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Dr Sarno Was a Trauma Informed Care Pioneer
22 Jun Dr Sarno Was a Trauma Informed Care Pioneer
Posted at 23:53h in News by Michael Galinsky 1 Comment
Recently I saw a tweet from an editor seeking science/medicine pitches because he was taking over a new full-time role at a newspaper. I sent him a note with a link to our film "All The Rage," suggesting that he either allow me to write a first-person piece about our experience of making and distributing a film that focused on the work of Dr. John Sarno, or to see if he was interested in having someone write a story about it. He wasn't. Still, I'm grateful for the back and forth that we had because it helped me articulate some ideas about why Dr. Sarno's work was so important, as well as what his dismissal by the medical community reveals about how systems often create barriers that go unseen by those within the system. Specifically, the conversation helped me to realize that Dr Sarno was practicing in a trauma informed manner decades before anyone had named the concept. Since the medical system didn't give credence to the import of emotions nor the impact of trauma on our physical bodies, his approach ran counter to prevailing beliefs, leaving him quite isolated. In the 4 years that we have been working on getting our film out into the world, we have been trying to highlight just how significant and ahead of its time his insights were.
The dismissal of Dr. Sarno is rooted in the idea that he didn't take a scientific approach to medicine because he didn't do randomized controlled trials to prove his theory that repressed emotions, related to early childhood trauma, were a cause of pain. What is ironic about this situation is that the reason he came to this conclusion in the first place is that the treatment methods he was taught early in his career had not delivered satisfactory results, causing Sarno to take a closer look at the basis for those treatments. None of the treatments he was taught – things like bed rest, traction, physical therapy, and electric stimulation – had seemed to help permanently improve patients' back pain. When he looked for research to support these treatments, he didn't find anything of note. There was no scientific basis for the treatments.
Dr. Sarno entered the medical field just after World War II. This was a period when the bio-technical approach to medicine was picking up steam. As the focus on double-blind randomized controlled studies took off, awareness of emotional factors became more limited. Emotions are messy and complex, and therefore not suited to be easily studied in a randomized control trial where the ideal of scientific exactitude is sought. Rather than deal with the complexity of emotions, the science-based approach to medicine simply ignored them because their complexity made the data less clear. Dr. Sarno went to medical school when the ideas of Dr. Freud were not completely out of vogue, and he carried that emotional awareness with him as he entered the practice of medicine.
After spending about a decade working in the first group practice in NY State that he helped organize, Dr. Sarno moved to the Rusk Institute at NYU where he spent the rest of his career. There, he continued his training in dealing with back pain. When he became frustrated with the limits of the methods he had been taught, he took a long look at his patients' charts and found that 80% had two or more other health issues that were known to be psychosomatic, or had a mind body connection. These included skin issues, migraines, colitis, depression, and other gut issues. He began to talk with his patients about what was going on in their lives and noticed that many of them were living in stressful situations, but were taking pains to put a positive spin on them. They tended to be people-pleasers who were disconnected from their own needs. For example, when asked if there were any major stressors in his life, one man said that there weren't. However, Dr. Sarno then asked for more information. It turned out that the man's mother-in-law had come to stay for a week, but never left. She'd been there for six years. He explained that it was fine, though, because his mother in law helped take care of the kids. When Dr. Sarno pressed further, the man admitted that it was a little frustrating to have his mother-in-law living with them. A few days later, the man's back problems were resolved. Dr. Sarno was shocked to find that this simple intervention yielded such powerful results.
He postulated that the pain was a distraction from emotions that felt dangerous due to trauma from childhood. We often think of trauma as the result of terrible circumstances or abuse. However, a child who feels unsupported, or unseen, or has parents that are emotionally unavailable, might develop coping patterns to deal with the pain of that disconnection. This can involve disconnecting emotionally to avoid those overwhelming feelings. These unconscious reactions to one's emotions can then carry on throughout their lives. Helping his patients to understand the connection between the feelings that they were having trouble accepting and their pain often led to the resolution of the symptoms. Our film about Dr. Sarno is called "All The Rage" because Dr. Sarno connected the pain to unresolved rage and other powerful emotions from childhood that keep people stuck in these unconscious patterns.
The newspaper editor's response to our pitch about Dr. Sarno highlighted many of the issues we've faced in trying to get our film seen. First, he said that he thought it was "a little too late" to do a story about Dr. Sarno. However, he stated that he was kind of interested in a story about people who had taken up Dr. Sarno's mantle and wanted to know if I could give him the lay of the land on whether anyone has been doing the scientific research. I responded with a more thorough description of what I wanted to write, or see written as well as some information on those who had followed Dr. Sarno. He pressed for more direct information about the latter. This prompted me to write a much longer response, which he ignored. That email then inspired this post.
The editor's response wasn't shocking, but it was disappointing. In fact, it made me think more about my own relationship with trauma and illness. We first started to work on our film about Dr. Sarno in 2004 but we quickly hit a wall. While we were coming off a film that had found some success, and had even been shortlisted for an Oscar, we could not find any support for this project. Ironically, I had come to see Dr. Sarno for my own completely debilitating leg pain, which I can now see was directly connected to the deep frustration of trying to get that previous film seen. It wasn't just the film. We had a baby two nights before the film premiered in the US, meaning my wife's water broke hours after we finished the film. The stresses of life piled up like so many rusted out cars in a junk yard.
While seeing Dr. Sarno helped me on a path of healing, it didn't completely cure my pain. I saw making the film as a way to gain deeper personal insights. My own experience shows how difficult this can be, especially when childhood trauma is involved. To make a long story short, not only could we not find any support for our work, we also couldn't figure out how to tell Dr. Sarno's story. Eventually we put the film on hold.
I continued to slowly heal. Then, about seven years later, when we had another film to release, I pushed myself as usual. Just before that film, "Battle for Brooklyn" opened I started to get terrible pain in leg. Despite having trouble walking I did a q and a at every screening on opening weekend. Despite a successful opening, and many stellar reviews, no other theater would show the film. Once again the frustration caught up with me and I was crushed to my office floor, and unable to sit up for weeks. This was when I realized that I had a lot of work to do, and that I would have to be a character in the film in order to get it made. Both of those facts provided leverage for me to lean into the work with more present awareness. I learned a great deal from the pain. When it flared up I knew to be more aware of what my body was reacting to. That was profoundly useful, but it was not, and is still not, simple nor easy.
The author's parents in 1990
I had a lot of time to spend reflecting on my life and childhood. Part of my healing process involved learning to let go of some of the anger that I felt towards my parents, which involved letting go of the expectation that they be perfect. Finding that empathy also helped me to make a little more empathy for myself, which made it possible to process and let go of some of habitual behavior patterns. Exploring that process while making the film helped others to connect with their emotions as they watched it.
When we started back up the process of working on the film back in 2011 we found that a number of other doctors had made the same connection to childhood trauma in various fields. Dr Gabor Mate had written the book "When the Body Says No" which focused on how the repression of emotions was central to the development of many auto-immune conditions. He talked extensively about the effects of childhood trauma. Dr David Clare had published "They Can't Find Anything Wrong" about his recognition that many gut issues were related to childhood traumas, and the repression of those uncomfortable feelings and thoughts. We included both of them in the film.
We also found the powerful work of Nadine Burke Harris who came to see that she was mostly treating the symptoms of stress in her Oakland clinic. Her discovery led her to stumble on the ground breaking ACE study. ACE stands for Adverse Childhood Experiences. In this 1991 research study doctors collected data on 17 thousand patients. They found that people who had been affected by 4 or more adverse childhood events like having a drug addicted parent, a parent in prison, or abuse in the home were wildly more likely to suffer from a wide range of diseases. This study was the first that conclusively connected childhood trauma to profound impacts on health. Unfortunately it took decades for the medical system to begin to pay attention to it. Now it's paving the way for a revolution in a trauma informed approach to illness. Still, there is great resistance to this approach from the larger medical and patient communities.
The author being examined by Dr Sarno
One thing that is significant about Dr Sarno's awareness is that he focused directly on the less dramatic traumas of childhood and how they might affect us. Decades before the term was in use, he was practicing in a trauma-informed manner. However, since these childhood traumas were seen as something to be dealt with in psychotherapy, there was very little acceptance of dealing with them from a medical perspective and Dr. Sarno was dismissed by his colleagues and the press. So, he toiled away in solitude, successfully treating patients, and publishing books about his work that helped hundreds of thousands of others heal as well.
My father was one of those who healed from terrible pain by simply reading his book. Later, my brother was saved from debilitating hand pain by seeing him in his office. I then read the book, understood the basic emotional connection, and banished my back pain for a decade. Later, when it re-emerged and crushed me, I struggled to fully heal despite seeing Dr Sarno in his office. Resistance to our emotions can be powerful. When we are taught as young children that our emotions are not acceptable, we bury them in order to get the care that we need. We try to become the people our parents need us to be rather than the people we need to be. It can be very difficult to re-connect with these feelings that we have banished.
the filmmakers after the festival premiere of All The Rage.
We finished "All The Rage" in 2017 and I have spent the past 4 years trying to get it out into the world. In that time I have been unable to get anyone to write about it. Dr. Sarno passed away 4 years ago, on June 22nd. The following day, unaware of his passing, we opened our film in NY at Cinema Village on what would have been his 94th birthday. The NY Times had never written about him before the review of our film that came out on the 23rd. Without that review, it's unlikely that they would have given him an obituary, as they generally measure newsworthiness of a subject by whether or not they have covered that person in the paper. We found about his passing on the 24th, and word started to spread through the audiences that day as several of his colleagues and former patients began to get the news. Despite the significant impact that he had on the culture, and our profound efforts to get the film seen, in those 4 years we have been unable to get anyone to write about Dr Sarno and his work, or our film. It's been seen in 95 countries now, but it exists in the shadows, outside the awareness of mainstream media culture. It's not for lack of trying. We hired 4 of the best publicists in documentary and I have continued to make efforts like the one above to get people to write about the film.
While we wove ideas related to trauma informed care into the film, my discussion with the editor helped me to see just how significant Dr Sarno's work was in relation to that idea. However, because his work didn't get much attention from his colleagues, the medical system, or the press his insights related to trauma awareness have largely gone unrecognized. I'd like to see that change.
After the editor made it clear that he wasn't interested in Dr Sarno, but might be interested in writing an article himself about the scientific research that follows up on is work, I responded with a note gently pushing back on the idea that he wasn't grounded in science. Doing so helped me to articulate a little more clearly that Dr Sarno was practicing trauma informed care well before others were thinking in the same manner. I spent a lot of time on that letter so I'll just post it here. Apologies for the fact that a little bit of the information about Dr Sarno's history was already stated above. I did not hear back from the editor after this note.
Dear Editor
Dr Sarno's ideas are being confirmed through several studies, including one collaboration between Tor Wagner and Howard Schubiner that is close to being finalized.
