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To investigate the relationship between ICU admission blood lactate, base excess, and ICU mortality and to explore the effect of incorporating blood lactate into the Pediatric Index of Mortality.Retrospective cohort study based on data prospectively collected on every PICU admission submitted to the U.K. Pediatric Intensive Care Audit Network and to the Australia and New Zealand Pediatric Intensive Care Registry.Thirty-three PICUs in the United Kingdom/Republic of Ireland and nine PICUs and 20 general ICUs in Australia and New Zealand.All ICU admissions between January 1, 2012, and December 31, 2015.None.One hundred twenty-three thousand two hundred fifty-two admissions were recorded in both datasets; 81,576 (66.2%) in the United Kingdom/Republic of Ireland and 41,676 (33.8%) in Australia and New Zealand. Of these 75,070 (61%) had a base excess recorded, 63,316 (51%) had a lactate recorded, and 60,876 (49%) had both base excess and lactate recorded. Median lactate value was 1.5 mmol/L (interquartile range, 1-2.4 mmol/L) (United Kingdom/Republic of Ireland: 1.5 [1-2.5]; Australia and New Zealand: 1.4 [1-2.3]). Children with a lactate recorded had a higher illness severity, were more likely to be invasively ventilated, admitted after cardiac surgery, and had a higher mortality rate, compared with admissions with no lactate recorded (p0.001). The relationship between lactate and mortality was stronger (odds ratio, 1.32; 95% CI, 1.31-1.34) than between absolute base excess and mortality (odds ratio, 1.13; 95% CI, 1.12-1.14). Addition of lactate to the Pediatric Index of Mortality score led to a small improvement in performance over addition of absolute base excess, whereas adding both lactate and absolute base excess achieved the best performance.At PICU admission, blood lactate is more strongly associated with ICU mortality than absolute base excess. Adding lactate into the Pediatric Index of Mortality model may result in a small improvement in performance. Any improvement in Pediatric Index of Mortality performance must be balanced against the added burden of data capture when considering potential incorporation into the Pediatric Index of Mortality model.

BackgroundThere is a scarcity of research that comprehensively examines programme impact from a context-specific perspective. We aimed to determine the conditions under which the Bihar Technical Support Programme led to more favourable outcomes for maternal and child health in Bihar.MethodsWe obtained block-level data on maternal and child health indicators during the state-wide scale-up of the pilot Ananya programme and data on health facility readiness, along with geographical and sociodemographic variables. We examined the associations of these factors with increases in the levels of indicators using multilevel logistic regression, and the associations with rates of change in the indicators using Bayesian Hierarchical modelling.ResultsFrontline worker (FLW) visits between 2014-2017 were more likely to increase in blocks with better night lighting (odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.01-1.51). Birth preparedness increased in blocks with increasing FLW visits (OR = 3.43, 95% CI = 1.15-10.21), while dry cord care practice increased in blocks where satisfaction with FLW visits was increasing (OR = 1.52, 95% CI = 1.10-2.11). Age-appropriate frequency of complementary feeding increased in blocks with higher development index (OR = 1.55, 95% CI = 1.16-2.06) and a higher percentage of scheduled caste or tribe (OR = 3.21, 95% CI = 1.13-9.09). An increase in most outcomes was more likely in areas with lower baseline levels.ConclusionsContextual factors (eg, night lighting and development) not targeted by the programme and FLW visits were associated with favourable programme outcomes. Intervention design, including intervention selection for a particular geography, should be modified to fit the local context in the short term. Expanding collaborations beyond the health sector to influence modifiable contextual factors in the long term can result in a higher magnitude and more sustainable impact.RegistrationClinicalTrials.gov: NCT02726230.

