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Psychometric Properties of the Japanese Version of the STarT Back Tool in Patients with Low Back Pain
Ko Matsudaira ,
* E-mail: kohart801@gmail.com
Affiliation Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
Hiroyuki Oka,
Norimasa Kikuchi,
Affiliations Clinical Study Support, Inc., Nagoya, Aichi, Japan, Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
Yuri Haga,
Affiliation Clinical Study Support, Inc., Nagoya, Aichi, Japan
Takayuki Sawada,
Sakae Tanaka
Affiliation Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
Ko Matsudaira,
Ko Matsudaira Hiroyuki Oka ... Sakae Tanaka
Background and Objective
The STarT Back Tool uses prognostic indicators to classify patients with low back pain into three risk groups to guide early secondary prevention in primary care. The present study aimed to evaluate the psychometric properties of the Japanese version of the tool (STarT-J).
An online survey was conducted among Japanese patients with low back pain aged 20–64 years. Reliability was assessed by examining the internal consistency of the overall and psychosocial subscales using Cronbach's alpha coefficients. Spearman's correlation coefficients were used to evaluate the concurrent validity between the STarT-J total score/psychosocial subscore and standard reference questionnaires. Discriminant validity was evaluated by calculating the area under the curves (AUCs) for the total and psychosocial subscale scores against standard reference cases. Known-groups validity was assessed by examining the relationship between low back pain-related disability and STarT-J scores.
The analysis included data for 2000 Japanese patients with low back pain; the mean (standard deviation [SD]) age was 47.7 (9.3) years, and 54.1% were male. The mean (SD) STarT-J score was 2.2 (2.1). The Cronbach's alpha coefficient was 0.75 for the overall scale and 0.66 for the psychosocial subscale. Spearman's correlation coefficients ranged from 0.30 to 0.59, demonstrating moderate to strong concurrent validity. The AUCs for the total score ranged from 0.65 to 0.83, mostly demonstrating acceptable discriminative ability. For known-groups validity, participants with more somatic symptoms had higher total scores. Those in higher STarT-J risk groups had experienced more low back pain-related absences.
The overall STarT-J scale was internally consistent and had acceptable concurrent, discriminant, and known-groups validity. The STarT-J can be used with Japanese patients with low back pain.
Citation: Matsudaira K, Oka H, Kikuchi N, Haga Y, Sawada T, Tanaka S (2016) Psychometric Properties of the Japanese Version of the STarT Back Tool in Patients with Low Back Pain. PLoS ONE 11(3): e0152019. https://doi.org/10.1371/journal.pone.0152019
Editor: Masahiko Sumitani, The University of Tokyo Hospital, JAPAN
Received: October 23, 2015; Accepted: March 8, 2016; Published: March 22, 2016
Copyright: © 2016 Matsudaira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper.
Funding: The authors received no specific funding for this work. Clinical Study Support, Inc. provided support in the form of salaries for authors NK, YH and TS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section.
Competing interests: The authors have the following interests. NK is a board member of Clinical Study Support, Inc. and co-authors YH and TS are employed by Clinical Study Support, Inc. HO has received grants to his institution from Pfizer, Inc. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.
Low back pain (LBP) is a major musculoskeletal problem in the general population from childhood to older adulthood, affecting more than 632 million people worldwide [1]. The 2010 Global Burden of Diseases, Injuries, and Risk Factors Study reported that LBP was the leading cause of disability among 291 diseases and injuries globally, and LBP ranked as the highest global cause of years lived with disability [2]. This highlights the high prevalence of LBP worldwide, and may also reflect the difficulty of successful LBP management. In primary care, approximately 85% of patients with LBP have no specific underlying causes or pathology [3]. Patients with non-specific LBP often experience recurrent pain, and the majority of these patients suffer from chronic pain [4–5]. Recurrent and chronic LBP may result in a serious social and economic burden.
Psychological factors have been widely acknowledged as contributors to the chronicity of LBP [6–7]. These factors include pain catastrophizing, fear-avoidance beliefs, and psychological distress. A number of previous reports suggested an association between psychological factors and poor long-term outcomes [5, 8–9]. In primary care, cognitive behavioral therapy focused on psychological factors is a dominant treatment approach for people with LBP [5]. To provide efficient, targeted care, it is becoming common to stratify patients with LBP according to their risk for poor long-term outcomes [10]. Significant clinical benefits and cost-effectiveness of stratified care compared with non-stratified physiotherapy practice have been demonstrated in a randomized clinical trial [11].
The STarT Back Tool (STarT) has been widely used to stratify patients with LBP according to risk for chronicity (Fig 1). The STarT was originally developed as a screening tool for prognostic indicators of back pain to help primary care clinical decision-making in the UK [12]. The STarT consists of 9 items. Items 1–4 evaluate physical factors, and items 5–9 assess psychosocial factors. The STarT classifies patients into three risk groups: patients with a total score of 0–3 are classified as low-risk; patients with a total score of ≥ 4 but a psychosocial subscore of ≤ 3 as medium-risk; and patients with a psychosocial subscore of ≥ 4 are classified as high-risk [12] (Fig 2). Targeted treatments have been developed for patients in each risk group: a minimal intervention by general practitioners or physiotherapists for the low-risk group, physiotherapy to address pain and disability for the medium-risk group, and psychologically-informed physiotherapy to address pain and disability as well as psychosocial obstacles to recovery for the high-risk group [11, 13, 14].
Fig 1. STarT Back Tool.
Response options for items 1–8 are "disagree" (0 points) or "agree" (1 point). Responses to item 9 are on a scale of 1–5: "not at all," "slightly," "moderately," "very much," or "extremely." The first three options ("not at all," "slightly," and "moderately") are scored as 0, and the remaining two options ("very much" and "extremely") are scored as 1. Items 1–4 constitute the physical subscale. Items 5–9 constitute the psychosocial subscale.
Fig 2. STarT Back Tool risk stratification.
Sub score Q5–9: psychosocial subscale.
Although the STarT has been translated into various languages, no validated Japanese version was available. In our previous study, we translated the original English version of the STarT into Japanese (STarT-J) and linguistically validated it [15]. As a next step, we conducted online surveys with Japanese people with LBP to evaluate the psychometric properties of the STarT-J. The present analysis aimed to evaluate the reliability and validity of the STarT-J in a large number of Japanese people with LBP, using cross-sectional data from these surveys.
To assess the psychometric properties of the STarT-J, we conducted online surveys collecting information on LBP in the Japanese population in January and February, 2014. Participants were recruited from an online panel provided by an Internet research company, UNITED, Inc. (Tokyo, Japan), which included approximately 1.25 million individuals aged 20–64 years registered as research volunteers. From these volunteers, 965,919 individuals were randomly selected and invited by e-mail to complete an online questionnaire on health problems associated with pain (first survey). We obtained 52,842 responses by the end of January 2014. Of these initial respondents, those who had LBP in the last 4 weeks were invited to complete another online questionnaire (secondary survey). LBP was defined as pain in the lower back experienced in the last 4 weeks that lasted for more than 1 day, according to the standard definition of LBP proposed by Dionne et al. [16]. Pain associated with menstruation or pregnancy and pain during a feverish illness were excluded. A diagram showing the lower back area (between the inferior costal margin and gluteal folds) was provided in the questionnaire. The secondary survey closed on 7 February 2014, when the total number of responses reached 2000. The mean (standard deviation [SD]) age of respondents in the secondary survey was 47.7 (9.3) years and 54.1% were male. We conducted two subsequent surveys, 6 and 24 weeks after the secondary survey, to follow up respondents and investigate their LBP condition. In the present analysis, we analyzed secondary survey data to evaluate the psychometric properties of the STarT-J.
We obtained approval from the Medical/Ethics Review Board of the Japan Labour Health and Welfare Organization, Kanto Rosai Hospital (Approval number: 2012–22). Participation was voluntary, and no personal information was collected. Although no written informed consent was obtained, submitting a completed questionnaire was considered as evidence of consent. Potential participants first read an explanation of the aim of the survey and only those who agreed to participate could proceed to the questionnaire. As an incentive, participants received reward points for online shopping from the Internet research company.
Development of the linguistically-validated STarT-J
In our previous study [15], the STarT was translated into Japanese and linguistically validated in a general cross-cultural adaptation process [17–19]. This process occurred in three steps: (1) forward-translation (English to Japanese), (2) back-translation (Japanese to English), and (3) cognitive debriefing. In the third step, we conducted a pilot study to assess if the questions and response scales were understandable and correctly interpreted by Japanese patients. After considering their feedback, and consultation with a specialist as necessary, we published the STarT-J [15].
We included a number of measures in the online questionnaires.
Pain.
The degree of pain associated with LBP during the last 4 weeks was assessed by a numerical rating scale (NRS), ranging from 0 (no pain at all) to 10 (the worst pain imaginable).
Disability caused by LBP.
We used the Roland—Morris Disability Questionnaire (RDQ) to assess the LBP-related disability participants experienced in their daily lives. The RDQ comprises 24 Yes/No questions. The total score ranges from 0 to 24, with a higher score indicating greater disability. In this study, we used the Japanese version of the RDQ, for which the reliability and validity have been previously confirmed [20].
Fear-avoidance beliefs.
Fear of pain can lead to avoidance of physical activity, an important indicator of a poor long-term LBP prognosis. The Fear-Avoidance Belief Questionnaire (FABQ), consisting of physical activity and work subscales, is widely used to assess fear-avoidance beliefs [21]. We used the FABQ physical activity subscale (FABQ-PA). The FABQ-PA score ranges from 0 to 30; a higher score indicates a stronger fear-avoidance belief. We also used the Tampa Scale of Kinesiophobia (TSK) [22–23], originally developed to measure the fear of movement or injury. The total TSK score sums the scores of 17 items (each rated on a scale of 1–4), and ranges from 17 to 68. A higher score indicates a higher level of kinesiophobia.
Catastrophizing.
Pain catastrophizing is also an important indicator of poor LBP prognosis. Catastrophizing was assessed using the Pain Catastrophizing Scale (PCS), originally developed to measure negative attitudes toward pain involving rumination, helplessness, and magnification. The PCS consists of 13 items. The total score ranges from 0 (no catastrophizing) to 52 (greater catastrophizing). We used the Japanese version of the PCS, for which the reliability and validity have been previously confirmed [24].
Depression and anxiety.
A 14-item self-assessment scale, the Hospital Anxiety and Depression Scale (HADS), was used to measure anxiety and depression. The HADS comprises anxiety and depression subscales, each with seven items. The total score ranges from 0 to 21, with a higher score indicating more mental distress. The validity and reliability of the Japanese version of the HADS have been previously confirmed [25].
General health status.
The EuroQol 5 Dimension (EQ-5D) [26] is an instrument that provides a simple, descriptive profile and single index value for general health status. The index score is derived from conversion of all responses, and ranges from −0.11 to 1.00. A score of 1 means "perfect health" and a score of 0 denotes "death."
Somatic symptoms.
Somatization was assessed using the 7-item somatization subscale from the Brief Symptom Inventory (BSI) [27]. Seven symptoms (faintness or dizziness, pains in the heart or chest, nausea or upset stomach, trouble getting your breath, numbness or tingling in parts of the body, feeling weak in parts of the body, hot or cold spells) are rated on a 5-point scale: "not at all," "a little bit," "moderately," "quite a bit," and "extremely." We used the linguistically validated Japanese version of the BSI-somatization subscale [28].
Data analyses
Participants' demographic and clinical characteristics were summarized using descriptive statistics. To examine floor and ceiling effects, percentages of respondents with total scores of 0 and 9 were calculated. Floor and ceiling effects were considered to exist when more than 15% of respondents had the lowest or highest possible score [29]. To examine the reliability of the STarT-J, we evaluated internal consistency by calculating Cronbach's alpha coefficients for the overall scale and the psychosocial subscale. An alpha index more than 0.70 is considered to indicate satisfactory internal consistency [30].
Concurrent validity was evaluated by measuring correlations between the previously described reference instruments and the STarT-J total score and psychosocial subscore using Spearman's correlation coefficients. Correlation coefficients were evaluated according to the criteria for correlation strength in psychometric validation proposed by Cohen: 0.10 representing a weak, 0.30 a moderate, and 0.50 a strong correlation [31].
To assess discriminant validity, we calculated the area under the curves (AUCs) for the total scores and psychosocial subscores against the reference standards. We defined cases using the following cut-off values: a RDQ score of ≥ 7 for disability, a PCS score of ≥ 20 for catastrophizing, a TSK score of ≥ 41 for fear-avoidance beliefs, and a HADS score of ≥ 8 for depression and anxiety. In addition, a single question was used to determine the presence of referred leg pain within the last 4 weeks. Discriminative ability was interpreted according to the same criteria as used in the original STarT study: 0.70 to < 0.80 indicating acceptable discrimination, 0.80 to < 0.90 indicating excellent discrimination, and ≥ 0.90 indicating outstanding discrimination [12].
