Medicare and Medicaid) and their health care experiences may be different than those with Medicaid as their primary insurer.
The survey consisted of a 2-wave mailing with follow-up telephone interview of non-respondents. The first mailing included an English survey and a cover letter in English and Spanish. The letter directed Spanish speakers to call an 800 number to request a copy of the survey materials in Spanish. Four weeks after the initial mailing, a second survey packet was mailed to non-respondents. Telephone follow ups in English and Spanish started 2 weeks after mailing the second survey packet. A monetary incentive of $10 was offered to non-respondents after the second call attempt. A 26% response rate (n=1,380) was achieved with the multi-pronged approach. After excluding individuals that did not have a personal doctor or a doctor visit during the last 12 months, the final analytic sample consisted of 991 respondents.
The analysis focuses on the CAHPS CC 27-item set after excluding screener items and ratings. Psychometric analysis was used to assess the internal consistency reliability and validity of the CAHPS CC scales. First, exploratory factor analysis (EFA) with varimax rotation in both SAS and Mplus was used. 54 The number of factors retained was determined by a combination of criteria: (1) the roots criterion of selecting factors with eigenvalues to be greater than 1; (2) the scree plot to examine the point at which the plot of eigenvalues begins to level off; and (3) the interpretability of factors based on the conceptual framework.55 The language services items were factor analyzed separately, since the items only applied to a small subset of respondents, those with limited English proficiency (LEP) and who had used an interpreter (N= 76). LEP respondents were identified as those for which English was not their primary language and who spoke English not well or not at all.
Second, confirmatory factor analysis (CFA) was conducted of the CAHPS CC scales derived from the exploratory factor analysis using Mplus We used fit index levels for Root Mean Square Error or Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker Lewis Index (TLI) as identified by the literature.56 Mplus accounted for the ordinal nature of the response options.57
Third, multitrait scaling analysis was used to assess item discrimination across scales.58 Multitrait scaling generalizes multitrait-multimethod analytic methods from the trait level to the item level. In doing so, it allows the user to investigate convergent and divergent validity at the item level.
Fourth, we used Cronbach's alpha to estimate scale internal consistency reliability. Cronbach alphas were estimated for the overall sample.
Finally, the convergent validity of the CAHPS CC scales was assessed. Regression analyses were conducted to examine the associations between the CAHPS CC composite scores and the overall doctor rating item, controlling for race/ethnicity, gender, age, education, self-rated health status, and language of the survey (Spanish vs. English). Separate regression models were run for each CAHPS CC composite. The CAHPS global rating (0-10) for personal doctor, where 0= worst possible doctor and 10= best possible doctor, was linearly transformed to a 0-100 possible range (i.e., multiplied by 10). The CAHPS CC composite scores were calculated by linearly transforming items to a 0-100 possible (with a higher score representing more favorable scores), and then averaging items within each composite. Negatively worded items were rescored to show a positive scale. Self-reported race/ethnicity consisted of non-Hispanic White, Hispanics, non-Hispanic Black, non-Hispanic Asian, and Other. The gender item asked whether the respondent is male or female. Age consisted of five categories: 18-24, 25-34, 35-44, 45-54, and 55-64. Education consisted of five categories: 8th grade or less, some high school but did not graduate, high school graduate or GED, some college or 2-year degree, 4-year college graduate or higher. Self-reported health status asked respondent to rate their overall health: excellent, very good, good, fair, and poor. Finally, Spanish survey is a dummy variable that identifies whether or not the survey was completed or administered in Spanish.
Descriptive statistics for the analytic sample are presented on Table 1. Hispanics were the largest racial/ethnic group (34%) in the sample, while non-Hispanic Whites and Blacks had the smallest representation with 15% each. Approximately 30% of respondents rated their health as fair or poor. The majority of the sample was female (67%) and younger than 44 years old (52%). A significant proportion of respondents (31%) had less than high school graduation or GED. Finally, 12% of respondents completed a Spanish survey.
A comparison of respondents and non-respondents based on gender, age, race/ethnicity, primary language, and health plan affiliation showed only a few significant differences. Respondents were more likely to be White (24% versus 20%) and older (39 versus 36 years, and less likely to be Black (18% versus 22%) compared to non-respondents. There were no significant differences between respondents and non-respondents in terms of gender, Hispanic or Asian ethnicity, preferred language, or health plan affiliation.