BACKGROUND The onset of the COVID-19 pandemic generated an urgent need for credible and actionable information to guide public health responses. The massive open-source online course (MOOC) format may be a valuable path for disseminating timely and widely accessible training for health professionals during public health crises; however, the reach and effectiveness of health worker–directed online courses during the pandemic remain largely unexplored. OBJECTIVE This study investigated the use of an open-source online course series designed to provide critical COVID-19 knowledge to frontline health workers and public health professionals globally. The study investigated how open-source online educational content can be optimized to support knowledge sharing among health professionals in public health emergencies, particularly in resource-limited contexts. METHODS The study examined global course enrollment patterns (N=2185) and performed in-depth interviews with a purposive subsample of health professionals enrolled in the course series (N=12) to investigate the sharing of online content in pandemic responses. Interviewed learners were from Ethiopia, India, Kenya, Liberia, Malawi, Rwanda, Thailand, Uganda, the United Arab Emirates, and the United States. Inductive analysis and constant comparative methods were used to systematically code data and identify key themes emerging from interview data. RESULTS The analysis revealed that the online course content helped fill a critical gap in trustworthy COVID-19 information for pandemic responses and was shared through health worker professional and personal networks. Enrollment patterns and qualitative data illustrate how health professionals shared information within their professional networks. While learners shared the knowledge they gained from the course, they expressed a need for contextualized information to more effectively educate others in their networks and in their communities. Due to technological and logistical barriers, participants did not attempt to adapt the content to share with others. CONCLUSIONS This study illustrates that health professional networks can facilitate the sharing of online open-source health education content; however, to fully leverage potential benefits, additional support is required to facilitate the adaptation of course content to more effectively reach communities globally.

ObjectivesTo examine antibody responses after the second vaccination in healthcare workers (HCWs) with underlying health conditions.DesignCohort study.SettingOxford University Hospitals in the United Kingdom.ParticipantsHealthcare workers who had SARS-CoV-2 serological data available and received two SARS-CoV- 2 vaccinations.Primary outcomePeak SARS-CoV-2 anti-spike IgG responses after the second vaccination and associations with underlying health conditions and the estimated risk of severe COVID-19 using an occupational health risk assessment tool.MethodsWe used univariable and multivariable linear regression models to investigate associations between antibody levels and demographics (age, sex, ethnicity), healthcare role, body mass index, underlying health conditions, vaccination status, prior infection and the Association of Local Authority Medical Advisors COVID-age risk score.Results1635 HCWs had anti-spike IgG measurements 14–84 days after second vaccination and data on any underlying health conditions. Only five HCWs (0.3%), all on immunosuppressive treatment, (including four organ transplant recipients), did not seroconvert after second vaccination. Antibody levels were independently lower with older age, diabetes, immunosuppression, respiratory disorders other than asthma and markedly so in organ transplant recipients. Levels were independently lower in ChAdOx1 versus BNT162b2 recipients and higher following previous infection. HCWs with ‘very high’ COVID-age risk scores had lower median antibody levels than those with ‘low’, ‘medium’ or ‘high’ risk scores; 4379 AU/mL, compared with 12 337 AU/mL, 9430 AU/mL and 10 524 AU/mL, respectively.ConclusionsTwo vaccine doses are effective in generating antibody responses among HCWs, including those with a high occupational risk. However, HCWs with underlying health conditions, especially diabetes, immunosuppression and organ transplant, had lower antibody levels, and vaccine response monitoring may be needed.

BACKGROUND Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. OBJECTIVE This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. METHODS We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. RESULTS We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants’ skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). CONCLUSIONS We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.

Background Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs. Methods A model for health layering of SHGs – Parivartan – was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression. Results In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks. Conclusions Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change. Study registration ClinicalTrials.gov number NCT02726230

Objective To identify factors that influence faculty to promote or reduce the expression of autonomy for pediatric hospital medicine (PHM) fellows and describe behaviors faculty employ to support fellow autonomy in the clinical setting. Methods This was a multicenter, qualitative study using semistructured interviews with core faculty in PHM fellowships. Data were transcribed verbatim and analyzed using a phenomenological approach. Each transcript was coded independently by 2 trained reviewers who then met to reconcile differences. Codes were identified using an iterative approach and organized into themes. Investigators engaged in peer debriefing during data collection, and member checking confirmed the results. Results Interviews were conducted December 2016 to January 2017 with 20 faculty from 5 PHM fellowships. Most participants were female (12, 60%) and assistant (13, 65%) or associate (6, 30%) professors. Data analysis yielded 6 themes. Themes reflect the importance of faculty experience, style, and approach to balancing patient care with education in the provision of autonomy for PHM fellows. Faculty appreciation for the role of autonomy in medical education, investment in their roles as educators, and investment in PHM fellowship training are also influential factors. Finally, fellow clinical, educational, leadership, and communication skills influence the provision of autonomy. Faculty employ various levels of supervision, scaffolding techniques, and direct observation with feedback to support fellow autonomy. Professional development was considered essential for developing these skills. Conclusions We identified 6 themes related to faculty provision of autonomy to PHM fellows, as well as strategies employed by faculty to support fellow autonomy.