I'd like to gently push back on the idea that it's "a little late" to examine the import of Dr Sarno's work, as well as the idea that his work wasn't rooted in a commitment to the scientific practice of medicine. Dr Sarno came of age in medicine when emotions were still seen as a factor to consider when getting the fullest picture of a patient's health, so it shouldn't be a surprise that he included the patient's emotional situation in his treatment practice. As medicine increasingly focused on double blind trials, emotions were increasingly disregarded because of the difficulty of controlling for their complexity. Over time, emotions slowly disappeared from the medical conversation. It's only in the past decade that they have begun to be reconsidered, and that the idea of trauma-informed care has begun to rise in importance. If you look closely at Dr Sarno's practice, you'll find that this is the approach he used throughout his career.
Dr. David Clarke, the gastroenterologist who wrote "They Can't Find Anything Wrong," stumbled onto this awareness when he had a patient that wasn't responding to any treatment. He ran into a psychologist colleague on the elevator and lamented about his frustration, suggesting she stop by and see the patient. A couple of days later, he saw his colleague again, asked how the meeting went, and found that the patient had been released. He was shocked to hear that after the psychologist helped the patient make the connection between major family stressors and her gut problems, the pain that had kept her on a high levels of pain meds for weeks had melted away. After that he started to talk to his patients more extensively, and found that pattern repeating. Soon, he was being sent every difficult case in Oregon. His book is based on 7000 cases, many of which were people who had chronic issues for years. As Dr. Clarke points out, nothing in his training prepared him for what he discovered by happenstance. Now he spends the majority of his time educating other clinicians about the import of understanding the import of emotional factors when trying to help people to heal.
As Dr. Sarno honed his understanding of the connection between stress/the repression of emotions, the majority of his colleagues across the country and the world continued on in the same manner, focusing solely on physical symptoms and findings, despite the fact that these practices were not developed through rigorous scientific study. At the same time, the introduction of technologies like early scanning devices, and later MRI's, led to a host of more invasive techniques including surgery and steroid shots, based on the assumption that what they were seeing on these scans was the cause of the problem, and that steroid shots seemed to help some of the time. To be clear, for years no one bothered to do any double blind studies to make sure that these assumptions were correct. As Dr. Sarno witnessed this change, he was frustrated by the steady stream of patients who came to him with scans that did not correlate with their symptoms. He couldn't find any studies that showed that the herniated discs were causing the problem. He referred to them as "normal abnormalities". He also found no studies that showed steroid shots were more effective than placebos (this link is to an article by Dr Schubiner in Psychology Today). Given these facts, continuing to use surgery or steroid shots would not seem to be indicated by a scientific approach to medicine. However, despite all this evidence medical practice has relied almost exclusively on these techniques which have been called into question through science. While medical groups continue to put out statements suggesting that the use of MRI scans be limited in the case of back pain, these calls are largely ignored. Further, as Tbilanow reported in 2008 the surge in spending on back pain showed no benefit.
Dr. Sarno was not alone in his awareness that the data on back pain was problematic. Dr Nortin Hadler detailed all of the problems with the treatment for back pain in his award-winning book, "Stabbed in the Back". When studies did begin to come out looking at the correlation between what was seen on MRI scans and pain, the data was quite clear. There was no causal correlation between what was found on scans and pain. The drug compounding crisis of a few years ago, when dozens died of infection after contaminated shots led to meningitis, illuminated that the shots were not only dangerous but also questionable. As the linked article states, " 'Not only were these people killed, but there was no ethical reason to give this treatment,' said Dr. William Landau, a professor of neurology at Washington University in St. Louis, referring to those who died of meningitis."
Gina Kolata, of the NY Times, wrote a series of articles dealing with back pain, imaging, and treatment. Over the course of two decades, she wrote article after article detailing studies that supported what Dr. Sarno was saying: that the scans are a bad idea because people are making assumptions about supposed abnormalities causing pain when there was no data to suggest it was true. In fact, in one of Ms. Kolata's more recent articles from 2017 she writes:
Scans, like an M.R.I., for diagnosis are worse than useless for back pain patients, members of the group said in telephone interviews. The results can be misleading, showing what look like abnormalities that actually are not related to the pain.
She goes on to say,
Added to the problem are the incentives that push doctors and patients toward medications, scans and injections, Dr. Deyo said. "There is marketing from professional organizations and from industry," he said. "We have the cure. You can expect to be cured. You can expect to be pain free."
Medical insurance also contributes to the treatment problem, back experts say, because it does not pay for remedies like mindfulness training or chiropractic manipulations which, Dr. Deyo added, "are not cheap." "Even if doctors want to recommend such treatments, there is no easy referral system." Dr. Atlas said.
"It is much easier at Mass General to get a shot than to get a mind-body or cognitive behavioral therapy," he added."
Back in 1994, she reported pretty much the same thing with quotes from the same Dr. Deyo. In 25 years – despite increasing mountains of evidence – unproven cortisone injections, pain pills, surgeries, and diagnostic imaging exploded in use and cost, which has severely compounded the problem. The rise in cost of incidence of chronic pain from 1984 to 2011 was astounding. At the same time, Dr. Sarno quietly healed thousands of people without drugs or expensive and invasive procedures. Instead, he did exactly what Kolata's 2017 article suggests in its closing paragraph,
Dr. Weinstein has a prescription: "What we need to do is to stop medicalizing symptoms," he said. Pills are not going to make people better and as for other treatments, he said, "yoga and tai chi, all those things are wonderful, but why not just go back to your normal activities?"
"I know your back hurts, but go run, be active, instead of taking a pill."
My point is that there was not much about the treatment of back pain that was securely rooted in science over the past 30 years, yet Dr. Sarno is routinely dismissed because he wasn't doing randomized controlled trials. Dr. Weinstein is quoted as an expert, and Dr. Sarno never showed up in any newspaper, despite selling millions of books, because he was quietly doing his work without any press releases. What makes Dr. Sarno's work so significant is that he wasn't just telling people that their pain was all in their heads. Instead, he gave them the insight that there were things going on emotionally that the patients were often not aware of because these problems were rooted in trauma from childhood. In other words, he had been taking a trauma-informed approach to back pain since the late 60's. His practice involved a thorough physical examination to rule out a more serious issue like a tumor, a fracture, or other medical issue. He said that his "prescription was knowledge"
Dr. Sarno helped patients understand just how powerful the mind body interaction was through lectures, personal discussions, and small group meetings. If he felt that the patient's emotional issues were more serious, he sent them to one of the psychotherapists he worked closely with. Over time, he phased out physical therapy because he found that it kept people focused on their physical symptoms rather than the emotional patterns and stressors that were causing the pain. He combined his medical knowledge with an awareness of the import of emotions. This is what the further research is proving to be a successful approach. Everything that Dr. Sarno developed through careful and thoughtful engagement with his patients is being borne out by research, including that which has been done by those who have followed him.
I believe that this story is much broader than just Dr. Sarno. Trauma awareness is rising in a whole host of fields. The ACE Study confirmed the impact traumatic circumstances can have on our health. Doctors who specialize in dermatology, gastroenterology, general practice, addiction, and every aspect of psychology and psychiatry are building on these insights. Dr Sarno often discussed how his theories were connected to other types of illness but he only treated people within his area of expertise.
Through trial, error, research, and insight, these other practitioners have came to see that trauma, emotional blind spots, and relationship patterns formed in childhood, often played a major role in many health issues. While few of them knew of each other's work when they had their insights, their public efforts to tell the story is beginning to connect them with each other. What connects them all, beyond their insights, is that they have had to take their ideas, observations, and research directly to audiences because the medical system hasn't valued their contributions. Dr. Sarno was doing this in the wilderness. Now, patients are finding the ideas through TED Talks, popular books, and online lectures. While you point out that the mind body connection is widely understood to be true, it still has not had a significant impact on practice. Doctors are starting to accept the idea, but they also face significant pushback from patients.
Currently, Dr. Gabor Mate, who is also in our film, is doing a very popular online event about dealing with trauma. The Holistic Psychologist (Nicole LePera) has a NY Times best selling book about uncovering trauma-related relationship patterns, Dr. Clarke's book deals with trauma and gut issues, Bessel Van Der Kolk talks of the body keeping the score, Dr Nadine Burke Harris re-oriented her work to deal with the stress of trauma and found great success, and Hilary Jacob Hendel's book "It's Not Always Depression" is helping people to connect with their underlying emotions. As I wrote in my previous note, Dr Wayne Jonas' book discusses the idea that 80% of healing comes from within. While all of these people are respected within their fields, they have had to step outside of their systems in order to tell their story to a wider audience in order to have it begin to impact practice.
Michael Galinsky
Heiner M.
Hello Mr. Galinsky
Translate with Google.
My Name is Heiner M, from Germany
I've just seen your film – All the Rage – and I'm thrilled. So far I thought that I was the only one who felt as intensely as Dr. Sano deals with the mind body syndrome. To this day I have received nothing from Dr. Sarno should be read.
I began to be interested in psychology 12 years ago. I wanted to find out why my brain makes such wild leaps of thought all the time. I didn't want to say more sentences with which I sometimes hurt other people emotionally.
Assuming that my behavior was not inherited, these faulty connections in my subconscious must have come into my brain in a different way. After about a year I understood that these connections had been saved in the subconscious for my childlike brain through too many illogical experiences. These missing connections then started in response to a keyword or a key reaction. Then there were outbursts of feeling that I didn't even notice or that I could control.
In order to free myself from these emotional outbursts, I needed another 4-5 years until I was able to experience the first successes of these emotions subside.
As Dr. Freud had already written that everything psychosomatic begins at home.
What happened next was INCREDIBLE !!!
As the emotional outbursts subsided, my physical problems also subsided. The back pain disappeared, the dark spots on the skin disappeared, the eyesight improved again, the gray hair became dark again, the intestinal problems disappeared, the skin became smooth again, the wrinkles disappear and so on …
I think you understand how it all relates! Dr. Sarno probably had too little time in his life to delve deeper into that of people's psychos. He also had to do his doctor's job every day.
The crucial point is the expansion of consciousness. Think of your father. Was her father born with his emotional outbursts? No!!! Her father got these emotional outbursts from his parents' house. Her father's parents took her from her parents' house.
If you can now look at your father from a different angle after these sentences, you expand your consciousness. Should a shiver of feelings run down your spine now, your subconscious tells you that it has understood the change in consciousness. Wait a few days to see whether you can feel any changes in the emotional area.
With correctly formulated sentences, you can already help people to think more consciously through interviews in a documentary film.
Thank you for the documentation !!!
WATCH ALL THE RAGE
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Richard Anthony Sayer "Tony" Arnell (Hampstead, 15 de setembro de 1917 – Bromley, 10 de abril de 2009) foi um compositor inglês de música clássica. Arnell escreveu obras de todos os géneros para as salas de concertos, e a sua lista de composições inclui seis sinfonias completas (e uma sétima concluída por Martin Yates) e seis quartetos de cordas. No Trinity College of Music, "estimulou pela primeira vez o interesse por bandas sonoras de filmes e música eletrónica", bem como pelo jazz. O compositor de música eletrónica David Hewson, que trabalhou com Arnell em filmes como Dilemma (1981), Doctor in the Sky (1984), Toulouse-Lautrec (1986) e The Light of the World (1989), foi um dos seus pupilos.

