title: Hmong Americans

text: Throughout the Vietnam War, and for two decades following it, the US government stated that there was no "Secret War" in Laos and that the US was not engaged in air or ground combat operations in Laos. In the late 1990s, however, several US conservatives, led by Johns and others, alleged that the Clinton administration was using the denial of this covert war to justify a repatriation of Thailand-based Hmong war veterans to Laos. It persuaded the US government to acknowledge the Secret War (conducted mostly under President Richard Nixon) and to honor the Hmong and American veterans from the war.


title: Hmong Americans

text: On May 15, 1997, in a total reversal of US policy, the federal government acknowledged that it had supported a prolonged air and ground campaign in Laos against the North Vietnamese Army and Vietcong. That day it dedicated the Laos Memorial on the grounds of Arlington National Cemetery in honor of the Hmong and other combat veterans from the Secret War. In 1999 there were about 250,000 Hmong people living in the United States, living in numerous medium and large cities.


title: Hmong Americans

text: Some Hmong remained in refugee camps in Thailand at the time of the September 11, 2001, attacks. This resulted in the tightening of US immigration laws, especially under the Patriot Act and the Real ID Act, and the immigration of Hmong refugees to the US has significantly slowed. Most Hmong refugees in Thailand had been engaged in documented armed conflict (although under US sponsorship) during and after the Vietnam War. The anti-terrorism legislation created barriers to such people being accepted as immigrants.


title: Hmong Americans

text: According to the 2010 US Census, 260,073 people of Hmong descent reside in the United States up from 186,310 in 2000. The vast majority of the growth since 2000 was from natural increase, except for the admission of a final group of over 15,000 refugees in 2004 and 2005 from Wat Tham Krabok in Thailand. Of the 260,073 Hmong-Americans, 247,595 or 95.2% are Hmong alone, and the remaining 12,478 are mixed Hmong with some other ethnicity or race. The Hmong-American population is among the youngest of all groups in the United States, with the majority being under 30 years old, born after 1980, with most part-Hmong are under 10 years old.


title: Hmong Americans

text: States with the largest Hmong population include: California (86,989; 0.2%), Minnesota (63,619; 1.2%), Wisconsin (47,127; 0.8%), and North Carolina (10,433; 0.1%), Michigan (5,924; 0.1%), Colorado (4,530; 0.1%), Georgia (3,623; 0.03%), Alaska (3,534; 0.5%), Oklahoma (3,369; 0.1%), and Oregon (2,920; 0.1%). The metropolitan areas of Fresno and Minneapolis-St. Paul have especially large Hmong communities. St. Paul, Minnesota, has the largest Hmong population per capita in the United States (10.0%; 28,591 Hmong Americans), followed by Wausau in Wisconsin (3,569; 9.1% of its population).


title: Hmong Americans

text: In terms of metropolitan area, the largest Hmong-American community is in Minneapolis-Saint Paul-Bloomington, MN Metro Area (74,422); followed by Fresno, CA Metro Area (31,771); Sacramento, CA Metro Area (26,996); Milwaukee, WI Metro Area (11,904); and Merced, CA Metro Area (7,254).


title: Hmong Americans

text: There are smaller Hmong communities scattered across the country, including cities in California; Colorado (Denver, Colorado – 4,264); Michigan (Detroit, Michigan and Warren, Michigan – 4,190), Alaska (Anchorage, Alaska – 3,494); North Carolina (Hickory, North Carolina); Georgia (Auburn, Duluth, Lawrenceville, Monroe, Atlanta, and Winder); Wisconsin (Eau Claire, Appleton, Green Bay, La Crosse, and Stevens Point, Plover, and Sheboygan); Kansas (Kansas City – 1,754); Oklahoma (Tulsa – 2,483); Southwest Missouri; Northwest Arkansas (Benton County); Washington; Oregon (Portland), Montana (Missoula) and throughout the United States.


title: Hmong Americans

text: As of the 2000 US Census, the largest Hmong population by metropolitan area resided in and around Minneapolis-St. Paul, with 40,707 people. The following areas were Greater Fresno with 22,456 people, Greater Sacramento (Sacramento-Yolo) with 16,261, Greater Milwaukee (Milwaukee-Racine) with 8,078, Greater Merced with 6,148, Greater Stockton (Stockton-Lodi) with 5,553, Appleton-Oshkosh-Neenah with 4,741, Greater Wausau with 4,453, Hickory-Morganton-Lenoir (North Carolina) with 4,207, and Greater Detroit (Detroit-Ann Arbor-Flint) with 3,926.


title: Hmong Americans

text: California has the largest Hmong population in the United States by state. As of 2010, there are 95,120 Hmong Americans in California.


title: Hmong Americans

text: In 2002, the State of California counted about 35,000 students of Hmong descent in schools. According to Jay Schenirer, a member of the school board of the Sacramento City Unified School District, most of the students lived in the Central Valley, in an area ranging from Fresno to Marysville. Fresno County and Sacramento County combined have almost 12,000 Hmong students.


title: Hmong Americans

text: As of 2002, of the Hmong students who took the California English Language Development Test, which measures English fluency in students who are learning English, 15% of Hmong scores at the "advanced" or "early advanced" classifications, while 30% of Vietnamese English learning students and 21% of all of California's over 1.5 million English learning students scored at those levels. Suanna Gilman-Ponce, the multilingual education department head of Sacramento City Unified, said that the Hmong students have lower rates due to having parents who speak little English; therefore they enter American schools with few English skills. In addition, their culture was not literate, so Hmong history was not written down and history books did not discuss Hmong history.


title: Hmong Americans

text: In 2011, Susan B. Anthony Elementary School in Sacramento established a Hmong-language immersion program. In 2019, Fresno Unified School district began offering dual immersion as well as Elective course offerings for high school students to learn the Hmong language. In the Fresno Unified School District, over 10,000 signatures of support were collected for the naming of a new elementary school for General Vang Pao, a well known leader from the Secret Wars in Laos and the Hmong American diaspora.


title: Hmong Americans

text: Colorado is home to approximately 5,000 Hmong who first settled in the state in the late 1976 to early 1980s. Today, most of the Hmong live in the north metro Denver area including Arvada, Brighton, Broomfield, Federal Heights, Lafayette, Northglenn, Thornton and Westminster.


title: Hmong Americans

text: In 1995, Golden, Colorado became the first city in the United States to designate a Lao-Hmong Recognition Day. Since then, other areas in the country followed suit, declaring July 22 “Lao-Hmong Recognition Day”. The establishment of this day recognizes the bravery, sacrifice, and loyalty to the United States exhibited by the Lao-Hmong. The Lao-Hmong Recognition Day was held in recognition and to honor of the Lao-Hmong Special Guerrilla Units (SGU) Veterans, "America’s Secret Army and Most Loyal Allies." The SGUs were composed of indigenous Laotians, especially the Hmong, Lao, Mien, Lue, Khmu and Thaidam tribes, and were known for their patriotism, valiant service, personal sacrifice and loyal support of the United States Armed Forces in Laos during the Vietnam War.


title: Hmong Americans

text: "Historically, the Lao-Hmong people were one of our country’s most loyal allies. During the Vietnam War, they fought bravely alongside U.S. soldiers. Many emigrated to the U.S. and now proudly call this country their home. We are grateful for their service and sacrifice to our nation," said U.S. Rep. Ed Perlmutter (CO-07).


title: Hmong Americans

text: The Hmong Alliance and Missionary District headquarters is located in Thornton, CO. In 2018, the Hmong District celebrates its fortieth-year anniversary in St. Paul, MN with over 110 churches scattered throughout the United States with an inclusive membership of 30,000 plus people. The Hmong District is led by Rev. Dr. Lantzia Thao (Tswv Txos), who acts as the Hmong District Superintendent overseeing the entire movement and operations.


title: Hmong Americans

text: Kansas has a moderately-sized Hmong population. Kansas City was one of the first cities to accept Hmong people after the war. Its Hmong population declined in the early 80s due to migration from Kansas to California, and the Northern Midwest. The population has since stabilized and has more than double every decade since 1990. According to the 2010 Census, 1,732 Hmong people lived in Kansas of which 1,600 lived in the Kansas Side of Kansas City and an estimated more than 400 families and 2,000 Hmong living in the Greater Kansas City Area in 2013. Lao Family was established in Kansas City in the 1980s but the Hmong separated from the organization to create the Hmong American Community, Inc. which today is still a functioning entity hosting Hmong New Year celebrations in Kansas City. Kansas City has a vast majority Green Hmong population and is greater than 80% converted to Christianity though more and more Hmong people move in every year that still practices the traditional religion. Kansas City is home to Hmong churches, multiple Hmong runs and owned manufacturing companies, nail salons, small business such as insurance and barber shops, vendors at the flea market, an organization such as Hmong Village Inc., Vang Organization, and Herr Organization just to name a few.


title: Hmong Americans

text: The Hmong community in Massachusetts is small compared to the Vietnamese and Cambodian populations of Massachusetts. As of 2011, according to Judy Thao, the director of the United Hmong of Massachusetts, an organization based in Lowell, about 2,000 Hmong resided in the State of Massachusetts. Thao said that the largest community, with 60 to 70 families, is located in the Fitchburg/Leominster area. As of 2010, there are 412 people of Hmong descent living in Fitchburg (one percent of the city's population). Thao said that about 20 to 30 families each live in the second largest communities, in Springfield and Brockton.


title: Hmong Americans

text: As of 1999, fewer than 4,000 Hmong people lived in Detroit. As of 2005, Michigan had 5,400 Hmong people; reflecting an increase from 2,300 in the 1990s. As of 2005, most Hmong in Michigan lived in Metro Detroit in the cities of Detroit, Pontiac, and Warren. As of 2002 the concentrations of Hmong and Laotian people in the Wayne–Macomb–Oakland tri-county area were in northeast Detroit, southern Warren, and central Pontiac. That year, Kurt Metzger and Jason Booza, authors of "Asians in the United States, Michigan and Metropolitan Detroit," wrote that "The 3,943 Hmong living in tri-county area is one of the most concentrated of the Asian groups." As of 2007, almost 8,000 Hmong lived in Michigan, most in northeastern Detroit. As of 2007, Hmong were increasingly moving to Pontiac and Warren.