For known-groups validity, to test whether the STarT-J scores differentiated participants with known differences, we examined 1) total scores among the groups with a different number of somatic symptoms, and 2) the number of absences due to LBP among the three risk groups (low, medium, and high) using the Jonckheere—Terpstra test. If participants responded "moderately," "quite a bit," or "extremely" to a BSI item, they were considered to have that somatic symptom. Participants were then categorized into three groups according to the number of somatic symptoms: no symptoms, one symptom, and two or more symptoms. With respect to the number of absences, days on which participants could not perform housework were counted, as well as absences from work. It was hypothesized that participants with more somatic symptoms would have higher total scores, and that participants in the high-risk group would have experienced more LBP-related absences.
All statistical analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA). The level of significance was set at 0.05.
Participant characteristics
The present analysis included data for 2000 Japanese patients with LBP. Table 1 presents a summary of participants' demographic and clinical characteristics. The mean (SD) age was 47.7 (9.3) years; 54.1% of participants were male. More than half (53.7%) of the participants had experienced LBP for more than 1 year. Most participants (92%) experienced recurrent LBP, and more than half (52.9%) reported having LBP 10 times or more.
Table 1. Participant characteristics: psychometric testing of the STarT-J (n = 2000).
Scores of the measures
The mean (SD) score for the STarT-J was 2.2 (2.1). No remarkable ceiling effect was observed as 0.9% of participants had the highest score of 9. However, a floor effect was observed as 23.4% of participants had the lowest score of 0. The score distribution for each item is shown in Table 2. Participants were classified into three risk groups according to their STarT-J score: 1557 (77.9%) into the low-risk group, 294 (14.7%) into the medium-risk group, and 149 (7.5%) into the high-risk group.
Table 2. Score distribution of STarT-J items and risk group distribution (n = 2000).
The Cronbach's alpha coefficients were 0.75 for the overall scale and 0.66 for the psychosocial subscale.
Concurrent validity
To examine concurrent validity, Spearman's correlation coefficients were used to measure correlations between the STarT-J total score/psychosocial subscore and the pain NRS, RDQ, FABQ-PA, TSK, PCS, HADS, and the EQ-5D (Table 3). The correlation coefficients for the total score ranged from 0.30 (HADS depression) to 0.59 (RDQ), demonstrating a moderate to strong correlation with these reference standards. Similarly, correlation coefficients for the psychosocial subscore ranged from 0.33 (FABQ-PA) to 0.54 (RDQ), demonstrating a moderate to strong correlation. Both the total score and psychosocial subscore were strongly negatively correlated with the EQ-5D (γ = −0.56 and γ = −0.53, p < 0.0001). In terms of the correlation with psychosocial measures, the total score was moderately correlated with the TSK (γ = 0.49), whereas the psychosocial subscore was strongly correlated (γ = 0.53). Moderate correlation coefficients were observed for both the total score and psychosocial subscore with the PCS (γ = 0.46 and γ = 0.49) and the HADS (γ = 0.40 and γ = 0.45) (p < 0.0001 for all).
Table 3. Spearman's correlation coefficients for the STarT-J and related measures.
Discriminant validity
To assess discriminant validity, AUCs were calculated for the total score and psychosocial subscore against the cases defined by the reference standards (Table 4). The AUCs for the total score were all above 0.70, indicating acceptable to excellent discriminative ability, with the exception of depression and anxiety (0.65). For the psychosocial subscore, the AUCs ranged from 0.67 (depression and anxiety) to 0.79 (disability), indicating poor to acceptable discriminative ability.
Table 4. AUCs for STarT-J total score and psychosocial subscore against reference standards.
Known-groups validity
We examined the STarT-J total scores and risk groups among participants with known-differences. As hypothesized, participants with more somatic symptoms had higher total scores. The mean (SD) score of participants with no somatic symptoms was 1.71 (1.76), one somatic symptom was 2.73 (2.14), and two or more somatic symptoms was 3.76 (2.50) (Fig 3). A linear increasing trend in total score across groups with an increasing number of somatic symptoms was observed (Jonckheere-Terpstra test, p < 0.0001). With respect to the associations between risk groups and the number of absences, participants in the high-risk group reported a larger number of absences (Fig 4). The mean (SD) LBP-related absences in the low-risk group was 4.0 (5.4) days, 6.6 (8.3) days in the medium-risk group, and 12.6 (11.1) days in the high-risk group. A linear increasing trend in the number of absences across the risk groups was observed (Jonckheere-Terpstra test, p < 0.0001).
Fig 3. Mean STarT-J scores for participants with different numbers of somatic symptoms.
The linear trend was tested using the Jonckheere-Terpstra test (p < 0.0001). STarT-J: The Japanese version of the STarT Back Tool. Number of somatic symptoms was assessed by the Brief Symptom Inventory somatization scale: a response of "moderately," "quite a bit," or "extremely" to an item was interpreted as the presence of that somatic symptom, and thus counted.
Fig 4. Mean number of absences for the three STarT-J risk groups.
The linear trend was tested using the Jonckheere-Terpstra test (p < 0.0001). STarT-J: The Japanese version of the STarT Back Tool.
In this analysis, we evaluated the psychometric properties of the STarT-J. In summary, the overall scale of the STarT-J was internally consistent, and the STarT-J had acceptable concurrent validity, discriminant validity, and known-groups validity in Japanese patients with LBP.
The Cronbach's alpha coefficient for the overall scale (0.75) demonstrated sufficient internal consistency, and was similar to the original and other language versions: 0.79 for the original [12], 0.74 for the French [32], 0.74 for the Brazilian Portuguese [33], 0.82 for the Iranian [34], and 0.83 for the Persian [35] versions. Although these results could not be compared directly because the study methods varied, the similar values support that the overall scale of the STarT-J is internally consistent and no items are redundant. The Cronbach's alpha coefficient for the psychosocial subscale was 0.66, below the value of 0.70 considered necessary to claim the subscale is internally consistent. However, it should be taken into consideration that the coefficient for the subscale was also lower than for the overall scale in the original version, although it was still 0.74 [12].
To assess concurrent validity, we analyzed the correlations between the STarT-J and reference standards (the pain NRS, RDQ, FABQ-PA, TSK, PCS, HADS, and EQ-5D). Overall, the Spearman's correlation coefficients indicated that both the total score and the psychosocial subscore were moderately to strongly correlated with these existing scales. In particular, the STarT-J total score was strongly correlated with the RDQ (γ = 0.59). Similar results were observed in the German (γ = 0.55) [36], French (γ = 0.74) [32], and Persian (γ = 0.811) [35] versions. Although a direct comparison cannot easily be made, these similar results reinforce the concurrent validity of the STarT-J.
Discriminant validity was assessed by calculating the AUCs for the total score and the psychosocial subscore. For the total score, the AUCs for disability and referred leg pain were both higher than the AUCs for fear-avoidance beliefs, catastrophizing, and depression and anxiety. This demonstrated that the total score better discriminated cases defined by physical reference standards. However, for the psychosocial subscore, the AUCs for fear-avoidance beliefs, catastrophizing, and depression and anxiety were not remarkably higher than AUCs for the physical reference cases. These AUCs for the psychosocial reference cases were similar to those for the total score, indicating the psychosocial subscale might discriminate cases defined by the psychosocial reference standards at a similar level to the overall scale. A similar trend was observed in the original STarT [12], although overall, the AUCs were higher compared with the STarT-J.
To assess known-groups validity, we investigated relationships between total scores and the number of somatic symptoms, and between risk groups and the number of absences. Participants with more somatic symptoms had higher total scores, and those in the high-risk group had experienced greater LBP-related disability. This demonstrated that the STarT-J can differentiate patients with different levels of LBP-related problems.
The present study has some limitations. First, we did not examine the test—retest reliability. The intra-class, test—retest reliability over specific time intervals should therefore be evaluated in a future study. Second, the analysis might have included patients not targeted by the STarT, that is, patients who had specific causes of LBP. The diagnostic triage for LBP is to classify LBP into one of three categories: LBP with specific pathologic change ("red flag"), LBP with sciatica/radicular syndrome, or non-specific LBP [37]. According to this classification, six of the participants in the present analysis were probable "red flags," 308 had radicular syndrome, and the remaining 1686 participants were considered to have non-specific LBP. As the original study included patients with non-specific LBP who had referred leg pain [12], the STarT is considered applicable to patients with LBP potentially associated with sciatica/radicular syndrome. Therefore, assuming diagnoses were accurate, most participants probably fit into the STarT target group. However, it should be noted that these diagnoses might not necessarily be accurate as they were based on participants' self-report. Third, the study population might not be consistent with the primary care population. Our study included more low-risk participants and less high-risk participants compared with the original study [12]. This might be because we recruited from a general Japanese population registered with an online panel rather than from patients in hospitals. Our study population would therefore represent the general Japanese population with LBP. As the observed floor effect suggests, more patients might have LBP that was not sufficiently severe to require hospital care. Although our study population was broader than the primary care population, the percentage of patients with non-specific LBP was similar to that observed in primary care settings. In our study, 1686 participants (84.3%) probably had non-specific LBP. In primary care, approximately 85% of patients with LBP have non-specific LBP [3]. Therefore, our study population resembled the primary care population in terms of the distribution of non-specific LBP. Fourth, as this was a cross-sectional study, it did not assess the ability of the STarT-J to predict chronicity of LBP. To assess its predictive ability, longitudinal studies will be necessary to investigate associations between risk groups and long-term outcomes of patients with LBP.
In the present analysis, we evaluated the psychometric properties of the STarT-J to enable Japanese clinicians to use the scale in the early stages of LBP. The STarT is a simple and quick tool, and is suitable for use in primary care settings. Stratified care is a dominant approach in the management of LBP [10]. Stratified care based on the STarT risk groups has been shown to be clinically and economically beneficial for patients with LBP [11, 38]. Therefore, we expect that the STarT-J may facilitate early stratified care in primary care settings in Japan. This may alleviate the physical, social, and economical burden of LBP in the Japanese population.
In conclusion, acceptable internal consistency for the overall STarT-J scale demonstrated the reliability of the STarT-J in Japanese patients with LBP; acceptable concurrent validity, discriminant validity, and known-groups validity demonstrated the validity. In a subsequent analysis, the ability of the STarT-J to predict chronicity of LBP will be examined using longitudinal data, to validate its clinical use in Japanese patients.
We thank all those who participated in our online surveys.
Conceived and designed the experiments: KM HO ST. Performed the experiments: KM HO. Analyzed the data: KM HO NK YH TS ST. Contributed reagents/materials/analysis tools: KM HO. Wrote the paper: KM HO NK YH TS ST.
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27. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13: 595–605. pmid:6622612
28. Matsudaira K, Inuzuka K, Kikuchi N, Sakae C, Arisaka M, Isomura T. Development of the Japanese version of the brief symptom inventory-somatization scale: translation and linguistic validation. Seikei Geka (Orthopedic surgery). 2012;63: 149–53. Japanese.
29. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60: 34–42. pmid:17161752
30. Nunnally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978.
31. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
32. Bruyere O, Demoulin M, Beaudart C, Hill JC, Maquet D, Genevay S, et al. Validity and reliability of the French version of the STarT Back screening tool for patients with low back pain. Spine (Phila Pa 1976). 2014;39: E123–8.
33. Pilz B, Vasconcelos RA, Marcondes FB, Lodovichi SS, Mello W, Grossi DB. The Brazilian version of STarT Back Screening Tool—translation, cross-cultural adaptation and reliability. Braz J Phys Ther. 2014;18: 453–61. pmid:25372008
34. Azimi P, Shahzadi S, Azhari S, Montazeri A. A validation study of the Iranian version of STarT Back Screening Tool (SBST) in lumbar central canal stenosis patients. J Orthop Sci. 2014;19: 213–7. pmid:24343300
35. Abedi M, Manshadi FD, Khalkhali M, Mousavi SJ, Baghban AA, Montazeri A, et al. Translation and validation of the Persian version of the STarT Back Screening Tool in patients with nonspecific low back pain. Man Ther. Epub 2015 Apr 15.
36. Aebischer B, Hill JC, Hilfiker R, Karstens S. German Translation and Cross-Cultural Adaptation of the STarT Back Screening Tool. PLOS ONE. 2015;10: e0132068. pmid:26161669
37. Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine (Phila Pa 1976). 2001;26: 2504–13; discussion 2513–4.
38. Foster NE, Mullis R, Hill JC, Lewis M, Whitehurst DG, Doyle C, et al. Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Ann Fam Med. 2014;12: 102–11. pmid:24615305
Is the Subject Area "Pain" applicable to this article?
Is the Subject Area "Depression" applicable to this article?
Medical risk factors
Is the Subject Area "Medical risk factors" applicable to this article?
Is the Subject Area "Psychometrics" applicable to this article?
Psychological and psychosocial issues
Is the Subject Area "Psychological and psychosocial issues" applicable to this article?
Is the Subject Area "Anxiety" applicable to this article?
Is the Subject Area "Primary care" applicable to this article?
Is the Subject Area "Lower back pain" applicable to this article?