A 73-year-old man was referred to the acute medical team by his general practitioner with a suspected diabetic footinfection. He had a background of type 2 diabetes mellitus, chronic venous insufficiency and ulcers, peripheral vascular disease and deep venous thromboses (DVT). The patient revealed that he had not removed his compression stockings for 4 months. He had chronic venous changes bilaterally, a swollen, erythematous right leg and foul-smelling discharge from …

As the two senior authors of this chapter, Janie Victoria Ward and Tracy L. Robinson-Wood bring to this work decades of reflection and concern about the seemingly intractable nature of colorism, a problem that will not go away. More than 30 years ago, as Black doctoral students in a program that trained psychologists, educators, and teachers, we wrote our first article on Black women and colorism. As we write this current chapter on colorism, we are struck by the fact that what we wrote then and what we are writing now is heartbreakingly similar. During the 1980s, we used the technology available to us: floppy disks, dot matrix printers, and cassette recorders to chronicle the experiences of colorism in the lives of Black women. We were doctoral candidates and budding researchers having conversations with Black women who recounted the psychological influence of messages they received about the significance of skin color and hair throughout their childhood, adolescence, and young adulthood. Some of these messages about skin color preferences were transmitted in the home and in schools by parents, extended family members, and by teachers. The members of our focus groups shared stories of the divisiveness and isolation they experienced as the forces of colorism pit Black people against one another on the basis of immutable characteristics. Over the last few decades, this issue has received increased prominence and conversations about skin color consciousness have become more commonplace. Social scientists have focused on the phenomenon, providing ample research evidence to support the notion that skin color preferences are alive, well, and result in undeniable social, economic, and political consequences for Black people (Herring, Keith, & Horton, 2004).

The CD45 antigen is a haemopoietic cell specific tyrosine phosphatase essential for antigen receptor mediated signalling in lymphocytes. Expression of different patterns of alternatively spliced CD45 isoforms is associated with distinct functions. We recently identified a polymorphism in exon 6 (A138G) of the gene encoding CD45 (PTPRC) that results in altered CD45 splicing. The 138G allele is present at a high frequency among Japanese (23.7%), with 5.1% individuals homozygous for the G allele. In this study we show that the A138G polymorphism is the cause of altered CD45 isoform expression, promoting splicing towards low molecular weight CD45 isoforms. We further report that the frequency of A138G heterozygotes is significantly reduced in number in cohorts of patients with autoimmune Graves' disease or hepatitis B infection, whereas G138G homozygotes are absent from a cohort of Hashimoto's thyroiditis patients. We also show that 138G individuals exhibit altered cytokine production in vitro and an increased proportion of memory T cells. These data suggest that the 138G variant allele strongly influences these diseases by modulation of immune mechanisms and may have achieved its high frequency as a result of a natural selection probably related to pathogen resistance.

BACKGROUND: A polymorphism in exon 4 (C77G) of CD45 that alters CD45 splicing has been associated with autoimmune and infectious diseases in humans. OBJECTIVE: To investigate the effect of C77G in hepatitis C virus (HCV) infected individuals and study the phenotype and function of peripheral blood mononuclear cells (PBMC) from healthy and hepatitis C infected C77G carriers. RESULTS: C77G individuals showed an increased proportion of primed CD45RA and effector memory CD8 T cells and more rapid activation of the lymphocyte specific protein tyrosine kinase (Lck) following CD3 stimulation. Transgenic mice with CD45 expression mimicking that in human C77G variants had more activated/memory T cells, more rapid proliferative responses, and activation of Lck. CONCLUSIONS: Changes in CD45 isoform expression can alter immune function in human C77G variants and CD45 transgenic mice. The C77G allele may influence the outcome of HCV infection.