title: Hmong Americans

text: The Greater Lansing Area is home to the second largest Hmong American population in Michigan. After 1970, Hmong Americans began to settle in Lansing, Michigan's capital city. Hmong Americans in the Greater Lansing Area, often, have strong ties to churches. Churches like St. Michael's, Our Savior Lutheran Church, and All Saints Episcopal Church sponsored Hmong Americans coming to Lansing, providing them resources to make the transition to America a smoother experience. Lansing hosts a statewide Hmong New Year Festival.


title: Hmong Americans

text: As of 1999, Minnesota has the second largest US Hmong population by state. As of 2001, the largest Hmong population in the United States by the city is located in St. Paul.


title: Hmong Americans

text: "Pom Siab Hmoob" (Gazing into the Heart of the Hmong) Theatre, which is reportedly the world's first Hmong theater group, was formed in 1990. It is based in the Twin Cities. It is now known as the Center for Hmong Arts and Talent (CHAT).


title: Hmong Americans

text: The film "Gran Torino" by Clint Eastwood, though set and filmed in Detroit, Michigan, stars five Minnesotan Hmong (Hmongesotan) Americans, and the original story was based on a neighborhood in Saint Paul. It was the first mainstream US film to feature Hmong Americans.


title: Hmong Americans

text: In 2010, North Carolina had a population of 10,864 Hmong and has one of the highest rates of employment compared to other states in the US. 50% of the Hmong population work in the manufacturing industry. The two centers of population are in the Hickory and Greensboro areas respectively.


title: Hmong Americans

text: A group of Hmong refugees settled in Philadelphia after the end of the 1970s Laotian Civil War. They were attacked in discriminatory acts, and the city's Commission on Human Relations held hearings on the incidents. Anne Fadiman, author of "The Spirit Catches You and You Fall Down", said that lower-class residents resented the Hmong receiving a $100,000 federal grant for employment assistance when they were also out of work; they believed that American citizens should be getting assistance. Between 1982 and 1984, three quarters of the Hmong people who had settled in Philadelphia left for other cities in the United States to join relatives who were already there.


title: Hmong Americans

text: In 1976, Hmong members of the U.S. Secret Army Special Guerrilla Unit, recruited by the CIA during the Vietnam War, were resettled in Rhode Island as refugees. In 1983 their population was estimated at 1,700–2,000. 2010 census results put the number of Rhode Island Hmong at 1,015. The Hmong United Association of Rhode Island puts on a Hmong New Year's festival annually. About sixty families are members of the Providence Hmong Church of the Christian and Missionary Alliance; they are known locally for their egg roll fundraiser, held in the spring.


title: Hmong Americans

text: In December 1999, according to the Hmong National Development Inc., Chicago had about 500 Hmong people. There is a sizable Hmong population in Westminster, Colorado (0.8% of the city's population as of 2010).


title: Hmong Americans

text: The 2000 US Census reveals that 60% of all Hmong above 24 years of age have a highest educational attainment of high school or equivalent, as many of these immigrants came to America as adults or young adults. According to a government data collected in 2013, 40% of Hmong Americans drop out of school. Among the Hmong population, 38% have not received a high school degree, and 14% have at least a bachelor's degree. Educational attainment among Hmong women is significantly lower than among Hmong men, with about one in five Hmong women having a high school diploma.


title: Hmong Americans

text: The lack of formal education among Hmong immigrants is due to the fact that many were once farmers in the hills of Laos or were refugees from war who fled into remote jungles, and had little or no access to schools.


title: Hmong Americans

text: In St. Paul about 2,000 Hmong people have their bachelor's degree, 150 have their master's degree, and 68 have received their doctoral degree, which is a very low percentage considering the population of Hmong Americans in St. Paul is less than 36,000.


title: Hmong Americans

text: In the topic of community issues and Hmong in education, factors to consider are family dynamic, parent engagement, accessibility to resources, and the various school climates. The lack of emotional support for Hmong LGBTQ+ youth in Minnesota and Wisconsin reveal mental and health concerns which affect their academic performance.


title: Hmong Americans

text: Hmong girls and boys had also encountered difficulties in achieving success in the field of education as they adapted the Hmong culture, which is considered as rural, to contemporary American society (Ngo & Lor, 2013). Cha suggested that the dropout rate of Hmong teenagers was the highest among those of Asian American groups (2013). In the first few years after immigration, Hmong girls almost had no chance to be educated in school. Later, as they got the opportunities to go to school, around 90% of Hmong girls chose to quit school because parents preferred obedient and compliant daughters-in-law when looking for partners for their sons (Ngo & Lor, 2013).


title: Hmong Americans

text: On the other hand, Hmong young men are burdened more due to the high expectations on sons in Hmong culture, which led to their challenges in school, such as bad relationships with teachers and lack of participation in class. The word used to describe the work those Hmong boys were involved in for family was “helping out” (Ngo & Lor, 2013, p. 155), referring to an accepted and natural habit including working outside, taking care of the siblings, completing daily household, being cultural brokers for parents and attending numerous traditional ceremonies. For example, Hmong boys were asked to write checks to pay for utility bills and to prepare food for their younger brothers. Also, they went to ceremonies not only to maintain the family relationship but also to keep the traditions from disappearing.


title: Hmong Americans

text: According to Yang (2013), after three decades of struggle, Hmong Americans had achieved in economic, political and educational aspects. Starting from small business, the businesses of Hmong had become international, diverse and high-tech since 2000. For example, about 50 home health care agencies which were supported by federal or state medical assistance were run by Hmong in Minnesota. The Hmong were also more involved in political activities that 57 percent of the Hmong in Minnesota regarded themselves as Democrats, shown by a survey in 2008, and several Hmong people, including Madison P. Nguyen, former Hmong refugee women in Minnesota, had been elected political staffs in city offices.


title: Hmong Americans

text: 2017 data collected by the US government found that Hmong Americans had a median household income of $48,000 compared to the American average of $53,600. The government estimated that 38% of Hmong Americans lived below the poverty line, compared to 16% of all Americans. The 2014 American Community Survey found that per capita income of Hmong Americans was $12,923, significantly lower than the American average of $25,825. When income is compared between US ethnic groups, Hmong Americans are the third lowest earning group. In a 2013, NPR discussion, sociologist Rosalind Chou stated that "when you break it down by specific ethnic groups, the Hmong, the Bangladeshi, they have poverty rates that rival the African-American poverty rate."


title: Hmong Americans

text: There are many cultural, political, and social issues that are being debated among Hmong American communities. Topics include political participation, poverty, gang violence, race relations, and education. The Hmong community also retains many ties with the Hmong still in Indochina and remains active in regional politics.


title: Hmong Americans

text: Politics and culture vary with the location of Hmong-American communities. The Twin Cities, St. Paul and Minneapolis, are more progressive as the queer/LGBTQ+ culture and politics surrounding sexuality and gender are projected and recognized at the local, regional, state, and national level.


title: Hmong Americans

text: Identities go beyond the Hmong-American identity. Heterosexuality and heteronormativity is traditionally tied to the Hmong identity and its history. Studies show that homophobia in the Hmong communities prior to the immigration to the United States is near to nothing, Hmong traditional elders didn't recall homophobia because non-heterosexual identities were nearly non-existent. Among the diverse identities of Hmong Americans, non-traditional gender and sexual identities have gained cultural, political, and social significance.


title: Hmong Americans

text: In 2003, Shades of Yellow (SOY), an LGBTQ+ non-profit organization, was established in St. Paul, Minnesota, to support Hmong people who identify as LGBTQ+. In March 2017, SOY announced the closing of their doors as leadership and funding levels changed.


title: Hmong Americans

text: In December 2005, the Sacramento Hmong LGBTQIA group was founded and serves to provide socials such as movie nights, potlucks, and cultural shows. The Sacramento Hmong LGBTQIA group collaborates with local organizations, for example, the Asian Pacific Islander Queer Sacramento Coalition (APIQSC), to build allyship and stronger political and social relationships within the LGBTQ+ Hmong and general API communities.


title: Hmong Americans

text: Sexual health is critical to the LGBTQ+ Hmong community as it is for the general Southeast Asian (SEA) community throughout the country. Social media and Southeast Asian presence in it calls for a high risk of contracting STI's and HIV, as well other transmissible diseases and health concerns. Sexual education and awareness, as well as education regarding online sex culture, is heavily recommended for awareness and safety when considering sexual health.


title: Hmong Americans

text: Compared to other Southeast Asian refugees in America, Hmong refugees have the highest rates of mental health disorders, with an overall mental illness incidence rate at around 33.5%. This mental health problem has been attributed to traumatic past experiences and problems adjusting to life in the United States.


title: Hmong Americans

text: Gender roles play an integral factor for the mental health of Hmong women. Gender construct of Hmong women, traditionally, socially and politically, have historically been oppressive and marginalizing. Even in traditional Hmong cloth ("paj ntaub)" and folklore ("dab neej)" Hmong gender roles are concretely sewn and told, and repeated. Misogyny and patriarchy in the Hmong community is present to this day which calls for Hmong women empowerment initiatives throughout the United States.


title: Hmong Americans

text: In religious and traditional Hmong families the subject of mental health is taboo because of Shamanism, with the belief that remedy to health is through communication and exchanges with spirits. Through spiritual ceremonies, overall health is remedied, not through health facilities or specialists, not through science. In addition, LGBTQ+ Hmong individuals struggle with mental health due to the lack of education and attention on mental health in Hmong communities, deals with depression, anxiety, substance abuse, and suicide.