A seven-factor structure was obtained based on EFA (eigenvalues > 1 and scree plot) and guided by the conceptual framework: Doctor Communication-Positive Behaviors (5 items); Doctor Communication-Negative Behaviors (3 items); Doctor Communication-Health Promotion (4 items); Doctor Communication-Alternative Medicine (2 items); Shared Decision Making (2 items); Equitable Treatment (2 items); and Trust (5 items). CFA (CFI= 0.98; TLI= 0.98; RMSEA= 0.06) provided support for the seven-factor structure: Item--total correlations (corrected for item overlap) were higher than 0.40 for all the multi-item scales (Table 2). The eight domains of the CAHPS CC match closely those of the initial conceptual framework, except that Provider Communication is further divided into four different scales based on both behavioral aspects (positive and negative behaviors) and content (health promotion and alternative medicine) of communication.
Exploratory factor analysis (eigenvalue > 1) of the language services items (4 items) provided support for a one-factor structure for Access to Interpreter Services. Factor loadings were higher than 0.40 except for one item (how often did the interpreter you had most often at this doctor's office treat you with courtesy and respect). This item was dropped from the Access to Interpreter Services resulting in a 3-item scale: 1) Did you use friends or family members as interpreters because there was no other interpreter available at this doctor's office?; 2) How often did your visit with this doctor start late because you had to wait for an interpreter?; and 3) Was there any time when you needed an interpreter and did not get one at this doctor's office?
Means, standard deviations, and Cronbach's alphas for each of the multi-item scales are shown on Table 3. The lowest CAHPS CC scores were observed for Doctor Communication-Alternative Medicine (Mean= 12.1), Doctor Communication- Health Promotion (Mean= 49.1) and Access to Interpreter Services (Mean= 76). Internal consistency reliability estimates were 0.60 or higher for seven of the eight composites, and was 0.70 or higher for four of the seven composites. The two-item Doctor Communication-Alternative Medicine scale had the lowest internal consistency reliability of 0.58.
All CAHPS CC composites were positively and significantly associated with the overall doctor rating (Table 4). The largest unique association was observed for Doctor Communication-Positive Behaviors (B = 0.71) with a 10 point increase (p < 0.001) in this composite resulting in a 7.1 point increase in doctor rating (0-100 scale). The smallest effect was observed for Access to Interpreter Services (B =0.08) with a 10 point increase (p < 0.10) resulting in a 0.8 point increase in doctor rating. The relatively small effect of Access to Interpreter Services may be due to the small sample size for this regression, since this scale was only applicable to those with limited English proficiency (LEP) and who had used an interpreter (n=76).
Among the strategies that have been advocated for reducing racial/ethnic differences in patient experiences with care is the provision of "culturally competent" medical care. This study provides support for the psychometric properties of the CAHPS CC item set in general, especially for the English survey. Our results suggest that the 26-item set measures eight separate domains (Doctor Communication-Positive Behaviors (Provider Communication core measure in the CAHPS C&G Survey); Doctor Communication-Negative Behaviors; Doctor Communication-Health Promotion; Doctor Communication-Alternative Medicine; Shared Decision Making; Equitable Treatment; Trust; and Access to Interpreter Services) rather than a single "cultural competence" construct (Appendix 1). Cultural competence is a multi-dimensional concept. Creating individual scales based on these items that correspond to each domain provides a rich set of items that can be used to supplement the CAHPS Health Plan and Clinician and Group survey instruments.59
There is the possibility that the multiple factors we observe may reflect "nuisance" factors rather than substantively meaningful factors. A bi-factor analysis can be used to explore whether a multidimensional model or unidimensional (bi-factor) model best represents the measurement structure of the data. Bifactor models posit that a unidimensional factor (e.g., cultural competence) accounts for the covariance among item responses, but that one or more "nuisance" or "group" factors also exist. Group factors can result from patterns in survey questions, such as common content (e.g., repeated questions about a similar topic) or common methodology (e.g., questions with similar stems). A multidimensional factor structure consists of meaningful and separate factors. If the bifactor model fits better than the multidimensional model, one would generally choose the bifactor model over the multidimensional model. In a separate study by Carle and Weech-Maldonado,60 we use bi-factor analysis to provide support for the multidimensional model and the use of separate CAHPS CC scales.