Biografia
Arnell nasceu em Hampstead, Londres. Estudou no Royal College of Music, também em Londres, entre 1935 e 1939, onde foi aluno de John Ireland (composição) e St. John Dykes (piano). Recebeu o prémio de composição Farrar no último ano de estudos naquela instituição. No início da Segunda Guerra Mundial, durante uma visita à Feira Mundial de Nova Iorque, Arnell (juntamente com outros compositores ingleses como, por exemplo, Arthur Bliss), viu-se forçado a permanecer em Nova Iorque, onde residiu até 1947. Face às circunstâncias, adquiriu uma sólida reputação nos Estados Unidos, mantendo-se, em simultâneo, praticamente desconhecido no seu país de origem. Durante o período passado em Nova Iorque, Arnell foi supervisor musical da BBC na América do Norte, tendo-lhe ainda sido encomendada a composição de uma cantata (com texto de Stephen Spender), The War God, destinada às comemorações da abertura das Nações Unidas, bem como uma fanfarra para receber Winston Churchill numa sua visita a Nova Iorque.

A música de Arnell foi dirigida por Thomas Beecham, Leopold Stokowski e Bernard Herrmann, entre outros, e, mais recentemente, por Martin Yates, seu aluno de composição no Trinity College. Nesta instituição, onde lecionou entre 1947 e 1987, também deu aulas a Peter Tahourdin (entre 1949 e 1952).

Arnell compôs a banda sonora de The Land (1942), um documentário de 45 minutos realizado por Robert J. Flaherty para o Departamento de Agricultura dos Estados Unidos. Foi-lhe também encomendada pela Ford Motor Company uma suíte sinfónica inspirada nos trabalhadores da fábrica do grupo em Dagenham. A obra faz parte de um filme intitulado Opus 65. Arnell criou e liderou, até à sua reforma, no final da década de 1980, o Departamento de Música da London International Film School.

Granjeou enorme prestígio como compositor para bailados através de colaborações com coreógrafos da craveira de George Balanchine, John Cranko e Frederick Ashton. Os seus numerosos bailados foram sucessivamente levados à cena tanto em Nova Iorque como em Londres. A música que compôs para Punch and the Child encontra-se disponível numa gravação de Sir Thomas Beecham, com a Royal Philharmonic Orchestra, que continua a merecer a atenção do público.

As sete sinfonias numeradas de Arnell, a par da Sinfonia Quasi Variazioni, o Concerto para Piano (com David Owen Norris como solista), os dois Concertos para Violino (com Lorraine MacAslan como solista), Lord Byron: a Symphonic Portrait, Robert Flaherty Impression, o prelúdio The Black Mountain e a abertura The New Age foram gravadas pela primeira vez sob a direção de Martin Yates, com a Royal Scottish National Orchestra, entre 2005 e 2008. As primeiras gravações dos bailados The Angels, Harlequin in April e The Great Detective, juntamente com Punch and the Child, foram levadas a cabo por Martin Yates com a BBC Concert Orchestra em setembro de 2008.

Pouco antes da sua morte, Arnell iniciou uma Sétima Sinfonia, dedicada a Nelson Mandela, entretanto concluída por Martin Yates. Foi gravada no verão de 2010 pelo próprio Yates, com a Royal Scottish National Orchestra, e lançada pela Dutton Epoch. Os Quartetos de Cordas foram recentemente editados pela mesma editora, numa versão do Tippett Quartet.

Arnell é reconhecido como um dos mais magistrais orquestradores do século XX, tendo sido descrito por Sir Thomas Beecham como o melhor orquestrador desde Berlioz.