title: Hmong Americans

text: In other aspects of health, like cancer, Hmong Americans have the highest cancer mortality rates compared to other Asian American groups. Low cancer screenings and lack of interventions to address stigma of utilizing public health services are among some reasons for this trend. Access to education can help with increasing health practices like receiving a Pap test for cervical cancer screening. A Patient Navigation Program implemented in San Francisco for Hmong Americans led to a 38% increase in Pap test participation, highlighting progress made in increasing participation via education. A cross-sectional study of 168 immigrant Hmong Americans found that half of them reported not understanding health information. Factors like acculturation and number of years in the US were positively correlated with health literacy rate, and lower health literacy rates were associated with poor health in the participants. Acculturation indicators such as language use and social connections, were positively correlated with higher BMI-for-age in Hmong American children 9–18 years old.


title: Hmong Americans

text: A study of 417 Hmong American parents and caregivers showed that the top two contributing factors to perceived barriers to immunization were socioeconomic position and use of traditional Hmong healthcare. Traditional Hmong healthcare includes the use of a traditional Hmong healer shaman, who is used as a complement to Western medicine by Hmong patients. Health disparities faced by Hmong Americans are overlooked with combined data that do not disaggregate ethnic groups within the label, Asian American.


title: Hmong Americans

text: Hmong Americans have experienced violence after immigrating to the United States. Some specific instances of violence against Hmong Americans have been murders, of which a few have occurred while they were engaging in hunting. Hmong Americans have hunted because it is a common traditional practice in countries such as Laos, Cambodia, and Thailand. These are common countries from which the Hmong ethnic group has immigrated, although they do not have a specific home country. Chong Moua Yang, a Hmong American hunter, was murdered in Bath Township, Michigan on November 16, 2018. His murder, however, still remains unsolved.


title: Hmong Americans

text: In a 2018 study of 231 college students' experience and knowledge surrounding domestic violence, Takahashi and Lee found that two thirds were aware of domestic violence in their community, and 32.8% of Hmong women experienced violence. These domestic issues would be solved within clan systems and divorce is often not welcomed in order to maintain the relationship.


title: Hmong Americans

text: The Hmong language is spoken by approximately 4 million with about 5% residing in the United States. There are two main different dialects, Hmong Leeg and Hmong Dawb. In America, these are known as Hmong Leeg and White Hmong. Many of the vowel sounds are quite a bit different in these dialects compared to some of the Asian ones. In the United States, about 60% speak White Hmong and 40% speak Hmong Leeg. The Centers for Disease Control states "Though some Hmong report difficulty understanding speakers of a dialect not their own, for the most part, White and Hmong Leeg speakers seem to understand one another." As of 2012, Hmong in California are developing a Hmong-English online translator, in collaboration with Microsoft.


title: Hmong Americans

text: To maintain Hmong culture, history, and language, many organizations were created to conserve Hmong culture including the Lao Veterans of America, Lao Veterans of America Institute, Lao Human Rights Council, Hmong Advancement, Inc., Hmong Advance, Inc., United League for Democracy in Laos, Inc., Lao Family, Hmong National Development (HND) association and the "Hmong Today" and "Hmong Times" newspapers. In the case of kinship among other relatives in the United States, the Hmong people tend to stay in groups where there are much other Hmong residing. This allows them to share their cultural values and practices together.


title: Hmong Americans

text: White Hmong (Hmoob Dawb) and Hmong Leeg (Moob Leeg) are the two primary dialects spoken by Hmong Americans. The difference between the two dialects is analogous to the difference between American and British English; thus, both can understand each other easily. Green Hmong is named so because of the color used in Green Hmong women's traditional costume.


title: Hmong Americans

text: There is a misconception that Moob Leeg and Green Hmong are the same. Although their dialects are the same they are both different sub-groups of the Hmong. Moob Leeg is said to be the original spoken Hmong language.


title: Hmong Americans

text: It is seen that the majority of the Hmong American population is either White or Hmong Leeg, but with language, there can be some language barriers. For example, providing quality interpreter services can be difficult. Complicating communication issues is the fact that until the late 1960s no written form of the Hmong language existed, and many of the Hmong people were unable to read or write their own language. This makes the use of written materials for Hmong patients fairly useless. This kind of complication in communicating was able to be seen in Anne Fadiman's book, "The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures", where the Lees cannot read or write their own language and have trouble when their daughter Lia has to go to the hospital. Lack of literacy creates a barrier in being able to properly give Lia her medications.


title: Hmong Americans

text: From funerals to soul calling, Hmong rituals and ceremonies have been an important part of the Hmong cultural and spiritual experience. Since arriving in the United States in the late 1970s, many Hmong families still practice their rituals, but the number of traditional funerals preferred had dwindled due to a large number of Hmong, mostly the younger generations, converting to Christianity, lacking finances, and other reasons. Living in the United States also with jobs and school, there is not that much time to take a week off, which is how long most of these funeral rituals take.


title: Hmong Americans

text: There are several differences between traditional funeral rituals in Laos, Thailand and in the United States. Usually in Laos and Thailand funerals occur immediately in the home after a person dies. The person is dressed and then held within the hours at the home (Lee, 2009). Funerals can last three to four days and require washing and dressing the deceased, and conducting animal sacrifices to properly prepare the soul to be reincarnated.


title: Hmong Americans

text: On June 4, 2007, following a lengthy federal investigation labeled "Operation Flawed Eagle," warrants were issued by a California-based US federal court for the arrest of General Vang Pao, eight other Hmong people, and one non-Hmong person for allegedly plotting to overthrow the government of Laos in violation of the federal Neutrality Acts and various US weapons laws.


title: Hmong Americans

text: The federal charges allege that members of the group inspected weapons, including AK-47s, smoke grenades, and Stinger missiles, with the intent of purchasing them and smuggling them into Thailand in June 2007 for use in Hmong guerrilla war efforts against the Laotian government. The one non-Hmong person of the nine arrested, Harrison Jack, is a 1968 West Point graduate, and retired Army infantry officer. The defendants faced possible life prison terms for violation. Vang Pao and other defendants were ultimately granted bail, following the posting of $1.5 million in the property. Following the arrests, many Vang Pao supporters had called on President George W. Bush and California Governor Arnold Schwarzenegger to pardon the defendants. On September 18, 2009, the federal government dropped all charges against Vang Pao, announcing in a release that the federal government was permitted to consider "the probable sentence or other consequences if the person is convicted.” On January 10, 2011, charges against all of the remaining defendants were dropped as well.


title: Hmong Americans

text: The 2008 film "Gran Torino", directed by Clint Eastwood, was the first mainstream US film to feature Hmong Americans. Eastwood plays Walt Kowalski, an elderly, racist Korean War veteran living in Detroit, Michigan who befriends a Hmong teenager named Thao, played by Bee Vang, who previously tries to steal his Gran Torino as an initiation into a local Hmong gang run by his own cousins.


title: Hmong Americans

text: In the episode Body & Soul of the TV series "House", the team treats a Hmong child that is believed to be possessed by a dab, which the doctors, as well the child's mother attempt to disprove. Following an exorcism in order to free the dab from the child, his symptoms go away, which his mother and grandfather attribute to the exorcism, while the doctors believe it was the long shot treatment of Ibuprofen to treat his Patent ductus arteriosus that cured him.


title: Hmong Americans

text: At least two Hmong have been elected to high public office. In 2002, Mee Moua became the first Hmong American legislator when she was elected to fill the Minnesota State Senate seat vacated by Randy Kelly when he was elected mayor of St. Paul. She later became the Senate majority whip. Cy Thao is a member of the Minnesota House of Representatives.


title: Hmong Americans

text: At age 14, Joe Bee Xiong fought alongside American soldiers like his father had done. When their village fell to the Communists, Xiong and his family fled to a refugee camp in Thailand and eventually ended up in Wisconsin in 1980. In 1996, Xiong was elected to the Eau Claire, Wisconsin, city council. Xiong was the first Hmong to be elected to a city council in Wisconsin. He ran for the state Assembly in 2004. Xiong was traveling with family in his native country, Laos, when he died, possibly of heart-related complications. Wisconsin Congressman Ron Kind worked with Xiong to investigate reports of human rights abuses against Hmong still in Laos and Southeast Asia and says Xiong was a great community leader and an inspiration to many. Another Hmong, Thomas T. Vue, presently serves on the Eau Claire city council. Furthermore, Chue Neng Xiong was elected to the Eau Claire, WI school board and sworn into service on April 22, 2013.


title: Hmong Americans

text: Community leaders and organizations, including Dr. Wangyee Vang, Dr. Cherzong Vang, the Lao Veterans of America, the Lao Veterans of America Institute, the Center for Public Policy Analysis, the Lao Human Rights Council, and others, have sought to educate the public and policymakers about the important contribution of the Hmong people, and Lao Hmong veterans, during the Vietnam War in support of US national security interests. In 1997, the Lao Veterans of America dedicated a monument in Arlington National Cemetery, the Laos Memorial, to help honor the Hmong veterans and community for their service to the United States during the Vietnam War and its aftermath. Each year, in May, they continue to host annual ceremonies with members of the US Congress and other officials, to honor the service of the Hmong. Many Hmong elders and young people attend the ceremonies and events in Washington, D.C.


title: Hmong Americans

text: Sunisa "Suni" Lee of Saint Paul, Minnesota, is a three time Olympic gymnastic Medalist. In the 2020 Summer Olympics, she first won Silver in the Women's artistic team all-around, followed by Gold in the Women's artistic individual all-around and then Bronze in the Women's uneven bars. Suni is also the first Hmong-American Gymnast to perform in the Olympics.


title: Hmong Americans

text: In 2022 Sheng Thao became the first Hmong American woman elected mayor of a major city in the United States (Oakland).


title: Arturo Beltrán Leyva

text: Marcos Arturo Beltrán Leyva (September 27, 1961 – December 16, 2009) was a Mexican drug lord who, alongside his brothers, founded and led the Beltrán-Leyva Cartel. Prior to founding his own organization, Beltran-Leyva was a longtime high-ranking member of the Sinaloa Cartel. His organization was responsible for cocaine, marijuana, heroin and methamphetamine production, transportation and wholesaling. It controlled numerous drug trafficking corridors into the United States and was responsible money laundering gun-running and other acts of violence against men, women, and children in Mexico. The organization was connected with the assassinations of numerous Mexican law enforcement officials.