text:
The Homosexual "Marriage" Divide-Which Side of The Rampart Will You Be on?
AbbyMcGinnis
Catholic Church, Christians, culture, family, Gay marriage, homosexual marriage, homosexuality, morals, Pope Francis, Ross Douthat, sin, society, st augustine, values
Which Side Of The Homosexual Rampart Will You Be Fighting On?
Mandeville, LA – Exclusive Transcript – "This is a point of reference here that, if you know someone that's homosexual and is trying to be Christian and Catholic, it is possible. You just have to take the same vow of celibacy that a monk takes. You cannot commit mortal sin of relations outside of the marital bond. You're not going to get a sacramental marital bond as a homosexual. It's not going to happen." Check out today's transcript for the rest….
Begin Mike Church Show Transcript
[reading]
In the week since, many Catholics have downplayed the starkness of what happened or minimized the papal role. Conservatives have implied that the synod organizers somehow went rogue, that Francis' own views were not really on the table, that orthodox believers should not be worried. More liberal Catholics have argued that there was no real chaos — this was just the kind of freewheeling, Jesuit-style debate Francis was hoping for — and that the pope certainly suffered no meaningful defeat.
[end reading]
Mike: Oh yes, he did. Meaningful is an understatement. It was a landslide against the initiative when the final votes were tallied.
Neither argument is persuasive. Yes, Francis has taken no formal position on the issues currently in play. But all his moves point in a pro-change direction — and it simply defies belief that men appointed by the pope would have proposed departures on controversial issues without a sense that Francis would approve.
Mike: Folks, again, I have to reiterate, not everything he says is infallible. You are also in charge of defending what you know to be doctrinal and canonical and dogmatic.
[private |FP-Monthly|FP-Yearly|FP-Yearly-WLK|FP-Yearly-So76|FP-Founding Brother|FP-Founding Father|FP-Lifetime]
You are just as culpable and answerable in your and my defense of these things as he is. He is just appointed, blessed, the Vicar of Christ. He has a distinction. Vicar is Latin for "voice of."
If this is so, the synod has to be interpreted as a rebuke of the implied papal position. The pope wishes to take these steps, the synod managers suggested. Given what the church has always taught, many of the synod's participants replied, he and we cannot.
Over all, that conservative reply has the better of the argument. Not necessarily on every issue: The church's attitude toward gay Catholics [Mike: If there is such a thing.], for instance, has often been far more punitive and hostile than the pastoral approach to heterosexuals living in what the church considers sinful situations, and there are clearly ways that the church can be more understanding of the cross carried by gay Christians.
Mike: This is a point of reference here that, if you know someone that's homosexual and is trying to be Christian and Catholic, it is possible. You just have to take the same vow of celibacy that a monk takes. You cannot commit mortal sin of relations outside of the marital bond. You're not going to get a sacramental marital bond as a homosexual. It's not going to happen. So, yes, you can be a homosexual, but you would be under the same prohibition that those heterosexuals living in — I've tried to explain this to someone the other day. I said: Look, heterosexuals are under the exact same sexual prohibition and on the exact same dogmatic prohibitions that homosexuals are. They're similar, almost identical. The partners are different, but the admonition against the sin is the same. There is no difference.
Folks, that's an important point. We talked yesterday on this show that about 40 percent of children born in these United States this year are going to be born as bastards, out of wedlock. That is a societal calamity. It is a tsunami coming our way of epic proportions that no civilization is going to survive unscathed. That's the fact. The only way to curb this is to curb the behavior. The only way to curb the behavior is to provide supernatural reasons why the behavior should not occur, thus religion. It's not that hard to figure some of this stuff out. People want to make it hard because they think: No, man has a solution for me. Man has failed miserably. We've been on the course charted by Margaret Sanger and her murderous, genocidal gang for the last 80, 90 years. It's not working out for the benefit of the children or the grandchildren. It's certainly not working out for the benefit of those that will never be born as a result of it. We have to start somewhere. This is as good a place as any to start.
[mocking] "Mike, get back to bashing Obama and politics." Again, politics is easy. We did some politics at the end of the first hour and we'll do them at the end of this hour and next hour. Meanwhile, this stuff is important, more important. It's civilizational. If we erected a government and made it in our image, which we did, we can do it again. [mocking] "We don't have men like the founding fathers." No, you don't have men that are publicly known like founders. They're out there, they're just not publicly known. Don't tell me there aren't men that aren't educated classically and liberally, and I mean liberally in the 16th century Jesuit sense of the term. That's baloney, absolute baloney. Back to Douthat.
Such a reversal would put the church on the brink of a precipice. Of course it would be welcomed by some progressive Catholics [Mike: If there is indeed such a thing] and hailed by the secular press. But it would leave many of the church's bishops and theologians in an untenable position, and it would sow confusion among the church's orthodox adherents . . .
These adherents are, yes, a minority — sometimes a small minority — among self-identified Catholics in the West. But they are the people who have done the most to keep the church vital in an age of institutional decline: who have given their energy and time and money in an era when the church is stained by scandal . . .
Mike: Douthat is a layperson, folks. He's right on all these points. He's correct. Imagine, this stuff is being published in the New York Times, the center, the epicenter of the demonic possession. Well, Mordor is the center but this is the northern center. This is the northern branch field office. You guys and gals living in New York City, you are living among the most demonic, diabolical, despicable people that have been lived among in the history of the earth. It is nothing short of a miracle or nothing short of — two things: things only happen, number one, because God wants them to happen, and number two, because he allows them to happen. He does not want to strike any of you down with lightning bolts, although I keep imagining that that day can't be far off. What Douthat is writing about here is, by and large, correct.
They have kept the faith among moral betrayals by their leaders; they do not deserve a theological betrayal.
Which is why this pope has incentives to step back from the brink — as his closing remarks to the synod, which aimed for a middle way between the church's factions, were perhaps designed to do.
Francis is charismatic, popular, widely beloved. He has, until this point, faced strong criticism only from the church's traditionalist fringe, and managed to unite most Catholics in admiration for his ministry. [Mike: Unfortunately that ministry is not conducive to and is not reflective of doctrinal thinking. This is a problem.] There are ways that he can shape the church without calling doctrine into question. . . He can be, as he clearly wishes to be, a progressive pope, a pope of social justice — and he does not have to break the church to do it.
But if he seems to be choosing the more dangerous path — if he moves to reassign potential critics in the hierarchy, if he seems to be stacking the next synod's ranks with supporters of a sweeping change — then conservative Catholics will need a cleareyed understanding of the situation.
They can certainly persist in the belief that God protects the church from self-contradiction. But they might want to consider the possibility that they have a role to play, and that this pope may be preserved from error only if the church itself resists him.
Mike: This is key. That is the key point in Douthat's piece in Sunday's New York Times editorial page, republished all around the country and all around the globe for that matter. That's the key point. The idea here that we are but a bunch of pedestrian serfs serving at the eternal and perpetual will of a pontiff who may be in error is not correct. He is fallible in some of the things that he does, just like we are fallible. He is capable of error, he is. This is why councils and tribunals are convened, to prevent the error or to correct the error. From time to time those encyclicals are issued. It takes a long time to write these things.
The key point here is that there are those who, for the reasons of their devoutness, who are standing and who will stand in opposition to this, meaning to a change in the way Western civilization defines and treats and promotes the family and family life. You have to, regardless of denomination. It shouldn't matter. We talked about this yesterday. We all have to do this, all of us. If we don't defend it, then there will be nothing left to defend. If you leave it up to the same nitwits that have given us Ebola, the same nitwits that have given us the NSA, that have given us the IRS, that have given us 24/7 soft-core porn on television, what do you think they're going to give us for families? There won't be any. It will only be a bunch of people that resemble the blessed Amish who refused modernity with every fiber of their being and still refuse it today, and there will be the rest of them. They will curse us, they will ostracize us, and it may even come down to martyrdom to get rid of us. [/private]
The newly available, Founding Father Films, Audio CD-Trilogy Set. Over 9 hours of American History, Family Friendly entertainment at one low price.
Folks, this is the battle. You can think that the battle is all political. It's not. The battle line is being drawn. We can see the ramparts. Which side of the rampart are you going to be on? Which side of the rampart are you going to pick a shield up on, gentlemen? Which side of the rampart are you going to pick a lance up on, gentlemen? Which side of the rampart are you willing to defend, the one that got us here as God created us, as the heirs and descendants of all of Christendom and of all the history of his work and his magisterium since he walked the earth 2000 years ago? Are you going to be on that side, or are you going to be on the side of the diabolical hordes that wish to conquer it and wish to try to vanquish it? Which side are you going to be on?
St. Augustine wrote a great book about this called The City of God. There are two cities: the city of man and the city of God. Most people, including most Christians unfortunately, and including, even more sadly and tragically, most "Catholics" want to be citizens of the city of man. They don't want to be citizens of the city of God. It's hard; it's difficult. It's the road less traveled. It's the road that doesn't hold out the rewards of fancy cars and big televisions and McMansions. People are taught from birth in the Western world today to aspire to those things and curse the others. You don't want to live a life of penance. That's horrible. Why would anyone want to live like Mother Teresa, for Heaven's sake? Why would anyone want to live a life of service, a life of being a good neighbor, being a good friend, being a good father and mother and having that take precedent over any earthly endeavor you can imagine? Are we the generation that holds the line or are we the generation that surrenders the line and is accursed by history? We have a choice in this matter.
End Mike Church Show Transcript
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redpajama_set_name: RedPajamaCommonCrawl