Obras selecionadas

Música sinfónica

 Sete sinfonias numeradas
 Sinfonia Quasi Variazioni
 Sinfonia – 1939
 Symphony for Strings
 Suite in Six Movements para grande orquestra
 Lord Byron – a Symphonic Portrait
 Robert Flaherty – Impression
 Landscapes and Figures
 Concertos para piano (2), violino (2) e cravo
 Abertura The New Age
 Abertura 1940
 Abertura (sem título)
 Prelúdio The Black Mountain
 Abertura The Food of Love
 Classical Variations (orquestra de cordas)
 Abstract Forms (orquestra de cordas)
 Dois divertimentos
 Fantasia para orquestra
 Ode to Beecham (com narrador)

Música de câmara

 Seis quartetos de cordas
 Quinteto de cordas
 Trio com piano
 Quarteto com piano
 Quinteto com oboé
 RVW's Almanac (quarteto com clarinete)
 Serenata para dez instrumentos de sopro e contrabaixo
 Cassação para quinteto de sopro
 Duas sonatas para violino e piano
 Variations on an American Theme para violino e piano
 Sonatina para dois pianos
 Quinteto para metais
 Quarteto para trompas

Obras solistas

 2 sonatas para piano
 2 sonatas para órgão
 Variations on Eine Feste Burg para órgão
 peças para violino, viola e violoncelo
 vários conjuntos de variações para piano solo

Música dramática

 Punch and the Child (bailado)
 Harlequin in April (bailado)
 The Great Detective (bailado)
 The Angels (bailado)
 Moonflowers (ópera de câmara)
 Love in Transit (ópera de câmara)
 The Petrified Princess (ópera de marionetas)

Música vocal

 Ode to the West Wind
 The War God
 Six Lawrence Songs
 Con Amore
 Xanadu
 Cretaceous Intermission
 Five Emily Songs

Obras para instrumentos semieléctricos (elétricos/acústicos)

 I Think of all Soft Limbs
 Nocturne: Prague
 Astronaut

Bandas sonoras de filmes

 The Land
 Opus 65
 A Visita
 O 3.º Segredo
 Topsail Schooner
 The Man Outside
 Bequest to a Village
 Stained Glass
 The Black Panther (com David Hewson)
 The Antagonist (com David Hewson)
 Dilemma (com David Hewson)
 Toulouse-Lautrec (com David Hewson)
 Doctor in the Sky (com David Hewson)
 We Are Many (com David Hewson)
 ''The Light of the World (com David Hewson)

Naturais de Londres

redpajama_set_name: RedPajamaWikipedia


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Mum went for a walk today that lasted more than 5 minutes, the result of which was Steve and I driving around in the car looking for her like she was our lost child. The doc said she needs to build walking up gradually after the heart attack, so you can imagine my fears when she had been out for 20 minutes, even though it was a nice sunny day.
As you can probably guess, she was home waiting for us when we got back, reading the paper and looking totally unflustered (unlike me, who went out in public without a shower and dirty hair – the shame). She had walked up the road and found a nice bench to sit on in the sun, while I'd been imagining more trips to the hospital and preparing explanations to the rest of my family about how I could have let her go out and collapse in the street.
And then Seagate the goldfish, who had a little patch of missing scales when we got him yesterday, looked a bit worse for wear this evening. It almost looked like one of the others had bitten him. So I executed emergency quarantine and have put him in his own little tank for the next few days to see how he gets on. It's quietened down now, and Steve is busy industriously listing things for sale on ebay, so I have indulged myself and found a wonderful, wonderful (oh, they are so going to be mine), retro pair of shoes that I am going to win this week on ebay. Heh heh.


Does getting pre approved for a mortgage loan hurt your credit score? – I'm 28 years old and I make $66k a year. I have about 50k in student loans I'm paying back and monthly manageable amounts and I also have a car payment loan I'm paying back through my credit union.
Getting Preapproved for a Mortgage.. This means we've checked your credit and you've been credit-approved for a specific amount. Also, an underwriter has reviewed your information and made an initial decision on your application.
Refi Rates 15 Year Fixed Best 15 Year Refinance Mortgage Rates Today | Current Refi 15. – 15-year mortgages work similarly to any other fixed rate loan with one important difference – they take less time to go away that a traditional 30-year fixed mortgage. The only common fixed-rate term with lower terms than the 15-year is a 10-year.


text:
26 January in Race History: Carlos Pace Takes His Only F1 Win
Home hero Carlos Pace made many a Brazilian heart happy when he took his only grand prix victory on today in 1975.
Pace drove Ecclestone's Brabham BT44B Cosworth to win the race a his at backyard Interlagos. Jean-Pierre Jarier's Shadow led off pole and set the fastest lap before retiring, while Pace (above) came from sixth as he beat fellow Brazilian Emerson Fittipaldi and his McLaren teammate Jochen Mass. The circuit would be renamed after Pace, who lost his life in a light aircraft accident two years later.
Racing history actually stretches back to the 19th century today, when Léonce Girardot took the 1899 Perigord Bozon Cup in his Panhard-Levassor. Sixty years to the day anon and on the other side of the world, John Roxburgh won both 1959 Phillip Island Tasman races in his Cooper Climax, while across the Tasman sea Bruce McLaren took the '63 Teretonga International in a Cooper T62 Climax.
Over in the 'States in '64 meanwhile, Don Branson won the USAC Sprint Car opener in Arizona, while Sam Bird took the 2019 Formula E Prix on this day in Santiago, Chile.
Moving on to sportscar racing back in South America in 1958, Peter Collins and Phil Hill shared a Ferrari 250 Testarossa (above) to win the 1958 Buenos Aires 1000. More recently, today was a good for Juan Pablo Montoya, Scott Pruett and Memo Rojas who twice won the Daytona 24 Hour on this day. Driving a Riley Lexus with Dario Franchitti in 2008, and a Riley BMW with Charlie Kimball in 20183. More recently, Filipe Albuquerque, Joao Barbosa and Christian Fittipaldi took 2018 24 honours in a Cadillac.
Also at Daytona but 41 years prior, Red Byron captured the inaugural 1947 NASCAR Battle of the Champions on the old Beach-Road course, while Cale Yarborough took the rain postponed 1974 Western 500 season opener at Richmond.
Moving off the beaten track, Jean-Claude Andruet won the first ever World Championship Rally driving an Alpine Renault A110 at Monte Carlo, today in 1973 (below). There were six other Montes that finished on this day — Bernard Darniche won the '79 rally in his Lancia Stratos HF, Ari Vatanen took the 1985 win in a Peugeot 205 Turbo 16 and Miki Biasion '88 in a Lancia Delta Integrale. Carlos Sainz was the '95 winner in a Subaru Impreza, Sebastien Loeb's Citroen Xsara won in 2003 and Thierry Neuville took the 2020 Monte in a Hyundai.
On the day that racing movie legend Paul Newman and F1 drivers David Purley and Sergio Perez were born, American mechanic Fred Marriott steered his steamer to a new 127.66 mph land speed record in 1906. It would stand for another four years. And one of Formula 1's original dogged privateers, Bob Gerard passed away aged 76, today in 1990.
26 Januarytoday in racing
Sébastien Ogier — the New Mister Monte Carlo
Jean Alesi Mastered Being in the Right Place at the Wrong Time
6 January in Race History – Southern Stars
11 January in Race History: Brabham, McLaren, Gurney & Shelby in the News