title: Arturo Beltrán Leyva

text: Since the mid-1990s Arturo Beltrán Leyva allegedly led powerful groups of assassins to fight for trade routes in northeastern Mexico. By 2008, through the use of corruption or intimidation, he was able to infiltrate Mexico's political, judicial and police institutions to steal classified information about anti-drug operations, and even infiltrated the Interpol office in Mexico.


title: Arturo Beltrán Leyva

text: The Beltrán Leyva brothers, who were formerly aligned with the Sinaloa Cartel, are now allies of Los Zetas.


title: Arturo Beltrán Leyva

text: The Beltrán-Leyva Cartel was founded and named after the brothers Arturo, Alfredo, Alberto, Carlos and Héctor Beltrán Leyva after they separated from the Sinaloa cartel, which was led by Joaquín Guzmán Loera a.k.a. "El Chapo".


title: Arturo Beltrán Leyva

text: Arturo Beltrán Leyva and his four brothers worked as underbosses and security chiefs for the Sinaloa cartel leaders. The breakaway from the Sinaloa Cartel was motivated by the capture of Alfredo Beltrán Leyva "El Mochomo" ('Desert Ant') by the Mexican military on January 21, 2008, which the brothers attributed to a betrayal by their boss Joaquín "El Chapo" Guzmán. After this incident, the Beltrán Leyva brothers and their lieutenants defected from the Sinaloa Cartel and allied themselves with the Gulf Cartel and Los Zetas.


title: Arturo Beltrán Leyva

text: Alfredo's influence had penetrated deep into the Attorney General of Mexico office by bribing Mexico's former drug czar, Noé Ramírez Mandujano and other top ranking officials. Ramírez Mandujano, who was the head of the country's top organized crime unit SIEDO, received US$450,000 per month to tip them off on the how, when and where any actions or operations against them would be taken.


title: Arturo Beltrán Leyva

text: On May 30, 2008, the United States Department of the Treasury sanctioned Beltrán Leyva under the Foreign Narcotics Kingpin Designation Act (sometimes referred to simply as the "Kingpin Act"), for his involvement in drug trafficking along with three other international criminals and three entities. The act prohibited U.S. citizens and companies from doing any kind of business activity with him, and virtually froze all his assets in the U.S.


title: Arturo Beltrán Leyva

text: On December 11, 2009, in Ahuatepec, Morelos, a town bordering Cuernavaca, Arturo Beltrán Leyva held a Christmas party at a house located in one of the most luxurious gated communities in Cuernavaca. He hired artists such as Ramón Ayala, Los Cadetes de Linares and more than 20 prostitutes to entertain his guests. The Mexican Navy's elite Special Forces unit surrounded the house and tried to capture him, but in the exchange of fire he escaped. Three gunmen were killed along with an innocent bystander (a neighbor) and more than 11 bodyguards were captured. Authorities confiscated US$280,000 in cash, 16 rifles (AK-47 and AR-15), 4 pistols, 74 rifle magazines and 1,700 rounds of ammunition.


title: Arturo Beltrán Leyva

text: Mexican Navy intelligence kept track on him and one week later, on December 16, 2009, he was traced to another luxurious apartment community where a 90-minute shootout ensued. About 200 Mexican Marines, two Navy Mil Mi-17 helicopters, from which marines rappelled, and two small Army tanks surrounded the building complex where he was hiding. Approximately 20 fragmentation hand grenades were used by Beltrán Leyva's gunmen to keep the Navy from advancing into his position.


title: Arturo Beltrán Leyva

text: Arturo Beltrán Leyva and three gunmen were killed; a fourth gunman committed suicide. Among the items seized by authorities during this raid, there were US$40,000 in cash, several thousand Canadian dollars, five assault rifles (AK-47 and AR-15), one pistol and several religious scapulars and medallions.


title: Arturo Beltrán Leyva

text: Analysts said the use of navy special forces was a notable development in the drug war because they are regarded as elite fighters who operate beyond the reach of corrupting influences.


title: Arturo Beltrán Leyva

text: The Mexican government had listed Arturo Beltrán Leyva as one of its 24 most-wanted drug lords and had offered a US$2.1 million reward for his capture.


title: Arturo Beltrán Leyva

text: Melquisedet Angulo Córdova, the Special Forces marine who was killed during the confrontation with Arturo Beltrán Leyva, was buried with military honors on December 21, 2009. The next day, a group of gunmen assassinated members of the marine's family, including his mother. Gudiel Ivan Sanchez was later arrested in Chiapas for his alleged role as one of the gunmen in the killings. While the December 22 shootings were taking place, a "narcomanta" (banner) was placed on a kindergarten school in the state of Morelos and a section of the school was set on fire. The 'narcomanta' warned of further reprisals against anybody interfering with the cartel's affairs.


title: Arturo Beltrán Leyva

text: A highly fictionalized portrayal of Beltran Leyva, renamed to "Bernal Leyda", is featured in the 2017 TV series "El Chapo".


title: Bob Bryar

text: Robert Cory Bryar (born December 31, 1979) is an American retired musician and sound engineer best known as the drummer of the rock band My Chemical Romance. The longest tenured and last official drummer, he performed in the band from 2004 until his departure in 2010.


title: Bob Bryar

text: Bryar joined the band replacing former drummer Matt Pelissier shortly after the release of their second studio album "Three Cheers for Sweet Revenge" (2004). He performed on all of the subsequent releases in support of the album, as well as the band's commercially successful concept album, "The Black Parade" (2006). Despite suffering numerous injuries while on tour, Bryar continued to tour with the band and joined them in the studio to record their fourth studio album before departing from My Chemical Romance in 2010. His most recent contribution was performing on the band's final release before their break-up in 2013, "Conventional Weapons". After his departure from the band, Bryar became a behind-the-scenes figure in tours for several bands before retiring from music in 2014. He subsequently became a real estate agent and an active supporter of dog rescue charities and sanctuaries.


title: Bob Bryar

text: Bryar was born in Chicago, Illinois, on December 31, 1979. He started playing drums at a young age, performing in his school's marching and jazz bands. After graduation, Bryar studied for a degree in sound engineering at The University of Florida Florida.


title: Bob Bryar

text: In 2000, Bryar began working as a touring sound engineer for rock bands including The Used and Thrice. During this time, he befriended My Chemical Romance while the band was on tour with The Used in 2004. Bryar became the drummer for My Chemical Romance after the band's tour in Japan, officially replacing former drummer Matt Pelissier shortly after the release of the band's second studio album "Three Cheers for Sweet Revenge" (2004).


title: Bob Bryar

text: Bryar was featured in all of the music videos for "Three Cheers for Sweet Revenge" (except the first version of the video for "I'm Not Okay"; he was featured in the second version), and also performed on all of the subsequent releases in support of the album including "Life on the Murder Scene" and "¡Venganza!". Bryar performed on My Chemical Romance's third studio album "The Black Parade" (2006). The album was favored by music critics and was a commercial success, being awarded double platinum status in the United Kingdom and the United States. Bryar and lead vocalist Gerard Way were injured during the filming of the music video for "Famous Last Words" directed by Samuel Bayer, with Bryar suffering third-degree burns on his hands and legs after he caught fire when he was too close to the flames. Their injuries caused the band to cancel their performance at the San Diego Street Scene festival. A month later, the band missed two tour dates after Bryar was hospitalized with a staph infection also caused during the filming of the music video. The band released a statement two days later, apologizing for cancelling shows, stating that they "want to be by his side the whole time". When the band went on The Black Parade World Tour in support of the album in February 2007, he began having complications in his wrist in November, causing the band to cancel their show in Maine. In response to his recent injuries, Bryar apologized on the band's MySpace, explaining that he has had problems with his wrist "over the past few years", and that he received a "golf ball-sized lump" in his wrist and began to "lose control and feeling in [his] fingers". He sat out for the tour and the band continued with Pete Parada as his temporary replacement. Although Bryar was unable to perform, he continued to tour with the band and assist with pyrotechnics and returned for the last leg of the tour in January 2008.


title: Bob Bryar

text: My Chemical Romance reentered the studio in 2009 to record their fourth studio album with producer Brendan O'Brien. On July 31 and August 1, they played two "secret" shows at the Roxy Theatre in Los Angeles, performing unreleased material from their upcoming album, including a song titled "Death Before Disco".


title: Bob Bryar

text: On March 3, 2010, rhythm guitarist Frank Iero announced on their official website that Bryar had departed from the band, writing:


title: Bob Bryar

text: The band released their fourth studio album "" in 2010 with Bryar being credited on writing five songs including the singles "Na Na Na (Na Na Na Na Na Na Na Na Na)" and "The Only Hope for Me Is You".


title: Bob Bryar

text: The band released "Conventional Weapons", a compilation album consisting of ten unreleased songs that were recorded in 2009 prior to Bryar's departure and the making of "Danger Days: The True Lives of the Fabulous Killjoys", all of which include Bryar performing drums. They released two songs each month from October 2012 to February 2013. My Chemical Romance broke up in March 2013.


title: Bob Bryar

text: After his departure, Bryar continued being involved in the music business as a behind-the-scenes figure in tours for several bands. On October 2, 2014, Bryar announced his departure from music, subsequently becoming a real estate agent. However, in February 2015, he announced his interest in returning to music.


title: Bob Bryar

text: On July 20, 2016, My Chemical Romance posted on their official Twitter and Facebook pages a video with the piano intro from "Welcome to the Black Parade", ending with a cryptic date, "9/23/16". The video was also published on the band's YouTube channel with the video titled "MCRX". This led to numerous rumors and reports on the band's possible reunion until it was revealed to be a reissue of "The Black Parade" with unreleased demos. The reissue, titled "The Black Parade/Living with Ghosts", includes 11 demos and live tracks. In September 2016, Bryar was featured in an exclusive interview with "Alternative Press" to promote the new album. In his first interview since departing from the band, Bryar recalled multiple memories of recording and touring "The Black Parade".