If you're into birding then you'll love Mkhuze Game Reserve – its home to some 400-odd different species which have flourished in the park's swamps and woodlands. For bigger mammal lovers like myself, the park has four of the Big Five (no lion) as well as nyala, wildebeest, warthog, impala, kudu and other smaller antelope. The park also offers rare sightings of hyena – heard but sadly not seen in my experience. Birders should make sure they take a stroll through the Fig Forest which provides numerous bird and monkey sightings, while the three hides offer excellent viewing of the larger mammals. At Nsumo Pan Hide I easily spied hippo and crocodiles and at Kumahloha hide I was amazed by the constant parade of wildlife coming down to the pan including rhino, giraffe, kudu, wildebeest, zebra and baboons.
Mkhuze features the usual acacia savannah, but as it lies just to the northwest of the iSimangaliso Wetland Park, it also features tropical swamps and well-watered riverine forest. The roads were easy to navigate, but some passed through areas of thick bush, which were not ideal for game viewing. The grasslands, however, were more open, where we found giraffe, wildebeest, kudu and nyala, and at the airstrip we were lucky to see cheetah (they love the flatness of airstrips). Although I did see rhino, they aren't as prolific as in Hluhluwe-Imfolozi. At the pans, we were able to get out of the car and walk down to some hides to watch the many aquatic birds. Mkuze's appeal is its location; easily accessed off the N2 highway and not far from the coast, offering a good combination of safari options with the other Maputaland reserves.
The best thing about Mkhuze Game Reserve are the hides. As a photographer, I can sit in one of these perfectly designed hides all day. Kumasinga hide in particular tends to be very rewarding. The water surrounds the hide, so animals can approach from any direction. In fact, at times, you are literally surrounded by animals while sitting inside. There is usually a constant stream of animals coming to drink. Nyala, impala and warthogs are almost a constant presence. Rhinos often come alone or in small groups and a herd of elephants can take over the whole waterhole. Often there is a variety of animals at the waterhole at the same time. Some animals, like zebra and wildebeest, like to wade into the water and come really close to the hide so you could almost touch them. If you're really lucky and you keep quiet, you might also see wild dogs or even a leopard. The hides are big, which makes moving around and photographing from different angles easy, but it also means that you sometimes share the hide with lots of other people. Therefore, South African school holidays aren't a great time for visiting this small park as it can be very frustrating in the hides especially.
Although it was recently incorporated as the 40 000 hectare uMkhuze Section of the iSimangaliso Wetland World Heritage Site, Mkuze is one of Africa's oldest game reserves. With Sand Forest giving way to gently undulating grasslands, peppered with flat-top acacias and fever tree-choked drainage lines, the park is well-known amongst ornithologists for its varied habitat and rich birdlife. Twitchers tend to concentrate their energies on Nsumo Pan and the neighbouring fig tree forests, while wildlife enthusiasts focus their energies on Kumasinga Hide: the most productive of Mkuze's four recently refurbished game-viewing hides. Despite ongoing problems with poaching, Mkuze still boasts excellent densities of most antelope species. The reserve is also home to rhino, leopard, cheetah and wild dog and a programme to reintroduce lions has just been approved, so it won't be too long before the final member of the Big 5 makes a welcome reappearance in Mkuze Game Reserve.
What most distinguishes this small Zululand reserve is its network of about five photographic hides overlooking waterholes that seasonally attract incredible numbers of game. It is an exceptional spot for close up views and photographs of white rhino – we counted about a dozen in one day – as well as an ongoing parade of impala, warthog, zebra and Chacma baboon. The striking nyala antelope is common and the male is likely to be seen performing its spectacular dominance display', erecting its long white spinal crest in a bristling assertively. More occasional drinkers include elephant, black rhino, giraffe and leopard, while regular avian visitors include the crested and crowned guineafowl and the garish purple-crested turaco. On a moderately busy day you might easily shoot 500-1,000 frames at the hide, but it also worth heading to Nsumo Pan, I the south of the park, where hippos grunt in shallows enclosed by a margin of tall yellow fever trees.
The allure of Mkhuze always calls me back. Though very small by African standards, this gem of a park has a special ambience and – whether an aardvark in the headlights or a python on the trail – often springs surprises. Sandwiched between the aloe-studded Lebombo Mountains and the St Lucia Wetland complex, its picturesque savanna woodland supports a wide selection of herbivores, including both rhino species and numerous nyala. A small elephant population has been introduced, and I have seen leopard here both by night and day.
Visitor a can enjoy guided day walks, night drives, self-guided trails and picnic sites – although the place never seems crowded. Best are the excellent viewing hides, each overlooking a different waterhole in its own distinct habitat. Photographers love these, and I have spent entire days watching the wildlife traffic coming and going. Other highlights include Nsumo Pan, teeming with hippos and crocodiles, and the fig forest trail, which winds among giant riverine trees. The birding is outstanding – arguably the best in South Africa – with such local specials as African broadbill and pink-throated twinspot among an astonishing 420 recorded species.