redpajama_set_name: RedPajamaCommonCrawl


The Dirty Pink UnderBelly: Guest Post - Oh, how I need relief!
Guest Post - Oh, how I need relief!
The following was written in a moment of exhaustion and desperation by a dear friend who is going through breast cancer for the 2nd time. She just finished chemo to shrink the mass, which is too deep for biopsy, for surgical removal.
"First, I know this is ungrateful of me. And yet, I feel this way and have to speak my mind while I'm feeling it. I am exhausted. My judgment is probably very poor. But I'm so tired, I don't even give a damn. There, see? You see what happens? I'm too tired to even go backspace that away.
I'm tired. Quit asking me if you can help. Don't tell me to call you if there is anything you can do. If you don't mean it, quit saying it. So many people want to tell me that they admire me. Don't admire me. I don't need admiration. I need help. I need love. Don't tell me you love me, either. Unless you are willing to DO. Because love is a verb. An action word. Even my son can tell you that. And don't think you can DO from your house, you gotta actually leave it. Come over. Help. Physically. More than a phone call. Because at the end of the day, the phone call may make me smile for a moment. But more often than not, it simply uses up my little bit of energy in my attempt to sound more pleasant on the phone. I'd rather have you visit. Come lift some of the burden. Come help with the things I don't have the ability or energy to do, the things that need doing.
You see me come to church, you see me smile, you see or hear my positive attitude, so therefore I'm fine. Right? I must not need anything. Right? Wrong. Where are you? Give my kid a ride to mutual. Or to school. Or home from school. Or come help me pack, I'm moving. I know I'm leaving, but I haven't left yet. I'm here. I am buried in stuff that needs to be done, and don't have the energy that a normal person has. I can't do it alone. I admit it. I need you. I need your boxes. I need your able hands and bodies. I need your strong backs and energy. I can't fold laundry without becoming exhausted. Let alone pack a kitchen. Or disassemble beds. Or clean a litter box. Each task I manage knocks me out for days. I can't afford to take that long. Are you a friend? Do you love me? Or do you just say these things because they look nice on paper? Or in print? Do you mean it? I'm not sure I believe you. I'm tired. I'm too tired to worry that this might offend someone. I'm too tired to worry that people will think I'm ungrateful. I'm so grateful for those who have helped. Those who have done something to make my burden lighter.
I'm just telling you, the burden is still there. It is heavier alone than with you, my friend. I need more. And I feel like I have to beg to get it. I'm tired of asking. Someone, someone somewhere has to be listening. Someone, somewhere, has to know that He has no hands but yours. And that I'm pleading for you to come help me. Come do. Don't ask permission! Just do! I need you. Do I ask too much? Yes, I'm sure I do. I'm a spoiled, rotten brat. And don't deserve anything more than what I'm getting. I'm sure. It must be so. Right? Oh, how I need relief!"
My friend does have people rallying round to get her through her upcoming surgery and move, but it's moment to moment getting through the rough times, and having people planning to help tomorrow often doesn't change the panic and despair of the moment.
What a powerful post. You have nothing to apologize for and you speak for many who have been through treatments as well as those whose treatments will never end. I especially love the 'don't admire me' comment. That got in my grill almost as much as the 'you're so strong and/or brave'. Because as we all know, we're only doing what anyone in the same situation would do -- and it's not like there's much choice.
One thing that is difficult to navigate is that having been through BC, I have offered specific help to women in my support group who were subsequently diagnosed with Stage IV disease. We were close-knit and were all too familiar with the insincere offers and empty gestures that you described so eloquently.
But despite several of us who have specifically asked (multiple times) if we could prepare meals, take kids for an afternoon and/or pick-up from school, clean, organize, or simply visit in person -- we've been brushed off and we're at a loss as to what to do next.
Fortunately, these women are responding relatively well to their treatments but while it might appear to the uninitiated that their day-to-day lives have not been compromised as they go out with friends, see shows, attend concerts, etc., their blogs detail the side effects of treatment, the exhaustion, pain, etc. and as such, we've all offered specific help. Unfortunately, it's not possible to simply 'show up' at someone's doorstep or apartment building without being announced, and you wouldn't want to risk showing up at a bad time.
We're really at a loss at this point because we haven't made empty gestures but are being pushed away.
Awesome, truthful post! There are many great lines, but I particularly relate to this one: "you see me smile, you see or hear my positive attitude, so therefore I'm fine. Right? I must not need anything. Right? Wrong." Story of my cancer experience. Thank you for writing so honesty.
It's hard to ask for help. It's even harder to accept help. That's why, I think, we should just DO. Do something. Anything.
Better that we risk feeling rejected by the patient than for the patient to feel abandoned by us.
When I was recovering from BC, a friend who lived across the country called me once a week, without fail, for six months. That was the best gift anyone gave me. Sometimes I didn't want to talk. Sometimes I did. But it was her *consistency* that made me feel less alone.
Ah, gawd...there should be some already-printed instructions we can hand out or email to people -- or better yet, have someone else hand out or email for us -- as soon as we are diagnosed with cancer. It's just too much to have figure out what we're supposed to do about the cancer itself AND figure out what other people ought to do to help us.
One of the most touching things anyone did for me early on, two days after I got home from surgery to remove half my breast, was simply to leave a bag full of great groceries & a bunch of flowers on my doorstep, with a teeny card to let me know who my benefactor was. The groceries themselves were well chosen, too. The person who left them was the Human Resources Officer where I worked. Her card said she didn't want to presume I was up for a phone call or an impromptu visit, but she just wanted to do something helpful. And she did. Bless her for that. Others could take lessons.
How's your friend doing now? How are YOU doing?
Asking for help is so hard to do. You'd think one wouldn't even need to ask sometimes, but... People who come through when the going gets rough are real gems.


text:
In the Footsteps of Marco Polo:
Lisa Pasold's Any Bright Horse
Stevie Howell
Lisa Pasold, Any Bright Horse
Calgary: Frontenac House, 2012.
Any Bright Horse tells the story of a modern-day Marco Polo character travelling primarily through Afghanistan and China. Marco Polo was not only a traveller but also one of the world's original best-selling storytellers and guides, a muse even to Christopher Columbus. Pasold has written in many genres before, and, as a book of poetry, Any Bright Horse is hard to pin down. It is an epic poem in prose form and includes enough of a narrative thread that it feels more like an impressionistic novel—but it isn't a novel, in the purest sense, because it doesn't rely on plot or arc and isn't driven by character or dialogue as much as it is by imagery and language.
Pasold is bilingual and her writing demonstrates a deep appreciation for acquired language: "[T]ravelling," she writes, "I learned the value of rock, ill-designed though I was for anchoring." However, due in large part to tension between the narrative nodes and brevity of delivery, not every line hits a lyrical high note or makes meaningful connections. And although the art of travelling is often one of economy and deftness, I would have preferred to see much more content on numerous pages that featured only a tiny fragment of text.
Any Bright Horse appears to be worth its weight, however, as it was recently nominated for the Governor General's Award, which is no small feat. And that's also a good sign for Canadian writers, not only because Pasold blurs the boundaries of poetry and, more broadly, literature, but because she also draws on a decidedly international frame of reference—challenging what has been appropriate and long-cherished territory for Canadian authors (primarily the rural and the domestic). On the other hand, the hybridity of her work is really as Canadian as it gets, but culture has a way of playing catch-up with demographics.
Pasold has said elsewhere that this book was an "oblique" comment on Canada's involvement in Afghanistan. This context fascinated me and prompted an immediate re-reading. Unfortunately, the reference is so oblique as to be obtuse. Perhaps the distance of the narration is meant to be part of her commentary, as it is in visual artist Omar Fast's film "5,000 feet is the best." The man at the centre of Any Bright Horse is both there and not there—he's elusive, and he asks us to make sense of his story for him. I have to admit that I felt all potential critical commentary—on Marco Polo as problematic hero; on travel as a bourgeois privilege; on the subjective nature of observing the "Other"—was squandered. At one point, Pasold writes, "It is the responsibility of the listener to keep the story on track." As persuasive and exotic as the tales within this book may be, I was ultimately not convinced by that sentiment.
Stevie Howell a is a poet and a critic whose work has appeared in numerous journals. In 2012, she was nominated for the inaugural Walrus Poetry Prize and released two chapbooks, Ringsend and Royal.
Arc: as Canadian as it gets.


Check out the full taxonomy and distribution of Garden Warbler on HBW Alive.
Migrant having a bath. Andratx, Mallorca.
A bird feeding on nectar of Giant fennel (Ferula communis) during migratory stopover.
A nest containing four newly hatched nestlings.
A nest containing four well developed nestlings.
Garden warbler vs Blakcap in the background.
Long song of a garden warbler sitting on a bush near a swamp area.
Juan José Bazán Hiraldo, Andreas Gruber, Ruslan Mazuryk, Pere Sugranyes, Wout van den Brink, Greg Baker, Éric Roualet, Yoël Jimenez, Javier Ortas, Pierandrea Brichetti, Desmond Allen, Daniêl Jimenez, Christian Wiesmann, Pieter de Groot Boersma, Marti08, Alain Beaufils, Keith Blomerley, Julien Rochefort, Jeremiusz Trzaska, e.pelayo, Thore Noernberg.
Lukasz Michal Pulawski, Pierandrea Brichetti, raniero massoli-novelli, Aurélien Audevard, Juan José Bazán Hiraldo, Andrew Emmerson, Peter Vercruijsse, Holger Teichmann, Marco Valentini, Éric Roualet, Cristiano Crolle, Stanislav Harvančík, ammadoux, Lior Kislev, Oriol Soler Ferrer, Erkki Lehtovirta, José Frade, Hanna Sztwiertnia, Alberto Soria, Tomas Grim, alainbfosse, tolanger, mak khogaly, Marti08, Mario Caffi, LMArce, Paul Cools, jacqueserard, Thore Noernberg, Anne Cotton, Ken Havard, Josep Batlle, Lutz Duerselen, Lars Petersson, Martin Flack, sangarsia.
Éric Roualet, Joe Klaiber, jakprevo38, Reinhard Meissner, Josep del Hoyo, Livlandfahrer, Stuart Fisher, Andrey Moskvichev.