title: Bob Bryar

text: In January 2020, Bryar participated in a remembrance for Rush drummer Neil Peart, recalling his "teenage obsession" and friendship with Peart. In June 2021, Bryar announced that he was "permanently closing the book on [his] drumming days," citing his ongoing wrist issues, old age, weight, and his desire to pursue "something new."


title: Bob Bryar

text: During his time with My Chemical Romance, Bryar was known for using kits made by C&C, a custom drum company based in Gladstone, Missouri, paired with Sabian "Paragon" cymbals and Remo heads. Bryar played Vic Firth’s "ROCK" sticks, until switching to Vater’s "XD-Rock" sticks in 2007.


title: Bob Bryar

text: Bryar’s kits were notable for their bizarre specifications, with his tom drums being incredibly shallow in depth, and his snare drums being much deeper.


title: Bob Bryar

text: Since his departure from My Chemical Romance, Bryar has been very active in dog rescue charities and sanctuaries. In June 2021, Bryar auctioned his Helena-themed drum kit on eBay and dedicated the money to the Williamson County Animal Control and Adoption Center located in Franklin, Tennessee. In October 2022, Bryar auctioned his uniform from "The Black Parade" on eBay and dedicated the money to abandoned and sheltered animals in Florida and South Carolina that were affected by Hurricane Ian, stating that "it's just sitting in a box doing nothing and people need help with money right now."


title: Health system

text: A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.


title: Health system

text: There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary. As with other social institutional structures, health systems are likely to reflect the history, culture and economics of the states in which they evolve. These peculiarities bedevil and complicate international comparisons and preclude any universal standard of performance.


title: Health system

text: According to the World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, healthcare systems' goals are good health for the citizens, responsiveness to the expectations of the population, and fair means of funding operations. Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship. Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity. They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal.


title: Health system

text: Often health system has been defined with a reductionist perspective. Some authors have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered:


title: Health system

text: Most countries' systems feature a mix of all five models. One study based on data from the OECD concluded that all types of health care finance "are compatible with" an efficient health system. The study also found no relationship between financing and cost control.


title: Health system

text: The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a social insurance program, or from private insurance companies. It may be obtained on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. In each case premiums or taxes protect the insured from high or unexpected health care expenses.


title: Health system

text: By estimating the overall cost of health care expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is typically administered by a government agency, a non-profit health fund or a commercial corporation.


title: Health system

text: Many commercial health insurers control their costs by restricting the benefits provided, by such means as deductibles, co-payments, coinsurance, policy exclusions, and total coverage limits. They will also severely restrict or refuse coverage of pre-existing conditions. Many government systems also have co-payment arrangements but express exclusions are rare or limited because of political pressure. The larger insurance systems may also negotiate fees with providers.


title: Health system

text: Many forms of social insurance systems control their costs by using the bargaining power of the community they are intended to serve to control costs in the health care delivery system. They may attempt to do so by, for example, negotiating drug prices directly with pharmaceutical companies, negotiating standard fees with the medical profession, or reducing unnecessary health care costs. Social systems sometimes feature contributions related to earnings as part of a system to deliver universal health care, which may or may not also involve the use of commercial and non-commercial insurers. Essentially the wealthier users pay proportionately more into the system to cover the needs of the poorer users who therefore contribute proportionately less. There are usually caps on the contributions of the wealthy and minimum payments that must be made by the insured (often in the form of a minimum contribution, similar to a deductible in commercial insurance models).


title: Health system

text: In addition to these traditional health care financing methods, some lower income countries and development partners are also implementing non-traditional or innovative financing mechanisms for scaling up delivery and sustainability of health care, such as micro-contributions, public-private partnerships, and market-based financial transaction taxes. For example, as of June 2011, UNITAID had collected more than one billion dollars from 29 member countries, including several from Africa, through an air ticket solidarity levy to expand access to care and treatment for HIV/AIDS, tuberculosis and malaria in 94 countries.


title: Health system

text: In most countries, wage costs for healthcare practitioners are estimated to represent between 65% and 80% of renewable health system expenditures. There are three ways to pay medical practitioners: fee for service, capitation, and salary. There has been growing interest in blending elements of these systems.


title: Health system

text: Fee-for-service arrangements pay general practitioners (GPs) based on the service. They are even more widely used for specialists working in ambulatory care.


title: Health system

text: In capitation payment systems, GPs are paid for each patient on their "list", usually with adjustments for factors such as age and gender. According to OECD, "these systems are used in Italy (with some fees), in all four countries of the United Kingdom (with some fees and allowances for specific services), Austria (with fees for specific services), Denmark (one third of income with remainder fee for service), Ireland (since 1989), the Netherlands (fee-for-service for privately insured patients and public employees) and Sweden (from 1994). Capitation payments have become more frequent in "managed care" environments in the United States."


title: Health system

text: According to OECD, "capitation systems allow funders to control the overall level of primary health expenditures, and the allocation of funding among GPs is determined by patient registrations". However, under this approach, GPs may register too many patients and under-serve them, select the better risks and refer on patients who could have been treated by the GP directly. Freedom of consumer choice over doctors, coupled with the principle of "money following the patient" may moderate some of these risks. Aside from selection, these problems are likely to be less marked than under salary-type arrangements.'


title: Health system

text: In several OECD countries, general practitioners (GPs) are employed on "salaries" for the government. According to OECD, "Salary arrangements allow funders to control primary care costs directly; however, they may lead to under-provision of services (to ease workloads), excessive referrals to secondary providers and lack of attention to the preferences of patients." There has been movement away from this system.


title: Health system

text: In recent years, providers have been switching from fee-for-service payment models to a value-based care payment system, where they are compensated for providing value to patients. In this system, providers are given incentives to close gaps in care and provide better quality care for patients.


title: Health system

text: Sound information plays an increasingly critical role in the delivery of modern health care and efficiency of health systems. Health informatics – the intersection of information science, medicine and healthcare – deals with the resources, devices, and methods required to optimize the acquisition and use of information in health and biomedicine. Necessary tools for proper health information coding and management include clinical guidelines, formal medical terminologies, and computers and other information and communication technologies. The kinds of health data processed may include patients' medical records, hospital administration and clinical functions, and human resources information.


title: Health system

text: The use of health information lies at the root of evidence-based policy and evidence-based management in health care. Increasingly, information and communication technologies are being utilised to improve health systems in developing countries through: the standardisation of health information; computer-aided diagnosis and treatment monitoring; informing population groups on health and treatment.


title: Health system

text: The management of any health system is typically directed through a set of policies and plans adopted by government, private sector business and other groups in areas such as personal healthcare delivery and financing, pharmaceuticals, health human resources, and public health.


title: Health system

text: Public health is concerned with threats to the overall health of a community based on population health analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of several continents (for instance, in the case of a pandemic). Public health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are also important subfields.


title: Health system

text: Today, most governments recognize the importance of public health programs in reducing the incidence of disease, disability, the effects of ageing and health inequities, although public health generally receives significantly less government funding compared with medicine. For example, most countries have a vaccination policy, supporting public health programs in providing vaccinations to promote health. Vaccinations are voluntary in some countries and mandatory in some countries. Some governments pay all or part of the costs for vaccines in a national vaccination schedule.


title: Health system

text: The rapid emergence of many chronic diseases, which require costly long-term care and treatment, is making many health managers and policy makers re-examine their healthcare delivery practices. An important health issue facing the world currently is HIV/AIDS. Another major public health concern is diabetes. In 2006, according to the World Health Organization, at least 171 million people worldwide had diabetes. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will double. A controversial aspect of public health is the control of tobacco smoking, linked to cancer and other chronic illnesses.


title: Health system

text: Antibiotic resistance is another major concern, leading to the reemergence of diseases such as tuberculosis. The World Health Organization, for its World Health Day 2011 campaign, called for intensified global commitment to safeguard antibiotics and other antimicrobial medicines for future generations.


title: Health system

text: Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progress in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework adopted for the evaluation of the health systems performance. Like most social systems, health systems are complex adaptive systems where change does not necessarily follow rigid management models. In complex systems path dependency, emergent properties and other non-linear patterns are seen, which can lead to the development of inappropriate guidelines for developing responsive health systems.


title: Health system

text: An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening including human resources development using standard definitions, indicators and measures. In response to a series of papers published in 2012 by members of the World Health Organization's Task Force on Developing Health Systems Guidance, researchers from the Future Health Systems consortium argue that there is insufficient focus on the 'policy implementation gap'. Recognizing the diversity of stakeholders and complexity of health systems is crucial to ensure that evidence-based guidelines are tested with requisite humility and without a rigid adherence to models dominated by a limited number of disciplines. Healthcare services often implement Quality Improvement Initiatives to overcome this policy implementation gap. Although many of these initiatives deliver improved healthcare, a large proportion fail to be sustained. Numerous tools and frameworks have been created to respond to this challenge and increase improvement longevity. One tool highlighted the need for these tools to respond to user preferences and settings to optimize impact.


title: Health system

text: Health Policy and Systems Research (HPSR) is an emerging multidisciplinary field that challenges 'disciplinary capture' by dominant health research traditions, arguing that these traditions generate premature and inappropriately narrow definitions that impede rather than enhance health systems strengthening. HPSR focuses on low- and middle-income countries and draws on the relativist social science paradigm which recognises that all phenomena are constructed through human behaviour and interpretation. In using this approach, HPSR offers insight into health systems by generating a complex understanding of context in order to enhance health policy learning. HPSR calls for greater involvement of local actors, including policy makers, civil society and researchers, in decisions that are made around funding health policy research and health systems strengthening.