text:
University of Cambridge > Talks.cam > Isaac Newton Institute Seminar Series > Historical life cycle reconstruction by indexing
Historical life cycle reconstruction by indexing
Gerrit Bloothooft (Universiteit Utrecht)
Monday 12 September 2016, 11:30-12:00
Seminar Room 1, Newton Institute.
If you have a question about this talk, please contact INI IT.
DLAW02 - Data linkage: techniques, challenges and applications
Co-authors: Jelte van Boheemen (Utrecht University), Marijn Schraagen (Utrecht University)
Historical information about individuals is usually scattered across many sources. An integrated use of all available information is then needed to reconstruct their life cycles. Rather than comparing records between pairs of sources, it will be shown to be computationally effective to combine all data in a single table. In such a table, each record summarizes the information that can be deducted for a person who shows up in a source event. The idea is that this table should be ordered in such a way that consecutive records describe the life cycle events of an unique individual, for one individual after another, where each individual has its own ID. To arrive at this situation, it is necessary to filter and index the table in two ways, depending on the possible roles of an individual: the first as ego in focus (at birth, marriage and decease), the second as parent at the same life events of children. The results of both indexes (in terms of preliminary record clusters and IDs) should be combined, while resulting clusters should be tested for validity of the life cycle.
The success of such a procedure strongly depends on the available data and its quality. The Dutch civil registration, introduced by the French in 1811 and now largely digitized, provides quite optimal conditions. Remaining problems of data fuzziness can be circumvented by name standardization (to various levels of name reduction) and by testing different sequences of the available information in records for indexing. Both approaches are only effective when there is more information available then needed to identify an individual uniquely – which in many cases seems to be the case for the Dutch civil registration. An example of the procedure will be given for data for the province of Zeeland, while options for application of the method to older data of (much) less quality and completeness will be discussed. The latter touches upon the limits of historical life cycle reconstruction.
This talk is part of the Isaac Newton Institute Seminar Series series.
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Seminar Room 1, Newton Institute
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In a roundabout way, one of its envoys may have done just that. Lars Faaborg-Andersen, the EU's ambassador in Tel Aviv, recently warned about the consequences of the Union deciding to cut its assistance to the Palestinian Authority should the current "peace" talks prove fruitless.
Faaborg-Andersen's choice of words are instructive. He appears to believe that the EU is doing Israel a favor by providing "stability" in the territories occupied in 1967.
As far as I can see, he did not elaborate on his comments. Had he done so, he could have explained that international law obliges an occupying power to meet the basic needs of a people under occupation. By stumping up around €460 million ($622 million) to Palestine each year, the EU is relieving Israel of its legal responsibilities.
The spin constantly being put on this aid is that it improves the living conditions of the Palestinians. The statements and "fact sheets" cranked out by Brussels bureaucrats don't explain that some of it directly finances the infrastructure of occupation.
In 2012, for example, the Union boasted about how it was giving €13 million ($17.5 million) to upgrade equipment such as X-ray machines and computer technology used at Karem Abu Salem, the crossing for goods between Gaza and present-day Israel.
There was a major omission in the announcement of this "generous" gift. Karem Abu Salem — known in Hebrew as Kerem Shalom — is controlled by Israel, which has placed severe restrictions on the flow of goods into the Strip. By lending Israel a hand, the EU was accommodating the illegal siege of Gaza. It wasn't the first time that the Union had facilitated such illegality.
If you understand French, I'd urge you to read Palestine, la trahison européenne (Palestine, the European betrayal). Written by Véronique De Keyser, a member of the European Parliament, and the late human rights champion Stéphane Hessel, this book documents how aid ostensibly earmarked for the Palestinians actually benefits Israel. After Hamas won a democratic election in 2006, the EU refused to channel aid through an administration headed by that party. In March 2006, Benita Ferrero-Waldner, then the Union's external affairs commissioner, decided that €40 million ($54 million) would be paid directly to Israel so that Israeli firms could deliver fuel to Gaza.
I have never argued that the EU should cease giving money to Palestine. Doing so would deprive too many people of education, healthcare and energy. Instead, what I have demanded is honesty and accountability.
The taxpayers of Europe should not be tricked into thinking that our money is always being spent in a benign fashion. We should be told straight out that it is aiding an occupation. If Israel refuses to accept its legal responsibilities, then it behoves the EU to send its aid bills to Israel and insist on reimbursement. And when Israel destroys EU-financed projects — as it has done on numerous occasions — the Union must take Israel to court. To their shame, the Union's representatives have always been too cowardly to sue Israel.
Fresh data contained in an official EU report on the arms trade reveals something even more sinister. It indicates that the value of export licenses for weapons issued by the Union's governments jumped by 290 percent between 2011 and 2012: from €157 million ($212 million) to €630 million ($851.5 million).
These statistics probably don't give a full picture of the cooperation involved. Britain (a long-standing EU member) released figures last year indicating that the sale of military items to Israel can be measured in billions, rather than millions. Still, they indicate that the Union is blithely ignoring its own law on the weapons trade. It forbids arms exports if they are likely to be used for repression or to exacerbate regional tensions.
There is, of course, a pattern forming here. Israel is treated as if it is above the law.
The Canadian government is no friend to Palestinians.
Does this mean it would be better if the EU did in fact cut its aid to Palestine? I can't see how that would help the Palestinians at all.
our defined contributions piece by piece, step by step.
hour of my demise. I can only do what I can do to help us all.
is most disturbing. Not only that Europe helps, by its "generous" subsidies for the PA under israeli occupation, to maintain the ongoing brutal occupation and colonisation of palestinian land, but at the same times arms the aggressor to the teeth ! I am ashamed. Will the palestinian people ever excuse us Europeans for having leting do our gouvernments ?
FOLLOW THE BDS PRINCIPLES----HERE THEY ARE !!!
return to their homes and properties as stipulated in UN resolution 194.
call to plans now being seriously considered by Israel.