text:
About Harwood
Field Hockey Exceeds Expectations, Upsets #3 Seed
Harwood Field Hockey after their 1-0 win in the quarterfinals.
(Photo By Tammy Hammond)
The Harwood field hockey team had a great season this year! They played every game to the very end with intensity and truly played for one another. Toward the end of the season, the team came together with their offensive momentum.
Thursday, October 28th, the Harwood field hockey team, which was seeded 6th, made the trip to Newport to play the #3 seed (North Country) in the quarterfinals. It was a nail-biting game with high energy. When Harwood came out on top with a 1-0 upset to head to the semifinals, the team was ecstatic. The following Tuesday, their season ended in Lyndon as they lost a hard-fought game 2-0.
This year, the team had nine seniors, five of whom have been playing together for the past six years. "We go into every season with the goal to win a playoff game," senior captain Maggie Aiken said. "This year, our senior year, to be able to pull that off and cause an upset was beyond rewarding, and I am so proud to be a part of this team." Although the team may be losing a handful of seniors, their season for next year is looking great, as sophomore Kate Wilksmen was a strong presence in goal this year. Wilksmen was able to protect the goal with confidence and poise, as well as control her defense.
Congratulations on an amazing season!
Harwood Girls Dominate States
Hole-in-One for Harwood
Harwood Boys Place 4th in State Championships
Girls Varsity Soccer Semifinals Wrap Up
Fall Sports Round-Up
Good Year for Bass Fishing and its Creators
More Than Just a Game
Cross Country Team Gets Parade Welcome
Ava Thurston is State Champion for 4th Year
Harwood's Halloween Spirit!
The student news site of Harwood Union Middle/High School in South Duxbury, Vermont
Keep all comments respectful, please. All comments will be approved before being posted.
All Common Ground Picks Reader Picks Sort: Newest


text:
TVLine Items: Katy Perry Sings for SNL, The Tick Gets Premiere Date and More
By Megan Muessen / April 26 2017, 12:56 PM PDT
Katy Perry will be returning to the Saturday Night Live stage for a third time as musical guest, joining host Dwayne Johnson for the May 20 season finale, NBC announced on Wednesday.
SNL Season 42: Best and Worst Episodes
SNL resumes Season 42 on May 6 with host Chris Pine (Wonder Woman) and musical guest LCD Soundsystem, followed on May 13 by host Melissa "Spicey" McCarthy and musical guest HAIM.
Ready for more of today's newsy nuggets? Well…
* Season 4 of The Great British Baking Show will premiere on Friday, June 16 at 9/8c on PBS.
* Amazon's reboot of the superhero comedy The Tick will debut on Friday, August 25. The show, which released its pilot last August, follows Arthur, an accountant with mental health issues, who discovers his city is owned by a supposedly-dead supervillain. Arthur finds help in the form of a blue-suited hero: The Tick. Check out the trailer below:
* TNT has released below a trailer for American Race (fka Race Card), its upcoming docuseries in which former NBA player Charles Barkley explores race from multiple perspectives. American Race will premiere on Thursday, May 11 at 9 pm.
Which of today's TVLine Items piqued your interest?
TAGS: Katy Perry, Saturday Night Live, The Great British Baking Show, The Tick
GET MORE: Casting News, Premieres, Trailers and Promos, TVLine Items


Somali president Mohamed Abdullahi Farmajo has met with his predecessor Hassan Sheikh Mohamud in Ankara, the capital of Turkey on Monday night.
According to a statement posted on the President's Twitter handle, Farmajo and Mohamud discussed a range of issues regarding the current situation in the country.
President Farmajo has taken office after winning last year's election in Mogadishu, succeeding Hassan Sheikh Mohamud, the 8th president of the Federal Republic of Somalia.
The president has arrived in Turkey on Sunday for the inauguration of his Turkish counterpart, Recep Tayyip Erdoğan who has been reelected in June during presidential polls.
Under Erdogan's leadership, Turkey's relations with Somalia has significantly improved.


text:
Q: GEE regression gives NaN values as result in a dataframe subset Hi I run gee regression in a dataframe and take this result.
library(geepack)
    rightwmen<-coef(summary(geeglm(Ideo_Ordinal ~Machiavellianism+Psychopathy+Narcissism ,data = RightMen, id = Ideo_Ordinal,
                                   corstr = "independence"))) %>%
      rownames_to_column() %>%
      mutate(lowerWald = Estimate-1.96*Std.err, # Lower Wald CI
             upperWald=Estimate+1.96*Std.err,   # Upper Wald CI
             df=1,
             ExpBeta = exp(Estimate)) %>%       # Transformed estimate
      mutate(lWald=exp(lowerWald),              # Upper transformed
             uWald=exp(upperWald))              # Lower transformed
    rightwmen

 rowname   Estimate    Std.err         Wald    Pr(>|W|)   lowerWald  upperWald df     ExpBeta
1      (Intercept)  5.7656276 0.03107560 34423.423510 0.000000000  5.70471944  5.8265358  1 319.1392808
2 Machiavellianism  0.1319520 0.10168671     1.683851 0.194413479 -0.06735392  0.3312580  1   1.1410536
3      Psychopathy -0.4449102 0.15069337     8.716788 0.003152931 -0.74026922 -0.1495512  1   0.6408818
4       Narcissism  0.2291297 0.07617612     9.047429 0.002630645  0.07982453  0.3784349  1   1.2575051
        lWald       uWald
1 300.2812223 339.1816504
2   0.9348643   1.3927190
3   0.4769855   0.8610943
4   1.0830970   1.4599978

which seems normal to me.
When I run the same code in a subset of the initial dataframe (around 1300 observations) I take:
rowname      Estimate Std.err Wald Pr(>|W|) lowerWald upperWald df  ExpBeta lWald uWald
1      (Intercept)  6.000000e+00     NaN  NaN      NaN       NaN       NaN  1 403.4288   NaN   NaN
2 Machiavellianism -2.051668e-16     NaN  NaN      NaN       NaN       NaN  1   1.0000   NaN   NaN
3      Psychopathy  1.303711e-16     NaN  NaN      NaN       NaN       NaN  1   1.0000   NaN   NaN
4       Narcissism  4.350156e-17     NaN  NaN      NaN       NaN       NaN  1   1.0000   NaN   NaN

Note that I have omitted the NAs. What could be possible explanations?
#SAMPLE DATASET
A tibble: 588 x 4
   Ideo_Ordinal Machiavellianism Narcissism Psychopathy
          <int>            <dbl>      <dbl>       <dbl>
 1            5           0.0360   -0.0144       0.106
 2            5          -0.425    -0.302       -0.259
 3            5          -0.216     0.125        0.0879
 4            5          -0.776    -0.562       -0.488
 5            5          -0.225     0.167        0.0309
 6            5          -0.167     0.107        0.0539
 7            5          -0.464    -0.00283     -0.150
 8            5          -0.102     0.141       -0.0487
 9            5           0.237     0.676        0.399
10            5           0.0220    0.00337      0.0293
# ... with 578 more rows

A: Since I don't have your data this is a (wild) guess. I'll delete the answer if that does not solve your problem.
One problem I often encounter with geeglm() and geepack is that the clustering must be in order. So if you clusters could be identified as
1 1 1 2 2 2 3 3 3 4 4 4
then you have 4 clusters. However, if the clustering is
1 2 3 4 1 2 3 4 1 2 3 4
then you have 12 clusters. geepack identifies clusters as changes in the clustering variable (in your case Ideo_Ordinal). If you sample rows from your data then you might actually get too many clusters which can throw parts of the EE algorithm off because the data are no longer ordered.
This "feature" is super annoying IMO - so much so that I wrote a function to check for the ordering of the cluster specifically for this. Check out MESS::ordered.clusters() which returns TRUE if the clusters are ordered and FALSE otherwise.