title: Health system

text: Health systems can vary substantially from country to country, and in the last few years, comparisons have been made on an international basis. The World Health Organization, in its "World Health Report 2000", provided a ranking of health systems around the world according to criteria of the overall level and distribution of health in the populations, and the responsiveness and fair financing of health care services. The goals for health systems, according to the WHO's "World Health Report 2000 – Health systems: improving performance" (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. There have been several debates around the results of this WHO exercise, and especially based on the country ranking linked to it, insofar as it appeared to depend mostly on the choice of the retained indicators.


title: Health system

text: Direct comparisons of health statistics across nations are complex. The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health systems in Australia, New Zealand, the United Kingdom, Germany, Canada and the United States. Its 2007 study found that, although the United States system is the most expensive, it consistently underperforms compared to the other countries. A major difference between the United States and the other countries in the study is that the United States is the only country without universal health care. The OECD also collects comparative statistics, and has published brief country profiles. Health Consumer Powerhouse makes comparisons between both national health care systems in the Euro health consumer index and specific areas of health care such as diabetes or hepatitis.


title: Health system

text: Ipsos MORI produces an annual study of public perceptions of healthcare services across 30 countries.


title: Health system

text: Physicians and hospital beds per 1000 inhabitants vs Health Care Spending in 2008 for OECD Countries. The data source is OECD.org - OECD.


title: Splatoon 2

text: The game received generally positive reviews upon release. As of March 2022, "Splatoon 2" had sold over 13.3 million copies worldwide, selling more than twice as many as its predecessor and making it one of the best-selling Switch games. A sequel, "Splatoon 3", was released on the Nintendo Switch on September 9, 2022.


title: Splatoon 2

text: Like its predecessor, "Splatoon 2" is a third-person shooter in which players control characters, known as Inklings and Octolings, and use colored ink as ammunition. Ink is also used to cover the ground, or any paintable surface, in order to swim or refill their ink tanks. Inklings and Octolings can morph between humanoid, or kid form, where they switch from walking and shooting, into squid form where they can quickly swim through ink of their own color, and replenish their ink supply, as well as return to full health.


title: Splatoon 2

text: The sequel adds new main, sub and special weapons, including dual-wield pistols called Dualies that allow the player to perform dodge rolls, shotgun-like weapons called Brellas that enable defensive maneuvers with folding shields, and jetpacks known as Inkjets. Like the previous game, it features the standard Turf War mode for Regular Battles, in which two four-player teams have three minutes to cover the most turf with their color of ink. "Splatoon 2" also maintains the first game's rotation of Splat Zones, Tower Control and Rainmaker for Ranked Battles, which is unlocked when you reach level ten, while also adding a new Clam Blitz mode. League Battles allow players to form teams with friends playing the same modes as in Ranked Battles, however, they removed tri-squad as a possible team option, making it so you can only create teams of two or four and for ranked battles the time limit is five minutes instead of three. A new mode, Salmon Run, allows up to four players to team up cooperatively to tackle waves of enemies called Salmonids and collect Boss Salmonids' eggs.


title: Splatoon 2

text: Once per month until July 2019, a "Splatfest" event was held in which players could choose one of two teams, usually based on common debates such as heroes versus villains and pancakes versus waffles. In addition, there were two collaborations during these Splatfests: Nickelodeon's "Rise of the Teenage Mutant Ninja Turtles" and "Super Smash Bros. Ultimate". Splatfest themes were usually announced two weeks in advance, and players were given the ability to choose their team in the game's lobby. Themes were usually region-specific and happen at different times of the month. The only mode available in a Splatfest was Turf War, but players could choose between normal and pro modes. Winning battles awarded 'clout' to the winning team, and at the end of the Splatfest, the winning side was decided by evaluating popularity and clout earned in both battle modes. All players who participate earn rare rewards, but players on the winning team receive a slightly higher cut. In July 2019, Nintendo announced that the final regular Splatfest would be held that month. However, bonus rematches of previous Splatfests were held in May 2020, August 2020, and October 2020. A Splatfest celebrating the 35th anniversary of "Super Mario Bros." was held in January 2021.


title: Splatoon 2

text: The game features a single-player campaign called Hero Mode, in which the player rescues captured Zapfish across various levels while fighting off evil Octarians. Unlike the previous game's single-player campaign which had a pre-determined weapon set, the player can now earn various weapons, some of which are required when playing levels for the first time. In addition to Sunken Scrolls that unlock artwork and in-game lore, players can collect Power Orbs to upgrade their Hero Mode weapons, and tickets that can be exchanged for temporary reward boosts in multiplayer battles, such as increased experience to level up quicker or more in-game money. Using a single weapon to beat all of the Hero Mode levels grants the player a Hero Weapon Replica (identical to the campaign weapon) to use in multiplayer matches. Players can also play multiplayer online through an internet connection or play locally, although local play requires multiple consoles and copies of the game. The game also features LAN support with an adapter accessory for local private tournaments. The game supports amiibo figures, which allow players to store their character's custom look and unlock additional content. Free post-release updates and events are ongoing.


title: Splatoon 2

text: "Splatoon 2" takes place approximately two years after the final Splatfest event of the first game, in which the pop idol Marie defeated her cousin and fellow Squid Sister, Callie. After having drifted apart in the months following the event, Marie worries that Callie was negatively affected by the result. After leaving Inkopolis to see her parents, Marie returns home to discover that the Great Zapfish that powers the city has gone missing again, as has Callie. Fearing that the evil Octarians are once more involved, Marie takes up her role as Agent 2 of the New Squidbeak Splatoon and recruits an Inkling from Inkopolis Square, the player character, to become Agent 4 and investigate.


title: Splatoon 2

text: With assistance from Marie and weapons expert Sheldon, Agent 4 makes their way through Octo Canyon fighting Octarians and recovering several stolen Zapfish, including ones powering the Octarians' war machines. They discover that Callie herself has sided with the Octarians after being brainwashed by their leader, DJ Octavio, who has escaped his imprisonment after his defeat in the first game and once more is using the Great Zapfish to power his new DJ stage, the Octobot King II. Marie arrives with Sheldon and frees Callie from her mind control, allowing them to help Agent 4 defeat Octavio. With the Great Zapfish safely returned to Inkopolis, the Squid Sisters happily reunite and resume their musical career.


title: Splatoon 2

text: A limited-time global multiplayer demo for the game, known as the ""Splatoon 2" Global Testfire", was released in March 2017. A special edition of Nintendo Treehouse Live was streamed during the first session, in which members of the Nintendo Treehouse participated in the demo. Similarly to the demo of the original game, it was only available to play for a specific time period, across six one-hour play sessions in one weekend. Another demo session demonstrating the game's Splatfest events was held on July 15, 2017.


title: Splatoon 2

text: The game was released worldwide on July 21, 2017. In Japan and Europe, neon-green and neon-pink Joy-Con controllers and "Splatoon"-themed Pro Controllers were released alongside the game. A game card-free version, which features a download code inside a game case instead of a game card, was also released in Japan, as well as a Switch hardware bundle including a download code for the game. A similar bundle was released in the United States as a Walmart exclusive.


title: Splatoon 2

text: New Amiibo figures of new Inkling Girl, Boy and Squid designs from "Splatoon 2" were released alongside the game. These figures, alongside previous "Splatoon" figures, unlock exclusive in-game clothing and music tracks and allow the player to save a loadout of weapons and clothing to the figure so they can be readily accessed at any time. Characters with these saved load-outs can be posed alongside the player for taking screenshots. Amiibo figures of Pearl and Marina from Off the Hook were released on July 13, 2018, and feature similar functionality to those already released, while a final trio of figures of Octoling Girl, Boy and Octopus designs were released in Japan and Europe on November 9, 2018, and in North America on December 7, 2018.


title: Splatoon 2

text: Like the previous game, "Splatoon 2" was continually updated post-release with free content. From launch, at least one new weapon was added to the game almost every week, while new stages and game modes were added at irregular intervals. In late April 2018, this changed to having a large group of weapons added every month instead, with new stages continuing to be added until October 2018. While these regular updates were originally due to continue for around a year after the game's launch, with monthly regional Splatfest events being held for around two years, the regular updates were later extended to last until the end of 2018. An expansion pack for the game's single-player mode, titled "Octo Expansion", was released on June 13, 2018.


title: Splatoon 2

text: The game's content update in December 2018 was announced as the final one, albeit with balancing patches and Splatfest events due to continue into Summer 2019, but it was later revealed that more smaller updates would release until July 2019.


title: Splatoon 2

text: Prior to "Splatoon 2"s reveal, clips of the game were featured in the announcement trailer for the Nintendo Switch. Its unanticipated appearance led to speculation by the media and public over whether or not the footage shown was that from a port of "Splatoon" or a sequel. It was also presented in the trailer in a way that promoted the game as an eSport, following investments by Nintendo in "Splatoon" eSport tournaments in late 2016.


title: Splatoon 2

text: "Splatoon 2" was officially unveiled to the public during the Nintendo Switch reveal presentation held in Tokyo on January 13, 2017, where it was announced for release in Q2/Q3 2017. The reveal was accompanied by a trailer featuring the game's new maps and weapons, and an on-stage appearance of producer Hisashi Nogami in-character as a scientist from the Squid Research Lab, a fictional scientific group from the game, which appeared in various promotional material for the original "Splatoon".


title: Splatoon 2

text: Similarly to the first game, "Splatoon 2" features Splatfest events that include crossovers with other brands, both from other Nintendo properties such as "Super Smash Bros. Ultimate" and third-party franchises including Teenage Mutant Ninja Turtles, McDonald's, Uniqlo, Nike, Sanrio, Meiji, and Pocky.


title: Splatoon 2

text: A manga series based on the game and illustrated by Sankichi Hinodeya began serialization in Shogakukan's "CoroCoro Comic" magazine in May 2017. It was published in North America by Viz Media in late 2017. A motion comic adaptation of the manga was announced in July 2017 and released on YouTube the following month.