How are 12% of healthcare and life sciences organizations making digital work?
While healthcare and life sciences works to increase customer value, manage risk, and reduce costs, many are looking to digital for solutions. This study asked 682 people across industries, including 65 from healthcare and life sciences, to rate the impact of digital technologies on their organizations. With a vast majority of respondents indicating that they have yet to unlock digital's full power, it is clear that firms need to find ways to overcome the barriers they face.


Welcome to RHAM Youth Lacrosse. Through our volunteer board and coaches we are able to have boys and girls lacrosse programs for grades 1-8 in Hebron, Andover an Marlborough, CT. We look to continue the development the sport of lacrosse in our area through our volunteers. Lacrosse combines many of the best features of several sports; every child should have the opportunity to experience playing lacrosse. Please help us grow the sport.
Our mission is to develop the sport of lacrosse for youth players in the towns of Hebron, Andover, and Marlborough.
1. At the recreational and development level, coaches should be sure that every player plays an equal amount of time in games.
2. The focus is on learning and development, and every player, regardless of inherent skill, should be given equal opportunities to learn and develop in ways that only game situations provide. Also, equal playing time ensures full Emotional Tanks for all - an essential consideration that should be a big focus in recreational and developmental leagues. Full Emotional Tanks in these leagues will foster progression up the ladder. At this level, the scoreboard is decidedly secondary.
3. At the competitive and elite levels, to suppose that all players will play an equal amount of time is unrealistic. Positive Coaching at these levels does not necessitate equal playing time. What is essential is that all players play at some point (e.g., Blowout games in which your team is way ahead or way behind). At these levels, the focus on the scoreboard naturally increases; however, this must not obscure the larger goal of the development of character.
Coaches have Defined Purpose and Motivation- The coach communicates clear purpose and objectives to his/her players.
Coaches have Skill Competence - The coach has a competent knowledge of the game and able to translate those skills appropriately to players.
Coaches are Relational - All players matter. Demonstrate that all players matter through emphasizing respect for self, teammates, opponents, officials and others by "Honoring the Game." The game's richness has been founded on the premise that the "whole is greater than the -sum of its parts" - that the collaborative relationship of all players on the field makes for successful performance and overall satisfaction.
Coaches possess Good Character - The coach is a powerful role model and therefore models high standards of conduct and values in his or her own life.


Good morning/afternoon/evening to you lovely people!
I'm back home for the holidays so I thought I'd do a festive dressy look which I'm probably gonna wear on Christmas Day as I like to dress fancy for the occasion.
The sad thing about being home for the holidays though is that I can't bring my whole makeup collection with me, so I'm confined to the contents of a makeup bag. It's a struggle I know but thankfully I managed to squeeze my Naked Palette into my suitcase, so all is not lost!
So this is the look, sorry about all the selfies I was trying to get some decent lighting to show off the amazing highlighter!!
Then I used my sample of Estee Lauder Double Wear in Bone, I've reviewed it here.
Next, I used Rimmel Wake Me Up Concealer in 010 Ivory under the eyes and Seventeen Phwoarr Paint on any blemishes.
I then used a powder brush to dust Avon Magix Loose Powder on my T-zone areas making sure to avoid my cheeks.
I contoured my jaw and forehead with the bronzer in the Sleek Face Form Palette in Fair and put a little on the bridge of my nose, I also used the blusher from this set.
I used the Soap & Glory Glow All Out Highlight & Sculpt Cheek Stick in Ice Shimmer on my cheek and browbones.
I filled in my brows with Soap & Glory Archery Brow Putty in Brownie Points and then used Maybelline Brow Drama in Dark Brown.
I left my eye shadow primer at uni so I just moved straight onto eye shadow and used the Urban Decay Naked Palette, I patted Sin all over the lid as a base and then used Half Baked on top, Naked in the crease, Buck in the outer corner and Virgin on the browbone and in the inner corner.
On my upper waterline I used Model Co black eyeliner and then Benefit They're Real Push-Up Gel Liner to create a wing.
On my lashes I used a couple of coats of Benefit Roller Lash.
And last but not least I used my favourite red lipstick, Russian Red by MAC.
Here's a close up of the eyes, for some reason the left looks bigger but maybe that's just me? Haha.


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Most veterans have to be first generation, low-income, and/or disabled. These students will benefit from a sizable grant awarded to Fresno State by the U.S. Department of Education's TRIO Student Support Services Veterans. The Student Support Services staff is committed to providing the tools and academic support for each participant to excel academically and graduate.
Veterans Education Program provides opportunity and access to resources at Fresno State and connects veterans to support organizations in the Central Valley. They facilitate a sense of belonging for veterans on campus by providing a lounge, study area, dedicated smart classroom, and academic skill sets requisite for successful careers.
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To learn more and to apply for a Mentor, please visit ACP's website or call (212)752-0700. Please note that you were referred by California State University, Fresno.
Connects California Veterans and their families to their educational, employment compensation and pension claims, healthcare, housing, and state benefits.
The Employment Development Department (EDD) assists veterans and their eligible spouses to maximize their employment and training opportunities. Veterans are entitled to many resources designed to help in their search for employment.
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Offers transitional counseling for combat veterans for the entire Central Valley. Individual and family counseling for veteran men and women.
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Offers assistance and case management to veterans in need. Services we provide include transportation assistance, haircut and clothing vouchers, snacks, computer access for job searches, place to network with other veterans, educational classes, and housing counseling and assistance.
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California's Website designed for California Veterans. There is much information on this site relating to benefits, programs and pending legislation.
To apply for your educational benefits, eBenefits, my healthy vet, and to transfer benefits to your dependents.
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The nation's largest wartime veterans service organization.
Benefiting the US Army, US Navy, US Air Force, US Marine Corps, and US Coast Guard.
California Association of County Veterans Service Officers, Inc.
College Fee Waiver, Veterans License Plates, VA News, and much more.
Executive Order 13607 of April 27, 2012. Establishing Principles of Excellence for Educational Institutions Serving Service Members, Veterans, Spouses, and Other Family Members.


You can but it won't look right unless that area is flat.
2) You can touch off the v-carve tool to the top of the 3D object and just engrave. The engraving will be on a flat plane and might look strange.
Aspire has a feature that we can project to a curved surface - but I don't think V-Carve Pro can do that.


79% of CMOs have their own IT budget, but only 50% of CMOs and CIOs deploy joint projects.
Only 12% of CFOs say their CMO is excellent at connecting marketing projects to return on investment.
Only 54% of CMOs believe that their sales and marketing organizations work well together.
B2B companies' inability to align sales and marketing teams around processes and technologies cost them upward of 10% or more of revenue per year.
ALIGNMENT IS CRITICAL. SO WHERE DO YOU GET STARTED?
Go back to the beginning. Let this guide help you identify the conversations you must have with your executives to allow marketing to get in line with the C-Suite, prove its value and effectiveness, and earn the seat at the table it deserves.