The lowest CAHPS CC mean scores were observed for Doctor Communication-Alternative Medicine, Doctor Communication- Health Promotion, and Access to Interpreter Services. These are domains of particular relevance to racial/ethnic minorities. Doctor communication on alternative medicine and health promotion is crucial when caring for diverse populations. Racial/ethnic minorities have greater use of alternative medicine, and tend to engage less in health promotion behaviors. Access to interpreter services is important for patient communication particularly as the population becomes more linguistically diverse. Policymakers and health plans should incentivize providers to engage in these types of behaviors.
While our results suggest that all CAHPS CC measures are positively associated with CAHPS doctor ratings, there are three scales that are most strongly associated with doctor ratings: Provider Communication- Positive Behaviors, Provider Communication-Negative Behaviors, and Trust. Health care organizations wanting to improve their CAHPS ratings can implement quality improvement activities to address CAHPS CC domains, with a focus on the behavioral aspects of communication and trust.
The study presents several limitations. First, the study was limited to a Medicaid managed care population. However, a recent study by Stern and colleagues tested the CAHPS CC with an uninsured/underinsured patient population with type 2 diabetes, and provided support for the model reported here.61 Further research is needed testing these measures with other insured populations such as Medicare and commercial. Second, due to resource limitations, the survey was only translated into Spanish. Translation into other languages as well as research examining the measurement equivalence of CAHPS CC in other languages is needed. Third, we did not have any provider identifiers. Therefore, we were not able to assess the inter-rater reliability of the measures at the provider or practice level. Future studies are needed to examine the inter-rater reliability of the CAHPS CC measures, as well as the temporal stability of the measures. Finally, the survey had a relatively low response rate. This may have resulted in potential response bias. Respondents were less likely to be Black, but there were no significant differences between respondents and non-respondents in terms of gender, Hispanic or Asian ethnicity, or preferred language. Despite these limitations, the CAHPS CC item set can serve as a tool to measure culturally competent care from the patient's perspective.
This project has been funded in part by Commonwealth Fund Grant # 20060692. Robert Weech-Maldonado was supported in part by the UAB Center of Excellence in Comparative Effectiveness for Eliminating Disparities (CERED), NIH/NCMHD Grant 3P60MD000502-08S1. Adam Carle was partly supported by 1R15NR010631 (NIH/NINR) and U01 AR057940-02S1 (NIH/NIAMS). Ron Hays was supported by a cooperative agreement from the Agency for Healthcare Research and Quality (U18 HS016980), the national Institute on Aging (P30AG021684), and NCMHD (2P20MD000182). This work was conducted while Quyen Ngo-Metzger was at the University of California, Irvine. The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of the department or agency names imply endorsement by the U.S. Government.
|Survey Item
|Response Scale
|Doctor Communication-Positive Behaviors
|1. In the last 12 months, how often did this doctor explain things in a way that was easy to understand?
|2. In the last 12 months, how often did this doctor listen carefully to you?
|3. In the last 12 months, how often did this doctor spend enough time with you?
|4. In the last 12 months, how often did this doctor show respect for what you had to say?
|5. In the last 12 months, how often did this doctor give you easy to understand instructions about taking care of these health problems or concerns?1
|Doctor Communication-Negative Behaviors
|6. In the last 12 months, how often did this doctor interrupt you when you were talking?
|7. In the last 12 months, how often did this doctor talk too fast when talking with you?
|8. In the last 12 months, did this doctor ever use a condescending, sarcastic, or rude tone or manner with you?
|Yes, Definitely
|Yes, Somewhat
|Doctor Communication-Health Promotion
|9. In the last 12 months, did you and this doctor talk about a healthy diet and healthy eating habits?
|Yes, Definitely
|Yes, Somewhat
|10. In the last 12 months, did you and this doctor talk about the exercise or physical activity you get?