title: Splatoon 2

text: "Splatune 2", a two-disc official soundtrack featuring music from the game by Toru Minegishi, Ryo Nagamatsu, and Shiho Fujii, was published by Enterbrain in Japan on November 29, 2017, debuting at number eight on "Billboard Japan" Hot Albums chart. A second soundtrack album, "Octotune," was released in Japan on July 18, 2018. This album features tracks added in the game's "Octo Expansion" DLC and other post-release updates, as well as a recording of the game's first live concert. It peaked at number five on the Hot Albums chart.


title: Splatoon 2

text: Similarly to the first game, a series of real-life virtual concerts featuring the game's signature band Off the Hook have been performed in various locations. Their first concert was held at Tokaigi 2018 in Japan on February 10, 2018, a second was performed at Polymanga in Switzerland on March 31, 2018, a third concert which featured a new song, "Nasty Majesty" from "Splatoon 2"s "Octo Expansion", was performed at NicoNico Chokaigi in Japan on April 28, 2018, a fourth concert was performed at Tokaigi Game Party 2019 in Japan on January 26, 2019, which featured more songs from the "Octo Expansion", and was the first concert to only feature Pearl and Marina, and a two-day concert featuring both the Squid Sisters and Off The Hook was performed at Nintendo Live 2019 on October 13–14, 2019, which featured performances based on previous concerts.


title: Splatoon 2

text: "Splatoon 2" received "generally favorable" reviews, according to review aggregator Metacritic. Critics stated that "Splatoon 2" retained what was great about the original game while adding new features to keep the game fresh. "Nintendo Life" praised the improved single-player campaign. "Destructoid" and "Game Informer" criticised the accessibility within the game's multiplayer modes—weapons couldn't be changed between matches at that time (though this was added in a later update), no split-screen play, and the Salmon Run mode is only playable online at certain times—but praised the new weapons and gameplay. "The Verge" blamed the lack of a built-in voice chat feature and ease of viewing the map for taking away from the multiplayer experience, yet still calling the game an improvement over the original. GameSpot cited "Splatoon 2" as "a fresh take on the already unique shooter" but pointed out that using a mobile app for voice communication made multiplayer more complicated than it needed to be. Game Revolution and GamesRadar both praised the colorful artstyle and depth of the multiplayer combat. IGN gave the game a score of 8.3/10—higher than the initial score of the original game but lower than its re-review—praising the "addicting" Salmon Run mode and improved graphics, while making similar complaints about the game's matchmaking system. "Electronic Gaming Monthly" and Nintendo World Report both stated that the game felt "more like "Splatoon 1.5"" than a true sequel to the original, but nonetheless complimented the game's new additions.


title: Splatoon 2

text: "Eurogamer" ranked the game 17th on their list of the "Top 50 Games of 2017", while "Polygon" ranked it 43rd on their list of the 50 best games of 2017. "The Verge" named "Splatoon 2" as one of their 15 Best Games of 2017. The game was nominated for "Best Switch Game" in both "Destructoid"s Game of the Year Awards 2017 and IGN's Best of 2017 Awards, the latter of which also nominated it for "Best Shooter" and "Best Multiplayer".


title: Splatoon 2

text: "Splatoon 2" debuted second on the UK software sales chart in its launch week, behind "Crash Bandicoot N. Sane Trilogy". It had 59% better first week sales than "Splatoon" and became the third biggest launch of a Switch game in that country. In Japan, "Splatoon 2" sold roughly 648,000 copies at retail within the first few days of its launch. Including download copies, the game had sold over two million in Japan by early 2018, making it the first home console game to do so in the country since 2010's "Wii Party". The game shipped 1.56 million copies in Japan and 3.61 million copies worldwide in its first fiscal quarter on sale. By June 2020, the game had sold 10.71 million copies worldwide, making it the ninth best-selling Switch game worldwide. As of March 2022, <nowiki>"</nowiki>Splatoon 2<nowiki>"</nowiki> had sold over 13.30 million copies worldwide, selling twice as much as its predecessor, and making it one of the best-selling Switch games.


title: Splatoon 2

text: On February 17, 2021, during a Nintendo Direct, Nintendo announced a teaser trailer for "Splatoon 3", also being released for the Switch and was set to be released on September 9, 2022. The teaser trailer revealed gameplay similar to that of "Splatoon 2", and revealed new items, weapons, and abilities, including an Ink Bow and a new apocalyptic design.


title: Brain Salad Surgery

text: Brain Salad Surgery is the fourth studio album by English progressive rock band Emerson, Lake & Palmer, released on 19 November 1973 by their record label, Manticore Records, and distributed by Atlantic Records.


title: Brain Salad Surgery

text: Following the tour in support of the last album, "Trilogy" (1972), the group acquired rehearsal facilities to work on new material, which would blend classical and rock themes. To control things, they launched their own record company, Manticore, in March 1973. The album was recorded from June to September at Olympic and Advision Studios and mixed in October 1973 at AIR Studios in London. As were all the group's previous works, it was produced by Greg Lake. The album includes a cover designed by H. R. Giger.


title: Brain Salad Surgery

text: Released to a mixed critical response, it has begun to receive more favourable reviews with time. "Brain Salad Surgery" continued the group's commercial success, reaching number 2 in the United Kingdom and number 11 in the United States, and eventually gaining Gold certifications in both countries. In its support, the trio embarked on their largest world tour to date, including a headlining spot at the California Jam festival.


title: Brain Salad Surgery

text: The album has been remastered/remixed and reissued numerous times, including stereo and 5.1 surround sound remixes by Jakko Jakszyk.


title: Brain Salad Surgery

text: After the release of their third album, "Trilogy", in July 1972, the group toured across Europe and the United States, playing in sold-out venues. By the beginning of 1973, Emerson, Lake & Palmer had become commercially successful in both the UK and the US.


title: Brain Salad Surgery

text: The group had become somewhat dissatisfied with their record label Atlantic Records for a lack of involvement. Around January 1973 Keith Emerson, Greg Lake, Carl Palmer, and their manager Stewart Young decided to form their own record company. Together, they bought an abandoned ABC cinema in Fulham, West London and converted it into a rehearsal room and company headquarters, which would later be named Manticore Records. Lake said: "We set up Manticore to try and make the entire record process as good as it could be. We were also aware of a number of artists who we knew were having problems getting their music released and getting a record deal". Since the group knew that they would not have enough time to run their company, Atlantic promoter Mario Medious, who had worked with the group since their debut album, was brought in to serve as the president of Manticore in April 1973. Atlantic handled distribution duties.


title: Brain Salad Surgery

text: Emerson, Lake & Palmer began working on new material at the end of 1972. As Lake explained in an interview, the group's previous record, "Trilogy", was recorded with the use of 24-track machines and featured too many overdubs that made the music very difficult to recreate properly on stage. So the trio agreed to record an album that they could perform live. The rehearsal facilities equipped in the former cinema allowed the group to play live, then write, play live again, write again, etc., resulting in a feeling of addressing an audience, that would be alluded to in the well-known line "Welcome back, my friends, to the show that never ends...".


title: Brain Salad Surgery

text: During writing sessions around the end of 1972 and the beginning of 1973, the first two tracks began to take shape. One of them was the first movement of what would become the dominating composition of the forthcoming album, the epic "Karn Evil 9", and the other was an adaptation of the 4th Movement of Alberto Ginastera's 1st Piano Concerto.


title: Brain Salad Surgery

text: At nearly 30 minutes long, "Karn Evil 9" would consist of three movements (called "impressions"). Due to time limitations, the first movement initially had to be split into two parts between sides one and two of the vinyl record. Although the original Atlantic CD retained the division of the suite, subsequent editions have presented it in an uninterrupted version. All music of the epic was written by Emerson and can be described as a futuristic fusion of classical and rock themes. Structurally, the first and third movements are separated by an extended instrumental passage in spite of the whole composition having initially been conceived as an instrumental. All lyrics in the first movement are credited to Lake. To assist in creating lyrics for the third movement, he brought in lyricist Pete Sinfield, with whom Lake had worked at the time he was in King Crimson. Sinfield had been planning to make a solo album and had asked Lake for help to release it on Manticore. Lake had agreed that the record label would support Sinfield's project and additionally suggested his contributing to lyrics for the group's next album. Sinfield recalled: "I was half way through making a solo album when Greg called me to say that Manticore wanted to release it. The catch was that he wanted me to collaborate on lyrics for a long piece that had begun to take shape". The main theme of the epic is the battle between artificial and natural intelligence, which would end with a man being taken over by the computer he had invented. It had initially been titled by Emerson as "Ganton 9" after a fictional planet to which all evil and decadence had been thrown out. However, Sinfield believed that the music Emerson had written sounded just like a carnival, and so he came up with the title "Karn Evil 9".


title: Brain Salad Surgery

text: The most recognisable section of "Karn Evil 9" is the second part of the first movement, containing the famous line "Welcome back, my friends, to the show that never ends...", which was eventually taken as the title of the group's second live album. It is often used as a song dedicated to the opening of sports seasons. It is also a common radio staple.


title: Brain Salad Surgery

text: Emerson had contemplated recording an adaptation of the 4th Movement ("Toccata concertata") of Ginastera's 1st Piano Concerto as far back as the beginning of 1971. He had heard the toccata for the first time when he was a member of The Nice and had been "struck with the music immediately". Emerson had not considered a possibility of Emerson, Lake & Palmer playing the piece until Palmer proposed to incorporate a drum solo into the trio's repertoire, which would be a core part of the composition. When Emerson played the toccata to Palmer, the latter approved it, and then, the piece was rehearsed by the entire group, although it was quite difficult, since Lake did not read music and Palmer was unable to apply a score written for piano to the drums.


title: Brain Salad Surgery

text: Both "Karn Evil 9: 1st Impression" and "Toccata" were included in the setlist for a series of concerts across Europe beginning at the end of March 1973. Around that time, a new semi-acoustic number, "Still...You Turn Me On", was introduced to the public. Written by Lake alone, the song has commonly been regarded as a necessary balance in the content, which is dominated by aggressive compositions. The next track intended for inclusion in the album was an adaptation of Hubert Parry's hymn "Jerusalem", with the lyrics from "And did those feet in ancient time", a short poem from the preface to William Blake's epic "". Finally, the last piece, which would make the album, was the honky-tonk piano-based song "Benny the Bouncer" composed by Emerson, with Lake and Sinfield writing the words.