text:
Chicago Bulls Report
Noah's not going anywhere
11yNick Friedell
Celtics rally late, edge Bulls 114-112 on Williams' FTs
Bulls: No structural damage to LaVine's knee
1dJamal Collier
Bulls star guard LaVine to have MRI on left knee
The Bulls discussed Joakim Noah in general conversations about a trade for Carmelo Anthony, but the team will not deal the center. Mike DiNovo/US Presswire
Nick FriedellESPN Staff Writer
Nick Friedell is the Chicago Bulls beat reporter for ESPN Chicago. Friedell is a graduate of the S.I. Newhouse School of Public Communications at Syracuse University and joined ESPNChicago.com for its launch in April 2009.
CHICAGO -- Have members of the Chicago Bulls brain trust had general, internal conversations about the possibility of including Joakim Noah in a trade for Denver's Carmelo Anthony? Sure, because they would be crazy not to at least bounce the idea around when it comes to adding a bona fide Top 10 player. The Bulls desperately want to get better, and they have to at least consider all the options.
But as ESPNChicago.com reported Thursday, while general discussions have taken place, a team source said Noah will not be dealt.
The Bulls consider the emotional center to be a cornerstone for their franchise. To put it another way, Derrick Rose is untouchable -- obviously. And while Noah may not be that bulletproof, the gap between him and Rose, as far as a potential trade goes, isn't as far as the casual fan may think.
The general consensus is that the Bulls feel like they are much closer to a title with Noah than they are without him. As I discussed on Thursday, are the Bulls really that much closer to a title if they add Anthony, but lose Noah, Luol Deng and Taj Gibson in the process? I don't think so.
Noah is turning into one of the best centers in the league, and he provides the Bulls with the type of consistent inside presence they haven't had in many years. If he stays healthy this season, many people believe -- myself included -- that he will become an All-Star. He's the type of presence the Bulls will need to go up against Dwight Howard and the Orlando Magic for years to come. Not to mention the Lakers with Pau Gasol, Andrew Bynum and Lamar Odom; the Celtics with Kevin Garnett and the Heat with Chris Bosh and company. Without Noah, the Bulls would be putting a lot of faith into Turkish rookie Omer Asik, and while he has shown some promise in early workouts and during the world championships, I don't think that is a move they feel comfortable making right now.
The move the Bulls want to make is the same one Noah wants himself: A contract extension that will keep the 25-year-old in Chicago for a long time to come.
Make no mistake, Noah wants to stay in Chicago. He loves the city, he loves the fans and he loves playing here. He told me last month that his agent Donald Dell has started working on the parameters of an extension with Bulls GM Gar Forman. He is proud of what the Bulls have started to build, and he wants to see it through until the end.
Like everybody else, he understands that the NBA is a business. He hears the rumors, and he even admitted there was a time he thought he might get dealt earlier in the summer in a potential sign-and-trade for one of the marquee free agents on the market. Noah knows he may not be in Chicago forever, but this is where he would like to be. The good news for the big man is that despite the speculation of the past few days, in the end, I think the Bulls feel the same way.


text:
Turkey: Digital Heritage: An Analysis In The Framework Of Turkish Law
by Berrak Su Kodal
Kavlak Law Firm
Heritage is a legal concept which may be defined as compilation of asset, rights and obligations belongs to a natural person and which are to be transferred instantly to the his/her heir(s) within the same moment with decease of the owner.
Heritage is one of the main assurances of right of property, it provides and secures continuity of private property. Fundamental feature of heritage may be traced back to the times when family concept become a building block of society. During the Roman Empire, not individuals but families owned property via Pater Familias (latin word for family man). Whereby, assets own by a family member remained as the family's property even after the death of him/her. This system has limited individuals' free will and prioritized family. Many years later, following the evolution of the individualisation, individuals have become more authorized to determine the next owner of the property they own while they are alive. A libertarian movement of thought argued that individuals should have full authority to designate their heirs.
As of today, a combined system is preferred in various country's legislation which prioritize individual's determination, including Turkish Civil Code1 ("TCC"). According to this system, individuals may decide on who to leave their assets, rights and obligations by writing a will or designating an heir. However, TCC provides a protection for certain family members in any condition to benefit deceased's heritage.
Scope of the heritage is, as it's mentioned above, rights, obligations and property of the deceased. Property is described in Turkish law, as a material of physical asset, which has an economical value and excluding people and animals.
One of the general rules of property law, any personal rights are not suitable for any legal transition. In other words, following the decease of a person, as a rule, the transfer is possible to the heirs of private law relations; however, personal rights cease with death and may not be transferred on to the heirs.
Article 599(2) of TCC mentions real estate and other property rights, claim rights, possession of movables and immovables and obligations to be transferred to the heirs as heritage. In this article, rights and obligations to be transferred has not been regulated as numerus clauses. Therefore, rights haven't been mentioned in the Article may be transferred through heritance, i.e. intellectual property rights may be transferred to the heirs.
Concept of property has evolved throughout the years, especially within the last decade, in line with the occurrence of technological and digital developments effecting daily life majorly. The term digital property has emerged from this development process. Nowadays, digital property constitutes at least as much value as non-digital property. Social media accounts, audial and visual media documents, crypto currency accounts, domain names, game characters, e-commerce web sites may be included to the scope of digital property.
In the framework of Turkish legislation, digital property or digital heritance has not been defined or regulated under any law. Nonetheless, this shall not constitute an issue regarding digital heritage since property types are not limited with the TCC. Therefore, it's possible to include digital property to a will or designate heir regarding digital asset.
Digital heritage hasn't been regulated in any foreign legislation as well, but it's possible to encounter the concept in various foreign court judgements. As of today, Some of international social media platforms offer their users an option to choose a legacy contact to manage their account following their death, even this is not a legal procedure, it shows that digital heritage shall be examined in the near future as a legal matter.
Considering the history and nature of legal concepts and law, most of the times changes in society and daily life has leaded major alterations and adjustments in legal areas and formed law systems. Improvement of property concept has been essence of law since the very beginning of law.
In conclusion, even digital property and digital heritance has not been subjected to any legislation or court judgement in Turkey yet, but it is expected to become a type of asset which is automatically transferred to legal heirs when owner passes away, even it's not stated in a will. And even today, digital property may be subject of wills and heir designations by the declaration of the intent in a will by deceased.
Turkish Civil Code
https://dergipark.org.tr/en/download/article-file/599861
Türk Özel Hukuku Cilt: 4 (Miras Hukuku), Prof. Dr. Mustafa Dural, Prof. Dr. Turgut Öz, Filiz Kitabevi, 2018.
Prof. Dr. M. Kemal Oğuzman, Prof. Dr. Özer Seliçi, Eşya Hukuku, Filiz Kitabevi, 2017.
1 Turkish Civil Code dated 22.11.2011 and numbered 4721, published in the Official Gazette dated 08.12.2011 and numbered 24607.
Berrak Su Kodal
Turkey Family and Matrimonial Wills/ Intestacy/ Estate Planning Government, Public Sector Constitutional & Administrative Law Real Estate and Construction Real Estate
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I just CAN'T stop listening to this song!
SP is such a cool show!
Well, I'm a badass Cowboy livin' in the Cowboy days.
Me and Artemis Clyde frog go save Salma Hayek from the big metal spider.
there losing fans why don't get mad !!!!