Millions of Americans need but don’t receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs’ implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients’ health tracking and relapses. We examined (a) clinicians’ initial perspectives about implementing Seva, and (b) the first year of implementation at Site 1. Prior to staggered implementation at three FQHCs (Midwest city in WI vs. rural town in MT vs. metropolitan NY), interviews, meetings, and focus groups were conducted with 53 clinicians to identify core themes of initial expectations about implementation. One year into implementation at Site 1, clinicians there were re-interviewed. Their reports were supplemented by quantitative data on clinician and patient use of Seva. Clinicians anticipated that Seva could help patients and make behavioral health appointments more efficient, but they were skeptical that physicians would engage with Seva (given high caseloads), and they were uncertain whether patients would use Seva. They were concerned about legal obligations for monitoring patients’ interactions online, including possible “cries for help” or inappropriate interactions. One year later at Site 1, behavioral health care providers, rather than physicians, had incorporated Seva into patient care, primarily by discussing it during appointments. Given workflow/load concerns, only a few key clinicians monitored health tracking/relapses and prompted outreach when needed; two researchers monitored the discussion board and alerted the clinic as needed. Clinician turnover/leave complicated this approach. Contrary to clinicians’ initial concerns, patients showed sustained, mutually supportive use of Seva, with few instances of misuse. Results suggest the value of (a) focusing implementation on behavioral health care providers rather than physicians, (b) assigning a few individuals (not necessarily clinicians) to monitor health tracking, relapses, and the discussion board, (c) anticipating turnover/leave and having designated replacements. Patients showed sustained, positive use of Seva. ClinicalTrials.gov ( NCT01963234 ).

Sexuality is the most fundamental aspect of our lives and yet it has long been the silent partner in sexual and reproductive health (SRH). Growing awareness of the rights-based approach to health, the commitment of governments and international bodies to promote sexual health and well-being, and the failure of many of the interventions to combat the HIV/AIDS epidemic are helping the reproductive health community put the “S” back into SRH even as the Millennium Development Goals fail to address SRH directly. The disconnect is due to the fragmented, non-holistic approach to reproductive health, short-sightedness in neglecting violations like gender-based violence, a lack of training for students and health care professionals in sexuality, a dearth of indicators and sexuality research and discrimination against vulnerable groups like youth and sexually diverse populations. Recommendations include reaching consensus about the nexus between sexuality and reproductive health and strengthening the commi...

This article imagines a `factional' client in the transport sector. It covers in some detail, in an annotated table, the individual parts of an intervention to enquire into (and catalyze change through the process of enquiring into) the technical, practical and cultural conditions surrounding records and filing in the client. It concludes by considering what might be narratively distinctive about the methods we have applied and, more generally, with a reflection on the issues facing the narrative enquirer. The article is part of an ongoing enquiry by Sparknow. In other essays and research papers, we will be considering knowledge work and the knowledge worker; negative space and its role in knowledge transfer; and the role of museums, libraries and archives in creating narrative coherence, past, present and future, in the 21st century organization. Throughout, we are holding in mind two questions: How can individual and collective relationships to the collections of the organization combat inertia and indifference? What role can collections, and the interaction of people with them, play in the organization as a living system of knowledge transfer?

This paper describes how NatWest Markets’ (NWM) recent initiative in knowledge management was born and the ways in which it has already evolved to meet the organisation's needs. NWM's knowledge management programme has not attempted to apply theories and impose changes from above, but has encouraged systematic experimentation linked to clear business targets.

This study examines skin color in the lives of African American adolescents and explores the relationship to self-esteem and dating relationships. Adolescents between the ages of 11 and 19 years were recruited through schools, churches, and informal networks. A questionnaire was developed by the researchers to explore the meaning of skin color in the lives of African American adolescents and its effect on self-esteem. Primary studyfindings were that (a) a relationship existed between satisfaction with skin color and self-esteem; (b) students self-reported as "lighter" or "darker" had lower levels of satisfaction with their skin color than did students whose skin color was classified as "somewhere in between"; (c) although the difference was nonsignificant, a greater proportion of men than women expresseda desirefor lighterskin; and (d) a gender difference was noted on the dating variable, "Skin color makes a difference to guys when they date girls." Implications of thefindings are discussed.