|Yes, Definitely
|Yes, Somewhat
|11. In the last 12 months, did you and this doctor talk about things in your life that worry you or cause you stress?
|Yes, Definitely
|Yes, Somewhat
|12. In the last 12 months, did this doctor ever ask you whether there was a period of time when you felt sad, empty or depressed?
|Doctor Communication-Alternative Medicine
|13. In the last 12 months, has this doctor ever asked you if you have used these other people to help with an illness or to stay healthy (for example, acupuncturist or herbalist)?
|14. In the last 12 months, has this doctor ever asked you if you used natural herbs?
|Shared Decision Making
|15. In the last 12 months, did this doctor talk with you about the pros and cons of each choice for your treatment or health care?2
|16. In the last 12 months, when there was more than one choice for your treatment or health care, did this doctor ask which choice you thought was best for you?
|Equitable treatment
|17. In the last 12 months, how often have you been treated unfairly at this doctor's office because of your race or ethnicity?
|18. In the last 12 months, how often have you been treated unfairly at this doctor's office because of the type of health insurance you have or because you don't have health insurance?
|19. Do you feel you can tell this doctor anything, even things that you might not tell anyone else?
|20. Do you trust this doctor with your medical care?
|21. Do you feel this doctor always tells you the truth about your health, even if there is bad news?
|22. Do you feel this doctor cares as much as you do about your health?
|23. In the last 12 months, how often did you feel this doctor really cared about you as a person?
|Access to Interpreter Services
|24. In the last 12 months, did you use friends or family members as interpreters because there was no other interpreter available at this doctor's office?3, 4
|25. In the last 12 months, how often did your visit with this doctor start late because you had to wait for an interpreter? Do not include friends or family members.
|26. In the last 12 months, was there any time when you needed an interpreter and did not get one at this doctor's office? Do not include friends or family members.
Robert Weech-Maldonado, Department of Health Services Administration, University of Alabama at Birmingham, 1675 University Boulevard, 520 Webb, Birmingham, AL 35294, Phone: (205) 996-5838, Fax: (205) 975-6608, Email: rweech/at/uab.edu.
Adam Carle, University of Cincinnati School of Medicine, 3333 Burnet Avenue, MLC 7014, Cincinnati, OH 45229, Phone: (513) 803-1650, Email: adam.carle.cchmc/at/gmail.com.
Beverly Weidmer, RAND, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, Phone: (310) 393-0411, x6788, Email: Beverly_Weidmer/at/rand.org.
Margarita Hurtado, American Institutes for Research (AIR), 10720 Columbia Pike- Suite 500, Silver Spring, MD 20901, Phone: (301) 592-2215, Email: mhurtado/at/air.org.
Quyen Ngo-Metzger, University of California, Irvine, Department of Medicine, University of California, Irvine School of Medicine, 100 Theory Drive, Suite 110, Irvine, CA 92697-5800, Phone: (301) 443-8894, Email: Qngo-metzger/at/hrsa.gov.
Ron D. Hays, University of California, Los Angeles, Department of Medicine, 911 Broxton Avenue, Room 110, Los Angeles, CA 90024, Voice: (310) 794-2294; Email: drhays/at/ucla.edu.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's Canada Institute for Scientific and Technical Information in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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A Sandusky man allegedly stole a woman's car and dog Wednesday, then led officers on a car chase Thursday afternoon before surrendering himself and the pooch.
Gregory Young, 51 of the 1100 block of W. Market St., was charged with unauthorized use of a motor vehicle, failure to comply with a police order, theft, operating a vehicle under the influence, resisting arrest, a protection order violation, marijuana possession, drug paraphernalia, open container, and driving under suspension.
Young had asked a Hancock Street woman if he could listen to music in her car Wednesday and she obliged. But soon, the woman noticed both he and her Yorkie, Prince, were gone.
Young assured the woman he'd be right back — but day faded into night, faded into morning, and still Young and Prince weren't back.
Worried, the woman filed a police report around 9 a.m., with Sandusky officers issuing a theft warrant for the dog, and an unauthorized use warrant for the vehicle.
A few hours later, Officer Sean Orman spotted Young —and the Yorkie— in the missing Pontiac Torrent at Washington and Perry streets, according to a Sandusky police report.