text:
GQ babble, GQ research, writing
sexual hygiene in the GQ books
May 21, 2015 darrah	5 Comments
turn of the century condom molds
The medical side of sex and sexually-transmitted disease in the GQ books is similar to the historical record, but with some important-ish differences.
STERILIZATION:
It's only mentioned a couple of times in the books, but all the slaves, male and female, are sterilized before they're sold. My thought is that they are about 15 when they undergo this compulsory procedure. It is done to prevent troublesome situations (young master impregnates chambermaid) from arising, but also to keep the production of slaves firmly in the hands of the Houses. Ganymede does not want its customers breeding their own slaves.
Although it was certainly understood that vasectomy would prevent pregnancy, men circa 1900 weren't going through the procedure for that reason. Rather, they were undergoing vasectomy to treat prostatitis, compulsive masturbation and bladder stones, probably with disappointing results. Although it wasn't a popular real-life birth control method at that time, I thought it very likely that the GQ slaving Houses would take advantage of all the medical technologies available.
As far as the female slaves are concerned, in real life the first tubal ligation was done in 1880, with many improvements to the procedure to follow. Hysterectomies were performed before that time. That is not to say these surgeries were at all routine. Considering the state of medicine and surgery circa 1900, it seems likely that in performing these procedures Houses would be at risk of losing some of their expensive stock, and so I imagine they'd be keenly interested in advancing medical knowledge and making the surgeries as safe and survivable as possible. I do imagine the GQ world is slightly medically advanced beyond the historical world in this regard.
Most slaves feel ambivalent about sterilization, at best. Martin has always liked children and wants very badly to help raise them. I think he would have liked to be a father (he is not as squeamish about the idea of a woman's body as Henry is :D ), and was sad to lose that possibility. He's looking forward to Henry having a family.
Tom is one of my favorites. He started out just as someone for Henry to have conflicted sexy feelings about, but he started to feel more important than that very early on. It was cruel to give him gonorrhea, but it also gave him legitimate importance in the story commensurate with my feelings about him. Besides, it seemed really, REALLY unrealistic for there to be all this sex without any STDs. I didn't want to write a treatise about the myriad dangers of unprotected sex, though, so I chose to only infect lovely, promiscuous Tom and his hapless victims, Jerry and Arthur.
Treatment of gonorrhea circa 1900 was often a prolonged and arduous process, painful and leaving scars. Antibiotics had not yet been discovered. A caustic solution of protargol/colloidal silver, was introduced into the affected area, sometimes multiple times a day, until the patient tested clear of gonococci. Some people were cured in days, some in years, and some, of course, never. In pre-antibiotic times, everything was harder to treat. Getting an STD today is serious, of course, but in most cases the consequences are nowhere near as dire as they were in 1900.
I hope to pay Tom back for his ordeal at some point by telling his whole story :)
PROPHYLACTICS:
Because they are only having sex with one another, Henry and Martin do not feel the need to use rubbers. Such a thing would never have occurred to Henry anyway. Some of Henry's friends are more careful with their slaves' (and their own) health than others. Freddie Caldwell does actually expect condoms to be used with Tom whenever practical, but he didn't dictate that Tom use them in his personal life, and Tom was foolish and thought he was invincible. Obviously, he was wrong.
Many condoms in 1900 were made out of rubber and were quite thick. And durable. You could wash them out and reuse them. There were also fish bladder condoms and animal intestine condoms.
Because of the Comstock laws, it is not clear to me whether any of the young masters could have gone into a pharmacy and purchased a condom at all in the real New York of 1900. Anthony Comstock was a very powerful busybody who considered contraception to be "obscene, lewd or lascivious." Uh, whatever, Mr. Comstock. People could and did buy condoms through the mail, and I suppose it's possible they bought them under the counter from sympathetic druggists, but for GQ purposes we have to assume no such laws existed at all. Obviously, Mr. Comstock would not have approved of companion slaves, either. (Disturbingly, the Comstock Act is still around, though much amended and not enforced.)
gonorrheaGQ seriesslave sexSTDssterilizationTom
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5 thoughts on "sexual hygiene in the GQ books"
Henry Tilney says:
Dear Darrah,
What an interesting post. I appreciate your commitment to realism in the world you present in the stories – although this is your AU, of course, and you can have people doing what you like, I suppose, as long as it is internally consistent. You can assume, I guess, that in this world as in ours the "the market" would have driven the delivery of reliable sterilisation for both male and female slave. One day you might turn your talent to describing the supply side of the slave trade. These would probably be stories without much romance, however, and so outside your scope of interest.
I share your affection for Tom. I knew that girl who was angling for him at the slave wedding was the dangerous sort.
I'm rereading the whole series now and loving Henry's vulnerability and jealousy. He's so very adolescent!
With thanks for what you do,
darrah says:
Thank you so much for your interest and support. I have had a discouraging few weeks, and it means everything to find such a nice message waiting for me!
It's not that I don't have any interest in telling stories about the supply side, but I question whether there is an audience for a world-building story vs. romance. The people who like the GQ books seem to really like the series, but there just aren't very many of those people, and I can't know how many of that small group would pay to learn more about Ganymede. It likely isn't enough people to cover the costs of putting out a story. It's depressing to have to consider future projects based on which will make money, but unfortunately I have to do that. I definitely plan to continue telling GQ stories (I have over 20 extensively outlined!), but I need to write something that has wider appeal that will (hopefully) make money. If I am successful enough at that, then I can justify spending time and money on putting out additional GQ stories. I love the universe, and I want to share it, but I can't go broke doing it.
Tom's story will get told no matter what. I don't know when, but it will happen!
I'm glad the books are enjoyable for you on re-read :) I don't know that I'm terrifically sympathetic toward real-life adolescents, but I love to write about the struggles and trials of people on the cusp of adulthood. It's a very confusing and dramatic time!
Dear Darrah
Thank you for the generous response. I can appreciate that art is also going to have a commercial edge, unfortunately. As a reader, just let me say how much integrity and professionalism you show in your work. You are respectful of your creation – and that shows in the way you give each of them an authentic voice in an authentic moral setting. You are respectful of your readers too: witness your commitment to time lines and to engaging with readers in this way.
I look forward to the conclusion of the series – and tot he other writing projects you have planned.
Doctor Science says:
Why gonorrhea and not syphilis? Syphilis was far and away the most dangerous STD in that era, not least because many infections were life-long, and because the symptoms of tertiary syphilis are so dire.
Well, actually, that's precisely why I didn't give Tom syphilis! I wanted to give him something that was quasi-treatable in that era, something he could reasonably recover from. I have plans for the character in the future, and tertiary syphilis does not fit in with those plans! I felt that gonorrhea had the level of all-around unpleasantness that best suited the story. Reading journal articles about gonorrhea treatment circa 1900 makes me very grateful to live in an era with antibiotics.


Row 3: K 2, * K the next st in the row below, K 1, repeat from * ending K 2 instead of K 1.
BACK:Cast on 71(75-79) sts. Work even in pattern st until piece measures 12(12-12½) inches. SHAPE ARMHOLES: At the beg of each of the next 2 rows bind off 5 sts. Dec 1 st each end of needle every other row 4(5-6) times. Work even on 53(55-57) sts until armholes measure 8(8¼-8½) inches. SHAPE SHOULDERS: At the beg of each of the next 6 rows bind off 5 sts. At the beg of each of the next 2 rows bind off 4(5-6) sts. Bind off remaining 15 sts.
LEFT FRONT: SHAPE TAB: Cast on 3(3-5) sts. Row 1: Knit. Row 2: Work Row 1 of pattern st. Row 3: K, inc 1 st each end of needle. Row 4: Work Row 3 of pattern st. Repeat Rows 3 and 4 until there are 11(13-15) sts, ending with Row 4. At the beg of the next row cast on 14 sts, K to end of row. At the beg of the next row cast on 14 sts and K these 14 sts, work Row 1 of pattern st on remaining 25(27-29) sts. Work even in pattern st on 39(41-43) sts until piece measures 12(12-12½) inches above last group of cast on sts. SHAPE ARMHOLE: At arm edge bind off 5 sts. At same edge dec 1 st every other row 5 times. Work even on 29(31-33) sts until armhole measures 6(6¼-6½) inches. SHAPE NECK: At front edge bind off 3(4-5) sts once, 2 sts twice and dec 1 st every other row 3 times. Work even on 19(20-21) sts until armhole measures 8(8¼-8½) inches. SHAPE SHOULDER: At arm edge bind off 5 sts 3 times and 4(5-6) sts once.
SLEEVES: SHAPE CUFF: Cast on 47(49-51) sts. K 1 row. Work in pattern st, dec 1 st each end of needle every 8th row twice, ending with a K row — 43(45-47) sts. K the next row to form hemline and to reverse pattern st. Then continue in pattern st, inc 1 st each end of needle every 2 inches 5 times. Work even on 53(55-57) sts until piece measures 12(12-12½) inches above hemline. SHAPE CAP: At the beg of each of the next 2 rows bind off 5 sts. Dec 1 st each end of needle every 4th row 12(13-14) times. At the beg of each of the next 6 rows bind off 2 sts. Bind off remaining sts.
FINISHING: Sew underarm, shoulder and sleeve seams. Set in sleeves. Block. Face jacket and cuffs with ribbon. Sew braid around all edges. Sew 1 button to each tab. Turn cuffs on hemline and tack in place.


text:
Q: Allow drag through div positioned over map I have an openlayers map and I have positioned a div to sit inside/over the map component.
This works fine, however when dragging the map, if the mouse moves through/over the div the drag action is terminated.
How can I avoid the drag action from terminating?
thanks, p.
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">

I want to drag through this

EDIT: solution using accepted answer:

some content which gets positioned over the map

initialise: function()
{
    this.map.events.register("movestart", this, this.applyDragThrough);
    this.map.events.register("moveend", this, this.applyDragThrough);
},

applyDragThrough: function(event)
{
    var elements = Element.select(document.body, ".mapDragThrough");
    var value = this.map.dragging ? "none" : "auto";
    elements.invoke("setStyle", {"pointerEvents":value});
},

A: You can set pointer-events css attributes of the overlay DIV to none.
This causes the element not to receive mouse events at all, allowing the map dragging to continue uninterrupted.
Here's a working example:

I want to drag through this

A: A possible solution could be to listen to hover event with jQuery and activate/deactivate Navigation control(or you probably are using MouseDefaults which you shouldn't) accordingly. The code should look something like this:
var nav = map.getControlsByClass("OpenLayers.Control.Navigation")[0];

$("#your-overlay-div").hover(function(){
   nav.deactivate();
},function(){
   nav.activate();
});

redpajama_set_name: RedPajamaStackExchange


text:
Q: $E(T(X))$ where $A:={n(\bar X-\mu)^2\over \sigma^2}\sim\chi^2_{(1)}$ ; $B:={\sum\limits_i(X_i-\bar X)^2\over \sigma^2}\sim \chi^2_{(n-1)}$
$X_1,X_2,\cdots X_n$ is a random sample from $N(\mu,\sigma^2)$.

I have to find out

an unbiased estimator of ${\mu\over \sigma}$

My work:
Initially I take $T(X)={\bar X\over \sqrt{{1\over n}\sum(X_i-\bar X)^2}}$ I need to find $E(T(X))$.
I know

$A:={\sqrt n(\bar X-\mu)\over \sigma}\sim N(0,1)$ ; $B:={\sum\limits_i(X_i-\bar X)^2\over \sigma^2}\sim \chi^2_{(n-1)}$

But how to find out $E(T(X))$ if I know $E(A)$ and $E(B)$ seperately?
My thoughts:

The fact that $\bar X$  is independent of $\sum\limits_i(X_i-\bar X)^2$might be of help.
Some modification of ${A\over B}$ might lead to the $t$ distribution.

Please help me proceed.