In this article, Janie Ward looks at the historical traditions of caring, interdependence, and valuing justice within the African American community. She posits that what has been lost to African American youth enmeshed in the violence of U.S. society is an awareness that aggression is a violation of the care and connectedness implicit in the notion of Black racial identity and community. Ward concludes that a solution to youth violence may lie in reconnecting African American teens to the communal values and traditions that have allowed Blacks to develop racial identity and racial solidarity in spite of their economic and social oppression in the United States.

This paper examines seven narratives of racial conflict elicited from African American adults and young people. Analysis focusses on the relational nature of the racial conflicts. Issues of power and authority inherent in the sociopolitical context in which racial knowledge develops and moral judgements regarding racial differences are determined are found to be likewise embedded in interracial interpersonal relationships. Adopting Brown & Gilligan's (1990) methodological approach to reading narratives of conflict and choice, the two moral themes of justice and care are explored in the constitution and resolution of the conflicts shared. Concerns specific to the psychological development of African Americans and to the transmission of race‐related morals and values in black cultures are addressed.

An individual’s attachment style can be conceptualized as a working model for interactions with others, developed as result of experiences with childhood caregivers. People with hypochondriacal tendencies are preoccupied with thoughts of having an illness and constantly seek medical reassurance. We hypothesized that students with preoccupied attachment would score highly on a measure of hypochondriasis and investigated whether the association would be explained by the general tendency to seek reassurance in relationships. A total of 117 undergraduate students completed questionnaires measuring attachment style; negative affectivity; reassurance seeking in relationships and hypochondriasis. Participants with preoccupied attachment style ( n = 17, 15%) had significantly higher hypochondriasis scores than those with other attachment styles. Hierarchical multiple regression analysis suggested that the association between the preoccupied attachment style and hypochondriasis was explained by the general tendency to seek reassurance in relationships, with negative affectivity, a dispositional variable, also acting as a significant predictor of hypochondriasis.

CD45 is crucial for normal lymphocyte signalling, and altered CD45 expression has major effects on immune function. Both mice and humans lacking CD45 expression are severely immunodeficient, and single-nucleotide polymorphisms in the CD45 gene that cause altered splicing have been associated with autoimmune and infectious diseases. Recently, we identified an exon 6 A138G polymorphism resulting in an increased proportion of activated CD45RO T cells and altered immune function. Here we report a significantly reduced frequency of the 138G allele in hepatitis C Japanese patients and a possibly reduced frequency in type I diabetes. The allele is widely distributed in the Far East and India, indicating that it may have a significant effect on disease burden in a large part of the human population.

Meningiomas are the second most common lesion encountered within the cerebello-pontine angle (CPA) and rarely project into or originate from the internal auditory meatus (IAM). It is important to distinguish between meningiomas and acoustic neuromas preoperatively as the choice of surgical approach may differ depending on the tumour type. Fortunately, most lesions can be accurately diagnosed with gadolinium-enhanced magnetic resonunce imaging (MRI). We report six cases of meningioma involving the IAM, often leading to an incorrect preoperative MRI diagnosis. We highlight the challenges these tumors present to radiologists and surgeons.

This chapter considers the relationship between the exchange traded and OTC derivatives markets. It begins by summarising the characteristics of both markets, before exploring the implications of differences in product design, trading environment, liquidity, administration and cost, and regulation and credit risk. An attempt is made to answer the question of whether the relationship is one of symbiotic reinforcement or destructive competition. The chapter concludes with some speculations of the author regarding future developments.