Orman flipped on his lights, but Young allegedly kept driving.
From Washington Street he turned onto Warren Street, then Madison, Elm, and Monroe streets, the report said.
Another officer tried stop Young at the intersection, but Young slid on by and continued on, traveling the speed limit and obeying all stop sign.
He drove down Wayne Street, then turned on Scott. Officer swarmed the Pontiac once it reached the Milan Road light, the report said.
Young allegedly refused to exit the car and resisted arrest.
A search of his pockets and the car later yielded three bags of marijuana, an open can of beer and bottle of liquor, and two bags of suspected crack.
Young was held at the Erie County jail on a $28,000 bond.
Prince was returned to his owner, safe and sound.


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text:
This week, Zoosk mourns the passing of Robin Gibb, with one of his most romantic songs, reminding us all what it's like to love somebody.
The Adobe Flash Player is required for video playback.Get the latest Flash Player or Watch this video on YouTube.
More From alexatzoosk:
Last Minute Valentine's Day Gifts: Go Big Without Going Broke
Zoosk Success Stories: Congratulations, Amanda!
Chivalry Isn't Dead… Or Is It? The Secret To Being Romantic!


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Five years later we have weathered the storm, but when stock prices plummeted and home values followed, we all became acutely aware of risks. It could happen again.
Encore Stage & Studio brings C.S. Lewis' classic to the stage.
Here's are our top five favorites for local families to celebrate Halloween in Northern Virginia.
The region's largest fall festival is celebrating its 21st year.
Jonathan and Jennifer Elkhouri from Salon Khouri in Fairfax, VA have an awesome charity event to help bring awareness to pediatric cancer and get kids involved in helping their peers who are battling the disease.
Choo! Choo! Take your tots' obsession with trains out of the playroom and turn it into a fun, family outing with these great area offerings for rail fans.
As summer comes to an end and families gear up for the colder months, the activity doesn't stop. During any given week, a normal child is transported in and out of a car seat dozens of times, but many parents, even well meaning ones, do not follow best practices while traveling with kids.
Located next to Union Station in the historic City Post Office Building, this smaller-scale Smithsonian packs in a lot of information and family fun into its glorious space.
Helping parents find safe, affordable, high-quality child care.
National Night Out is celebrating its 30th Anniversary.


text:
Originally written on Sign on San Diego | Last updated 11/17/11
DENVER - AUGUST 29: Quarterback Tim Tebow of the Denver Broncos warms up prior to facing the Pittsburgh Steelers during preseason NFL action at INVESCO Field at Mile High on August 29, 2010 in Denver, Colorado. (Photo by Doug Pensinger/Getty Images)
Tim Tebow's 20-yard touchdown run with 58 seconds left capped a 95-yard drive and sent the Denver Broncos to a 17-13 victory over the stunned New York Jets on Thursday night.
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Eric Peterson, Published August 14 2013
RedHawks sneak past Rockland at Newman
On his 28th birthday, C.J. Retherford celebrated with the go-ahead RBI single in the eighth inning. That run-producing hit gave the Fargo-Moorhead RedHawks a 3-2 victory against the Rockland (N.Y.) Boulders in independent baseball before 4,104 fans.
"He kind of jammed me a little bit, but I fought it off and floated it into the outfield," said Retherford, who has 60 RBIs in 65 games with F-M.
The RedHawks (53-30) have won 10 of their past 12 games, inching closer to the American Association North Division championship. F-M lowered its magic number for clinching the division to 10 over second-place Winnipeg. The Goldeyes had their Wednesday game at Sioux City suspended.
"It was a good game for us," said Retherford, who went 2-for-4 to lift his season average to .291.
The RedHawks played from behind through the first seven innings. Rockland, which is in the Can-Am League and plays its home games in Pomona, N.Y., scored two runs in the first inning. Both of those runs scored after cleanup hitter Carlos Rivera cracked a bases-loaded single into left field.
RedHawks starter Alex Caldera struggled in the top of the first, walking, hitting and walking the first three batters he faced to load the bases for Rivera.
"He knows what he's got to do," RedHawks manager Doug Simunic said of Caldera. "He's a smart pitcher. He's got to come out and execute in the first inning."