redpajama_set_name: RedPajamaStackExchange


text:
Government's Easy Button: VA CTO Levin Leads the New Data Movement
The federal government has entered a new era: The Data Button Movement.
It was about two years ago that Peter Levin, the chief technology officer at the Department of Veterans Affairs, and his team set out to create the project following a meeting at the Markle Foundation with other leading healthcare thought leaders.
The goal was in itself simple and complicated. Find ways to weed through the bureaucratic and interoperability mess to let patients get easy access to their health records that they could share with physicians for their own personal use.
The result was the Blue Button, a simple concept where a patient is provided a highly visible, clickable button to download his or her medical records in digital form from a secure website offered by their doctors, insurers, pharmacies or other health-related service.
It was democratizing data at its finest.
"The Blue Button in itself is not a great technological revelation," said the energetic Levin, "but it really reflects the intensity and the need for people to get their data. And it also demonstrates that once people have access to data, they can do amazing things. And the private sector innovations are wonderful and creative. This is exactly what you hope for when you liberate data: more eyes, more ideas, more services. This is what we always had in mind".
And now the Blue Button has blown up. The Office of Personnel Management announced it will be used by all healthcare providers on the federal health benefits plan, meaning it will be a part of nearly every federal employee's healthcare plan.
The VA has increased its use, expanding it to include a veterans service records for easy access and to help in job searching. Levin said there are two simultaneous projects going on with the Button, one is increasing the capabilities of the button, basically building the infrastructure to handle 10 times the users at three times the speed.
There are also efforts to increase the button's utlity by including features like radiological images, provider notes and the like to include in people's electronic health records.
And, just two weeks ago, the Department of Energy announced the Green Button that lets consumers get more detailed information on energy usage. Levin tells us other agencies are looking to implement buttons of their own, making the number of different buttons available look like an open data bag of M&M's.
The private sector is taking notice. United Healthcare is scheduled to join the program in a few weeks and companies like Walgreens have already signed on.
Did we mention that the Blue Button didn't cost a dime to create?
"I really believe we have started a new industry here," Levin said, pointing to the announcement of the Green Button initiative where companies – in that case two of the three largest energy companies in California – rallied around the cause to create new applications and services.
"My vision for the Blue Button is a steady, transparent migration into a complete and clinically valid electronic health record. We are moving from paper-and-sneaker medical information exchange to personal records that are electronically available to individual patents but still require a person-in-the-middle to get one clinic to another. What we want is convenient, and secure and automatic interoperability between institutions. Blue Button brings us much closer to that ideal situation," Levin said.
What may end up being the Blue Button's true legacy, though, is the mountains of data it can produce for research.
Levin and other government officials still talk reverentially about when the National Oceanic and Atmospheric Administration opened its data to the public in the early 1980s, leading to innovations like the Weather Channel and improved weather prediction models.
The Blue Button, and others like it around the government, are looking to use this data and communities of interested parties to fuel future innovations and improve the lives of citizens across the country.
"It's an exciting time," Levin said, "and the best part is that we are making a huge difference in areas we can all agree on. Access to data means access to new services, new jobs, and improved health outcomes. All this and more by just getting people their information. Now that's good government."
Blue Button
Green Button
Peter Levin
Petty Officer 3rd Class Amber Degouveia, a health series technician assigned to Coast Guard Base Alameda Medical in California, administers the intranasal flu vaccine to a Coast Guard member in October 2015. (Image credit: U.S. Coast Guard / Petty Officer 2nd Class Barry Bena)
VA admits to improperly disclosing COVID-19 vaccine data for 500,000 staff
The agency removed a spreadsheet containing personal details including vaccination status following an internal investigation.
The Department of Veterans Affairs. (Tajha Chappellet-Lanier)
VA data shows Oracle Cerner EHR hit with nearly 500 major incidents since initial rollout
The George E. Wahlen VA Medical Center in Salt Lake City. (Veterans Health Administration / Flickr)
VA appoints new health data exec to lead interagency partnerships
Senate passes bill to force greater transparency over VA health records modernization costs
VA CIO reiterates commitment to working with Cerner to improve EHR uptime
VA CIO says department must hold tech contractors 'to a standard'
VA improving data standardization to meet clinicians' electronic health record needs


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Who is submitting the resolution? Resolutions can be submitted by a district, a committee, or by a group of at least 10 Utah Public Employees' Association (UPEA) members. A resolution form should include signatures.
Who is the contact person? The resolution form must include the name and telephone number of an individual who can be contacted with questions.
Resolutions must be submitted, faxed, or postmarked no later than Jan. 2. The Resolutions Committee will not consider resolutions not received by this date.


Modern geo-replicated databases underlying large-scale Internet services guarantee immediate availability and tolerate network partitions at the expense of providing only weak forms of consistency, commonly dubbed eventual consistency. At the moment there is a lot of confusion about the semantics of eventual consistency, as different systems implement it in subtly different forms, stated using disparate and low-level formalisms. Additional difficulties arise from the use of special conflict resolution policies or combinations of different consistency levels. All this complicates the implementation and use of eventually consistent systems.
In this talk, I will present our framework for specifying various eventually consistent systems and reasoning about their correctness and performance. My explanation will not assume prior knowledge on eventual consistency, programming languages and verification. It will be mostly based on examples. If time permits, I will briefly sketch interesting research challenges regarding eventually consistent systems, which touch on multiple CS disciplines, such as systems, programming languages and algorithms.
This is joint work with Sebastian Burckhardt at Microsoft Research Redmond, Alexey Gotsman at IMDEA Software Institute and Marek Zawirski at INRIA & UPMC-LIP6.
Dr Yang is a University Lecturer (corresponding to an Associate Professor in the US system) in the Department of Computer Science, University of Oxford; and a tutorial fellow at Worcester College. He received a PhD from University of Illinois at Urbana-Champaign, USA (2001), and was a postdoc in KAIST and Seoul National University (2001-2006). He held a lectureship (corresponding to an Assistant Professorship in the US system) at Queen Mary, University of London (2006-2011) until he joined Oxford. He was also an EPSRC Advanced Research Fellow from 2007 to 2012.


text:
Usher Syndrome House Call
Procedures By The Doctors Staff on 8:00 PM PDT, June 10, 2014
Dr. Phil Sets the Record Straight
Dr. Phil shares his thoughts on rumors, relationships and revealing "selfies!"
Dr. Phil comes clean about a rumor surrounding his baldness. Does he actually have a full head of hair and chooses to wear a bald cap to look more dignified?
Have you ever had trouble interpreting an e-mail or text from your ex? Dr. Phil shares his no-nonsense approach to analyzing and deciphering messages.
What are Dr. Phil's thoughts on plastic surgeon Dr. Andrew Ordon's revealing "selfie" that he accidentally texted to a patient?
Surprising Causes of Acne
Think acne only affects teenagers? Think again! Board-certified dermatologist Dr. Ava Shamban reveals unexpected reasons for your breakouts.
Six-Toe Surgery
Guinwa, 21, has been living with an embarrassing abnormality all of her life. She was born with two extra toes — one on each foot. The condition, known as polydactyly, is usually discovered at birth, but it can also be detected during a prenatal ultrasound. During embryonic development, the hands and feet split to create 10 fingers and 10 toes. Polydactyly results when an irregularity occurs in this process, resulting in the formation of extra digits on either the hands or the feet. The condition can be inherited, but the vast majority of cases have no known cause.
"Growing up, strangers would always be staring," Guinwa says. "I shopped for sandals that would cover my toes or wore closed toe shoes. I always avoid doing anything that requires me being barefoot, even getting a pedicure."
Guinwa was told that she should wait until the growth plates in her foot had finished developing before undergoing surgery to correct her condition. When she turned 18, Guinwa visited numerous doctors for an evaluation, but none of them were able to perform the complicated surgery — until she met podiatrist Dr. Ali Sadrieh.
This video contains images of a graphic surgical procedure. Viewer discretion is advised.
Watch Dr. Sadrieh perform a polydactyly reduction surgery on Guinwa's feet.
See Guinwa's incredible foot makeover! Plus, see the surprises The Doctors have to help Guinwa flaunt her feet for the first time!
• Click here for a chance to win a $100 gift card to Nina Shoes!This giveaway has ended.
• Click here for a chance to win a Clarisonic Pedi Sonic Foot Transformation!This giveaway has ended.
Former Guest Update: Was She Cured?
When 25-year-old Sarah first appeared on The Doctors in May 2012, she was struggling with an extremely embarrassing and uncomfortable condition. After suffering a 4th degree tear during labor, Sarah developed a fistula — an abnormal connection or passageway between two organs in the body. In Sarah's case, the fistula formed between her rectum and her vagina.
Sarah visited pelvic surgeon Dr. Tom Margolis for a surgical solution to her condition.
See how Sarah is doing today. Plus, OB-GYN Dr. Jennifer Ashton explains the different approaches to repair a rectovaginal fistula.
Living with Usher Syndrome
Kamryn, 15, was diagnosed with severe hearing loss at age 2 and has been wearing hearing aids ever since. Kamryn recently discovered that she faces an even more serious challenge when doctors informed her that she has Usher Syndrome — a rare, genetic disorder that causes deafness and gradual vision loss. "I started noticing in math class that I couldn't read the board, and I was in the very front," Kamryn says.
People with Usher Syndrome are always deaf or hard-of-hearing before they become visually impaired or blind. Usher Syndrome causes the development of a progressive ocular disease called retinitis pigmentosa (RP). Retinitis pigmentosa is a gradual degeneration of the retina, leading to peripheral vision loss, then central vision loss, and ultimately, total blindness in most cases.
Since her diagnosis in May 2013, Kamryn's vision has rapidly diminished, and she has been declared legally blind. While researchers are working toward finding treatments, there is currently no cure for Usher Syndrome or retinitis pigmentosa.
In a special house call, Dr. Sears meets Kamryn, who is holding a bake sale to help fund genetic testing for Usher Syndrome.
See the surprises The Doctors have to help Kamryn with her vision loss and medical expenses.
Ophthalmologist Dr. Kerry Assil explains how retinitis pigmentosa gradually leads to complete vision loss.
Ask Our Doctors: Atlanta Edition
What's the best way to regain a pre-pregnancy tummy after undergoing a C-section? Is it harmful to exercise if your muscles are still sore from a previous workout? The Doctors tackle questions from Atlanta viewers!
What is Toega?!
Can These Extreme Medical Conditions Happen to You?
Is There Treatment for Tinnitus?