William Wells Brown, the first published black novelist, de scribed Clotel, his beautiful heroine, as whiter than white, with long straight hair, light eyes, and "fine" European fea tures. This image of black female beauty appeared repeated ly in such novels as Frances E. W. Harper's Iola Leroy (1865), Nella Larsen's Passing (1929), and Jessie Redmon Fauset's The Chinaberry Tree (1931). Later novelists explic itly criticized the white standard, exploring the problematic fate of the darker woman. The heroine of Wallace Thur man's The Blacker the Berry (1929) learns she can never for get the lesson of childhood: envy those lighter and despise j those darker than she. Even more complex in relation to col| or and hair is Toni Morrison's The Bluest Eye (1970). In that novel, Maureen Peal's experience as the pretty high-yellow | "dream child" is contrasted with that of Pecola Breedlove. I From the other side of the street, Maureen screams "I am cute. And you ugly! Black and ugly..." And Pecola and her sister reflect, "We were sinking under the wisdom, accuracy, and relevance of Maureen's last words. If she was cute?then we were not And what could that mean? We were lesser." Literature, of course, reflects life; these novelists suggest some of the ways the stereotypes and prejudgments of color consciousness have provoked rivalries and caused pain with in the black community, and have led to complex and ambiv alent feelings about blackness in individual black women. Within the family, where a variety of skin colors may be represented, black children first learn the values attributed to various skin colors. In the presence of a newborn, one can still hear passed down folklore that predicts the baby's future skin color and hair texture. When the child enters the larger social world, she carries these color-conscious attitudes with her, and they are reinforced by others. Experiences of color consciousness repeat themselves across the life span of black women. Color often enters into the choices black people make of whom to date and whom to marry. Indeed, the pathological effects of color consciousness have affected some black men so deeply that it is not outrageous to imag ine a scenario in which a light-skinned black woman finds herself chosen by a man who, she later discovers, is acting out some subconscious desire to possess the unobtainable white woman. A woman's self-concept develops in part from observing and internalizing what others think about her. Consequently, the attributes society assigns to the "attractive" and "unat tractive" black female have profound implications for her psychosocial development If a dark-skinned young girl is constantly told that she is ugly, and experiences treatment that supports these views, she may begin to take ugliness as a moral or psychological attribute. She may be driven to com pensate for her devaluation through activities in which she can excel and thus redeem her self-worth. In contrast, the I lighter-skinned woman may feel misunderstood by darker blacks who fail to understand the pain and conflict associated with what is a biological occurrence. Her own self-worth may be damaged, for example, in adolescence, when she may wonder if boys, in choosing her, just want a "pretty face." In the pages that follow, we try to untangle some of the forces of racism and sexism that gave birth to color con sciousness in the black community and maintain it today. Color consciousness is rooted in the social, political, and economic conditions that existed during the centuries of slav ery in the United States. In the American South, blacks were subjected to enforced segregation, while white men were able to sexually victimize enslaved and defenseless black women. The bi-racial offspring were called "mulattoes": light-skinned, straight-haired children bom of interracial par entage. Social advantages were often granted to these chil dren by their white fathers, who offered them a better quality of life than that available to other blacks. They gained such specific benefits as release from field work, better housing, education (formal or informal), clothing, and on some occa sions, emancipation, despite the mothers' continued en slavement Indeed, mulattoes enlarged the free Negro population in the years prior to the Civil War. Liberated before the masses of other black slaves, many mulattoes lived a marginal existence, and although they were not recognized as equals by whites, they often chose to disso ciate themselves from other blacks. Fleeing persecution and discrimination in the South, the mulattoes came North, bringing lighter skin color and its elitist affectations with them. Many disdained their darker brothers and sisters, preferring instead the supposed gentility and culture of the white race. Following Emancipation, mulattoes quickly discovered that their lighter color functioned as a valuable social resource in the closed white society. Due to the preferential treatment af forded light-skinned blacks in the mission schools and black colleges established after the Civil War, skin color served as a foundation for the emerging black middle class. Sociologist E. Franklin Frazier (1957) explained how, even within black educational institutions, many lighter blacks had been social ized to differentiate themselves from the black masses by conforming to white puritanical standards and avoiding the "ungrammatical" speech and dialect of the sons and daugh ters of slaves. There are also reports that skillful light-skinned black men and women posed as white in order to gain admis sion to segregated white colleges and universities, and later, upon completion of their degrees, reclaimed their racial iden tity. In many urban areas, other major social institutions such as the black church also divided along color and class lines: middle-class, usually lighter-skinned congregations sought to dissociate themselves from the overt religiosity of the "com mon" black people. By the turn of the century, white psychologists argued that the more white blood found within a person, the better (mor ally, physically, and mentally) that person was. Whether the field of psychology paved the way for racism to flourish, or