Caldera found his groove after that shaky first. The right-hander followed that up with six scoreless innings. Caldera set Rockland down in order in the second, fourth and sixth innings. He allowed just two singles over his final six innings.
"He really settled down, which was great," Retherford said. "The first inning, he was a little erratic. After that, he was lights out."
The RedHawks scratched across their first run on a Nic Jackson RBI single in the sixth inning. They trailed 2-1 entering the eighth inning.
Jackson played a role in F-M's second run. His infield single in the eighth inning moved Zach Penprase to third base. Penprase would score on the play after Rockland shortstop Matt Nandin dropped the ball at second base to make the score 2-2.
Retherford came to the plate with two outs and runners on first and second base. Rockland left-hander Garrett Johnson, a 6-foot-10 reliever, was on the mound. Retherford got ahead 3 balls, no strikes in the count before he lined a Johnson offering just over the Rockland infield.
"He was able to plate the run, and he's just a pro hitter," Simunic said of Retherford. "He knew what he had to do to get the ball in play over the infield."
Simunic would still like to see more from his offense. The RedHawks finished with nine hits against the Boulders, all singles.
"We're not hitting right now," Simunic said. "We had nine hits, but nothing that has a lot of glue on it. … We need our big guys to get going a little bit. We need to get some extra-base hits. We haven't done a lot of that."
NOTES: Left-hander Jake Laber (6-5, 4.00 ERA) is set to start today for the RedHawks. Rockland is expected to counter with right-hander Nathaniel Roe (0-2, 4.61 ERA). First pitch is scheduled for 12:30 p.m. … The RedHawks have a 27-15 record at Newman Outdoor Field this season. … The RedHawks are 5-1 against Rockland all-time. F-M was 3-0 against the Boulders last season.
ab r h bi ab r h bi
Webb cf 2 1 1 0 Prnpse ss 4 2 3 0
Bmbck 2b 2 1 0 0 Brquin 3b 4 1 0 0
Edmnsn rf 3 0 1 0 Jckson cf 4 0 2 1
Rivera 1b 3 0 1 2 Rthrfrd 2b 4 0 2 1
Molina dh 4 0 0 0 Brchold 1b 4 0 0 0
Crdllo 3b 4 0 0 0 Alberts dh 3 0 0 0
Alvino c 3 0 1 0 Ssnskie rf 3 0 1 0
Kmzek pr 0 0 0 0 Enrtson lf 3 0 1 0
Mtthews lf 4 0 0 0 Jnnings c 3 0 0 0
Nandin ss 4 0 1 0
Totals 29 2 5 2 Totals 32 3 9 2
FM 000 001 02x –3 9 0
E–Nandin (2). LOB–Rockford 7, RedHawks 5. DP–Rockford 1, RedHawks 2. SB–Penprase (35).
Blevins L,8-8 7Zc 7 3 3 0 4
Johnson Xc 2 0 0 0 1
Caldera 7 3 2 2 4 5
Opsahl Xc 1 0 0 1 1
Mrmnts W,2-0 Zc 0 0 0 0 1
Kilcrease Zc 1 0 0 0 0
Harris S,6 Xc 0 0 0 0 0
Umpires–Home: Stegner. First: Linton. Third: Hicks. Time–2:17.A–4,104.
Readers can reach Forum reporter Eric Peterson at (701) 241-5513.
Peterson's blog can be found at peterson.areavoices.com


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[updated: Tuesday, May 12, 2015]
Matson's longstanding environmental community partnership in Hawaii is called Ka Ipu 'Aina, a Hawaiian expression which translates to 'container for the land.' The program was established in 2001 and, in the generation since, has been successful in partnering with non-profit groups more than a thousand times to clean up both the inland and coastal areas throughout the state. [resource credit: www.matson.com]
On May 2, 2015, WHCC participated in Ka Ipu 'Aina, beach clean-up at Pōka'i Bay & Ku'ililoa Heiau. Mahalo nui to, Matson, Clinton Jamile (CCH Park Supervisor), William Aila Jr. and Glen Kila who led proper protocol.