Is language a virus? It is certainly contagious. Writing jumps from the written page into other spaces and landscapes. Writing is something physical, a dance, I only use the computer for the final stages, a pencil on a notebook helps me to feel the connection between my body-movement and my mind-language, and only when the real writing has taken place I allow the words to navigate into the computer to edit, polish, cut and paste.
Writing-reading is a continuous, a chain of actions and activities, physical and intellectual. Reading-writing happens everywhere and that does not need to be confined to the book, the book is not the only way to read and as cultural artefact it has its specific culture connotations that required to be 'read'.
Most of my writing has been published in Galician, some children books have been translated into Catalan and Castilian (Spanish). My writing in English has been published in the bilingual book The Book of Invisible Bridges, and the majority is used for performances of various kinds, songs, etc.
I write-read, I perform writing-reading, but I also perform about writing-reading.


On December 26, 2004, giant tsunami waves destroyed communities around the Indian Ocean, from Indonesia to Kenya. Beyond the horrific death toll, this wall of water brought a telling reminder of the interconnectedness of the many countries on the ocean rim, and the insignificance of national boundaries. A Hundred Horizons takes us to these shores, in a brilliant reinterpretation of how culture developed and history was made at the height of the British raj. Between 1850 and 1950, the Indian Ocean teemed with people, commodities, and ideas: pilgrims and armies, commerce and labor, the politics of Mahatma Gandhi and the poetry of Rabindranath Tagore were all linked in surprising ways. Sugata Bose finds in these intricate social and economic webs evidence of the interdependence of the peoples of the lands beyond the horizon, from the Middle East to East Africa to Southeast Asia. In following this narrative, we discover that our usual ways of looking at history--through the lens of nationalism or globalization--are not adequate. The national ideal did not simply give way to inevitable globalization in the late twentieth century, as is often supposed; Bose reveals instead the vital importance of an intermediate historical space, where interregional geographic entities like the Indian Ocean rim foster nationalist identities and goals yet simultaneously facilitate interaction among communities. A Hundred Horizons merges statistics and myth, history and poetry, in a remarkable reconstruction of how a region's culture, economy, politics, and imagination are woven together in time and place.
Sugata Bose is Gardiner Professor of History at Harvard University.


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Next Post: New Year's Resolutions in progress for 2013!
First annual NWA TechFest event was a huge success!
I am proud to say that the NWA community came out and did the first NWA TechFest justice!
Due to a few minor glitches in the first run of the touch screen kiosks, we were unable to get an exact head count. It was very safe to say we had over 250+ attendees. The volunteers ran the registration through the kiosks this time, but next time, at the 5th annual Tulsa TechFest – Friday, November 12th, it will be all Self-Service Touch screen kiosks.
All the speakers did excellent jobs and the evaluations are still coming in, but they have all been very good so far!
Special kudo's were given to our keynote presenter Microsoft's Murray Vince, General Manager OEM Embedded, Field & Service Partners, for coming up with a new term in the title of his presentation: Retail Computure: The Retail Computing Future!
There will be more news and information from the event released as it comes in. The attendee's donated a total of $269 to the big local non-profit community program: The Jones Center. We are still waiting on the weight from the NWA Food bank for the cans that were donated.
Thanks to all who attended and help make it a huge success!
Posted: July 14, 2010 .	Posted in: Uncategorized. Bookmark the permalink.


How effective is direct remote interaction in EuroDIG?
This report describes the evolution of remote participation in EuroDIG and provides an assessment of the current situation, focusing on the issue of inclusiveness by direct remote interaction. It also provides steps to improve and put in greater perspective the effectiveness and reach of remote participation hubs, as well as outlining further directions research can take regarding the networks of people and organisations mobilised in the process.


text:
Research Home Tools Thesaurus of Geographic Names Full Record Display
Vernacular Display | English Display
Page Link: http://vocab.getty.edu/page/tgn/7000985
Record Type: administrative
El Kef (inhabited place)
Lat: 36 10 00 N degrees minutes Lat: 36.1667 decimal degrees
Long: 008 42 00 E degrees minutes Long: 8.7000 decimal degrees
Note: Located on a rocky hill at an important highway junction into Algeria; occupies ancient Carthaginian site; was made a Roman colony by Augustus; today is a market center for grain and cattle; noted for ruins of a rampart, temple and Roman baths.
El Kef (preferred,C,V)
al-Kāf (C,V)
Al-Kef (C,V)
El-Kef (C,V)
Le Kef (C,V)
Sicca Veneria (H,V) ............ Roman
World (facet)
.... Africa (continent) (P)
........ Tunisia (nation) (P)
............ Kef (governorate) (P)
................ El Kef (inhabited place) (P)
Additional Parents:
.... Roman Empire (former nation/state/empire) (P,H)
........ Africa (province) (P,H) from 146 BCE
............ El Kef (inhabited place) (P,H)
Place Types:
inhabited place (preferred, C) ............ after 814 BCE
town (C)
regional capital (C)
market center (C)
archaeological site (C)
colony (H) ............ of ancient Rome
al-Kāf.......... [VP]
................. Encyclopaedia Britannica (1988) VI, 677
Al-Kef.......... [VP]
................. Webster's Geographical Dictionary (1988) 660
El Kef.......... [VP Preferred]
................. Canby, Historic Places (1984) I, 512
................. NIMA, GEOnet Names Server (1996-1998)
El-Kef.......... [VP]
Le Kef.......... [VP]
Sicca Veneria.......... [VP]
.......................... Canby, Historic Places (1984) I, 512
.......................... Encyclopaedia Britannica (1988) VI, 677
.......................... Webster's Geographical Dictionary (1988) 660
Subject: ..... [VP]
.................. Canby, Historic Places (1984) I, 512
.................. Encyclopaedia Britannica (1988) VI, 677
.................. NIMA, GEOnet Names Server (1996-1998)
.................. Webster's Geographical Dictionary (1988) 660


LBRY's main app developer calls himself "easily the least interesting person on the team."
That actually speaks to just how interesting the LBRY team is. Or maybe to Alex Liebowitz' sense of modesty. The fact is, Alex is a pretty interesting guy in his own right. He's been on the team for a few months now, and it's high time we introduced him.
Alex is an economist turned web developer. He studied econ at UMass Amherst but left with a few incompletes to enter the world of software, where (as he put it) nobody looks at the degree on your resume. Nevertheless, Alex is a self-professed economics nerd. As a result, he's a perfect fit for the LBRY team.
Alex brings hands-on software development skills and experience to the table. His experience includes building web and desktop apps for large national corporations. Alex also helps run a large podcasting network.
But it's through his identity as an artist that his passion for LBRY comes out.
Alex is a serious guitar player, currently studying under Phillip de Fremery, a noted classical guitar teacher who studied under Andres Segovia. Because LBRY combines the transparency and directness of peer-to-peer networks with the legitimacy and convenience of paid streaming services, Alex said he saw the revolutionary potential in LBRY early on. It offers a way for artists to take advantage of peer-to-peer technology and get paid for what they do without corporate middlemen getting a huge chunk of the take.
"As a musician, I've seen the destructive side of peer-to-peer and streaming technology up close. Much more than any of the other creative arts, the music industry has been torn apart by streaming.
"LBRY is based upon a profound insight: the problem with peer-to-peer networks is not that they're decentralized; it's not that we need a corporation sitting between creators and consumers deciding who's allowed to put their content online – and taking a hefty cut for the favor. It's that up to now, they've offered no way for creators to get paid, and no way to ensure legitimate content is the most visible and easily accessible on the network. LBRY incorporates an instant and painless payment system that allows artists to charge whatever they want and get 100% of the revenue."
Alex may not think he's exciting, but his technical skills coupled with his business knowledge and understanding of LBRY user needs will serve us well.