title: Brain Salad Surgery

text: After the album was almost completely recorded, three additional tracks, which would be put on the shelf for a while, were written: the instrumental "When the Apple Blossoms Bloom in the Windmills of Your Mind I'll Be Your Valentine", credited to the entire group, "Tiger in a Spotlight" and the title song, both composed by Emerson, with Lake and Sinfield providing lyrics. "Brain Salad Surgery" was the first album to have no songwriting contributions from Palmer (aside from the drum solo in "Toccata"), who, nevertheless, has regarded it as his favourite by far.


title: Brain Salad Surgery

text: The recording sessions began in June 1973 at Olympic Studios in Barnes, London, with Lake, as he had done on the group's previous records, serving as the producer, and Chris Kimsey as the engineer. The only track committed to tape at Olympic was the first movement of "Karn Evil 9". Following a period of further writing, the work on the upcoming album continued in August at Advision Studios in Fitzrovia, London, with engineer Geoff Young. The second and third movements of "Karn Evil 9" were completed in the first half of that month, with the third impression being the first track to be recorded at Advision. The muse's sped-up and altered voice from the second movement and the 'computer' voice from the third movement were contributed by Emerson, and his only vocal credit in the trio's repertoire. In order to achieve the "computer" voice, he ran his voice through the Moog's ring modulator.


title: Brain Salad Surgery

text: Although an arrangement of Ginastera's toccata had been performed by the group on their European tour from March to April 1973, the composition had received additional instrumentation before its final version was recorded. Palmer had written a percussion movement with the use of eight specially developed drum synthesizers. This movement with an "atmospheric" electronic sound was inserted in the middle section of "Toccata". Soon after the adaptation was committed to tape in September, the group became aware that they did not have the rights to release this music. Emerson contacted Ginastera's publishers who responded that the composer would not allow any adaptation of his works, but they advised him to talk to him personally. So Emerson flew to Geneva to discuss the issue with Ginastera himself. Once Ginastera heard the new arrangement, he gave the authorization to use his piece. To quote Emerson: "He played our recording of "Toccata" on a tape recorder. After a few bars he stopped the tape ... and exclaimed 'Diabolic!' I thought he said 'diabolical' and expected him to show us the door. He had been listening to the tape in mono and our recording was in stereo. I jumped up and switched the machine to stereo hoping he would listen again. It transpired that he wasn't concerned about that at all. He listened again and declared 'Terrible!' which actually was a compliment. 'You've captured the essence of my music like no one else has before', the great maestro said."


title: Brain Salad Surgery

text: The next songs recorded at Advision were "Still...You Turn Me On" and "Jerusalem". The adaptation of the hymn is notable for the debut of the first polyphonic synthesizer in history, the Moog Apollo, which was just a prototype of the Polymoog at that time. Together with the Lyra monophonic and the Taurus bass synthesizers, it formed the Moog Polyphonic Ensemble, also known as the Constellation. The Apollo synthesizer was also used by Emerson on "Benny the Bouncer", which was the last track recorded for the album.


title: Brain Salad Surgery

text: The results of the four-month recording sessions were mixed in the first week of October 1973 at AIR Studios in London. The original mix was turned down by Emerson, Lake & Palmer, and as a result, most of the material was remixed once more to their satisfaction. The first mixes of several tracks have been released on some more recent reissues of the album.


title: Brain Salad Surgery

text: Since cover art for the impending album was required, Manticore manager Peter Zumsteg introduced Emerson to a popular artist, Hans Ruedi Giger, who was living in Zurich. In April 1973, as a part of their European tour, the group played a two-day concert there. After the concert, Emerson with Zumsteg visited the artist at his home. At that time, the working title for the album was Medious' expression "Whip Some Skull on Ya", which is translated as fellatio. Coincidentally, under the impact of the music, including Emerson, Lake & Palmer, Giger had just created a human skull-based triptych entitled "Work 216: Landscape XIX". When he revealed the triptych to his guests, Emerson immediately felt that it was completely appropriate for the album cover art.


title: Brain Salad Surgery

text: Subsequently, the album title was changed to "Brain Salad Surgery", which has the same meaning as "Whip Some Skull on Ya". The phrase was probably taken from the song "Right Place, Wrong Time" by Dr. John, which had been a hit single in summer 1973 and contains the line "I been running trying to get hung up in my mind, got to give myself a little talking to this time, just need a little brain salad surgery, got to cure this insecurity".


title: Brain Salad Surgery

text: Giger painted two new pieces approximately the actual size of the vinyl record entitled "Work 217: ELP I" and "Work 218: ELP II". The first painting was chosen by the group as the front cover. It contains the artist's distinctive monochromatic biomechanical artwork, integrating an industrial mechanism with a human skull and the new 'ELP' logotype, which was also designed by Giger and has been standard for Emerson, Lake & Palmer ever since. The lower part of the skull is covered by a circular screen, which displays the mouth and chin in its flesh-covered state, as well as what appears to be the top of a phallus below the chin, arising from the 'ELP' tube. Art director Fabio Nicoli insisted on a non-standard construction of the vinyl sleeve rather than being a normal gatefold. The front cover of the novelty triptych sleeve was split in half down the centre, except for the circular screen, which was attached to the right flap, and was opened up like a gate. Opening the flaps revealed the second painting, featuring the full face of a human female (modelled after Giger's partner Li Tobler) with ringlets of wire hair framing the closed eyes and multiple scars, including the infinity symbol and a scar from a frontal lobotomy. The illustration originally had the complete phallus, but when the artwork was presented to the record company, it was rejected and dismissed as pornographic. As Giger refused to take the penis off the painting, the group had another artist airbrush it into a shaft of glowing light. The back cover was entirely black with the large white lettering 'Brain Salad Surgery'. "Work 217: ELP I" was also used as a custom label, with the spindle of the turntable penetrating through the lips. The vinyl packaging included a 12-panel fold-out poster with photographs of Emerson, Lake, and Palmer, which were taken by Rosemary Adams.


title: Brain Salad Surgery

text: When Manticore Records went defunct in 1977, Atlantic Records reissued the album with the initial design as well as with an ordinary vinyl packaging, which consisted of simple non fold-out outer and inner sleeves. The 'face' painting was used as the back cover of the outer sleeve.


title: Brain Salad Surgery

text: After the exhibition "Giger in Prague" was closed on 31 August 2005, the two original 34×34 cm acrylic-on-paper paintings "Work 217: ELP I" and "Work 218: ELP II" were lost or stolen and have not yet been found.


title: Brain Salad Surgery

text: Prior to the album becoming available, British newspaper "New Musical Express" released an issue with an attached free promotional flexi disc on 10 November 1973. Packaged in a miniature facsimile of the original album sleeve, the one-sided flexi disc, playing at 33 1⁄3 rpm, contained the song "Brain Salad Surgery", along with excerpts from all five tracks of the forthcoming album. Being a late-recorded track, the title song had not been intended for "Brain Salad Surgery" and was not included in its track listing. However, it was later used as the B-side to the UK number two hit single "Fanfare for the Common Man" and ended up on the compilation of studio outtakes "Works Volume 2" (1977).


title: Brain Salad Surgery

text: "Brain Salad Surgery" was released in the United Kingdom on 19 November 1973 by Manticore Records and was available on vinyl record, cassette, and 8-track cartridge through distribution by Atlantic Records. The very first vinyl pressings were manufactured in the United States, along with the sleeves due to their non-standard construction. The album was a large seller, peaking at number 2 on the UK Albums Chart and spending there 18 weeks. It was held from the top spot for two weeks in a row only by "Tales from Topographic Oceans" from the arch-rival group Yes. On 1 March 1974, the album was certified Gold by British Phonographic Industry for sales in excess of 100,000 copies.


title: Brain Salad Surgery

text: In spite of the feeling that Lake's acoustic song "Still...You Turn Me On" stood out as an evident single choice, Emerson, Lake & Palmer did not select it for a release, both because Palmer did not play on the track and because it was least representative of the album or their general direction. Instead of that song, the group's interpretation of "Jerusalem" was chosen for the single, which would be backed with another studio out-take, "When the Apple Blossoms Bloom in the Windmills of Your Mind I'll Be Your Valentine". The single was released on 30 November 1973, but its success was inhibited by the BBC, which banned the song from airplay. As a result, "Jerusalem" failed to chart in the United Kingdom.


title: Brain Salad Surgery

text: In the United States, "Brain Salad Surgery" was released in December 1973 by Manticore on vinyl record, cassette, and 8-track cartridge, and distributed by Atlantic. Although no singles were issued, it climbed to number 11 on the "Billboard" 200 and stayed in the charts for 47 weeks, more than any other Emerson, Lake & Palmer album. It has been certified Gold by the Recording Industry Association of America for selling at least 500,000 copies in the United States.


title: Brain Salad Surgery

text: The album was released for the first time on CD, which was mastered by Barry Diament, in 1986. The earliest copies for the U.S. market were pressed in Japan. It was also released on CD in 1987 in West Germany under the Manticore label by RCA/Ariola and was the first to feature Karn Evil 9 playing in its entirety (While the tracks for Karn Evil 9 is split up, 1st Impression Part 1 & Part 2 does not fade out and fade in). Since then "Brain Salad Surgery" has been remastered/remixed, expanded, and reissued multiple times in different formats, with the studio outtakes "Brain Salad Surgery" and "When the Apple Blossoms Bloom in the Windmills of Your Mind I'll Be Your Valentine" having often been added as bonus tracks. In 1993, the album was remastered by Joseph M. Palmaccio. In 2000, Rhino Entertainment Company released a DVD-Audio containing a 5.1 surround sound mix, done by John Kellogg and Paul Klingberg.