[updated: Saturday, February 21, 2015]
In celebration of their 40th Anniversary, The Wai'anae Mall has made our very own, Paige Kawelo Barber, their "Hall of Fame Inductee" of the Wai'anae Coast. Accepting their plaque honoring Paige was her husband, Bert Kaihe Barber. - pictured below are club Executive Members (L-R): Stephanie Kawelo, Rochelle Kawelo & Mele Worthington.
[updated: November 2015]
For more information on how you may contribute to our Association and/or a specific project, please see our CONTACT page and send us a message.
We have prepared a cookbook consisting of, a wide variety of recipes collected from many ethnic groups that reside here in Hawai'i.
For more information to purchase a Cookbook, CLICK HERE!
Website designed by: Hina C.


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We are developing online courses on a number of subjects. These will be courses that involve a number different assets which will be created by a number of people. As a storyboard writer it will be your job to develop that technical content of the course and to establish a scene by scene sequence of the topics that need to be covered. As mentioned already your responsibility will be to complete a storyboard for a Programming Pl/SQL course which will have topics coverage that coincide wi...
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#60 - kibuza (08/01/2013) [-]
Reality Check: Stoners don't give 2 ***** . We're too busy with life's real problems. Like what flavour of Doritos I should get.
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I like me a good ol fashioned bag of Nacho Cheese.


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Bentley Doesn't Like Paris Hilton Showing Off Her Pink Bentley
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The folks at Bentley may be fans of Paris Hilton's Benjamins, but seeing the reality star driving their car around in the weekly tabs? Not so much.
RELATED: Paris and more celebs out and about
The company is reportedly annoyed that Paris has been photographed with her pink Bentley Continental GT.
"There's a certain element still buying it possibly for very different reasons: the follow-on crowd who just said, 'Well, so-and-so is driving the car, so I want one," a source tells Forbes.
RELATED: Paris at the airport and more celeb TwitPics
To counteract the perceived negative publicity, Bentley has reportedly launched ad campaigns featuring famous people with slightly more panache: the former editor of Vogue Paris, a polo player and an art collector.
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"For 11 of these Fusarium species, this is the first report of their ability to be transported great distances above the surface of the earth," Schmale said. "Our work has important implications for the rapid spread of invasive plant and animal pathogens in the United States."
Schmale's research is not limited to the study of Fusarium, however. He has expanded his interests to explore entire microbial populations in the atmosphere—a type of research he calls "aerogenomics."
"One of the species we collected with our autonomous UAVs appears to be a bacterium known only to exist in a cavern in Arizona," he said. "What was that bacterium doing 100 meters above Kentland Farm" In many of our other samples, we have found organisms that have never been cultured before. Some of these microbes may thrive only in the atmosphere, and many of them may be new to science."
This and other fascinating results have led Schmale to hypothesize that some airborne microorganisms have "novel biochemical processes for interacting with each other as a community of organisms in the atmosphere." He explained, "We know that microbes mediate important biochemical processes in the soil and the ocean. It is not so farfetched that a similar drama unfolds in the atmosphere, which we already know is teeming with microbial life."
Although Schma
Source:Virginia Tech


text:
Gunmetal Black Ep 01
episode 14.27 / 5.00 5,257 Views
Lucina's First Day
A look at the first day of Lucina in Super Smash4.25 / 5.00 18,064 Views
BATMAN v SUPERMAN final showdown
SPOILERS!!4.20 / 5.00 15,080 Views
That was just stupid.
This is really just a dude making a video making fun of a girl who commited suicide. It was sort of funny which is why it isnt just 1 star, but it's still pretty stupid. If people saw this on the homepage there would be a 25/25/25/25 split of people who 1. Don't care 2. Find this very offensive 3. Think it's pretty enjoyable or 4. Love it because they like it when people get offended. Overall: Nah.
goodbyegoodbyegoodbyegoodbyegogoodbye odgoodbyebyegoodbyeGOOOOOOOOODBYEEEEE EEEEEEEEEE
This still manages to make me laugh
This is in such bad taste. I mean your mouth should be disintergrating from how bad a taste it is.. amirite?! .. no but bad jokes aside this is a fucking abomonation.. along with youself.