text:
Anxiety Says Everyone Hates Me
I am a strong person, physically. At six-foot-three inches tall and 250 pounds, most people wouldn't waste their breath arguing that assertion. And, whether because of, or in spite of, my bipolar and anxiety diagnoses, I consider myself to be strong mentally, as well. I am intelligent, accomplished, likeable, and successful.
Despite the mountains of evidence of this, my brain works diligently to convince me that every interaction I have with another person is a misstep. If I text someone and they don't reply back, it is obvious they are mad at me. If someone doesn't answer the phone when I call, say hello when they pass by, or reply to my email, then my mind goes into what can only be described as an emotional roller coaster. It isn't a fun, state-of-the-art roller coaster, either. It's an old wooden one, poorly maintained, and it's painful when it turns corners. The ride up the first hill is jerky, slow, and the anticipation sends shock waves I can feel all over my body. It is emotionally, physically, and even mentally straining. It is fear, panic, anticipation, and dread all rolled into one giant full body panic attack.
Anxiety Convinces Me That Everyone Hates Me
At that moment, I feel as though everyone I know is mad at me. They all disrespect me, think I am stupid, and do not want me in their lives any longer. Quite simply, my anxiety says everyone hates me.
Now, on top of all the other emotions, guilt forms. I feel guilty that I put someone in such a difficult position. I imposed by reaching out to them. Asking them a question, for a favor, or simply saying hello was uncalled for. I should not have done it and, since I'm a good person, I want to apologize. I want to reach back out to them and ask if they are mad, if they are okay, what I did wrong, and let them know I want to make amends. I want to set things right.
I Just Want the Anxiety to Stop
More often than not, what does get me in trouble and where I do make a mistake is by war dialing, constantly texting or e-mailing, or asking them one too many questions about why something is a certain way. Even apologizing for a legitimate mistake can be over the line, if handled the wrong way.
Ninety-seven times out of a hundred, the reason I didn't hear back was because the person was busy, in a meeting, mulling it over, or because people have things to do other than answer me. In the rare occasions where I did make a mistake, offend, or bother someone, the issue is generally cleared up quickly with an explanation and an apology. The people in my life know that I am a good person and don't intentionally hurt others and they doubly know I wouldn't intentionally hurt them.
Ignoring the Anxiety that Says that Everyone Hates Me
It is hard to sit back, relax, and not engage the anxiety. It baits me to do something I will later regret. I work with my therapist to find techniques to calm down and I explain to my friends and family that when I ask if they are mad me, it is because I genuinely care and I want to make sure they are okay. I am also honest in admitting that checking in with them alleviates my suffering. Often, it is more about me than about them, and they understand that.
There are as many ways to alleviate anxiety as there are people. It is trial and error, but there are techniques that work for many people. Mindfulness, meditation, advanced preparation, sleep hygiene, therapy, and medication can all be used to control this disorder. But the biggest factor in this will always be me.
You can find Gabe on Facebook, Twitter, Google+, LinkedIn, and his website.
APA Reference
Howard, G.
(2014, May 6). Anxiety Says Everyone Hates Me, HealthyPlace. Retrieved
on 2024, July 25 from https://www.healthyplace.com/blogs/anxiety-schmanxiety/2014/05/anxiety-says-everyone-hates-me
Author: Gabe Howard
I can relate to this feeling completely. Everyone in my life loves me and thinks I have such great potential and I can do anything I put my mind to. I also believe that but getting myself there is the hard part. I'm 26 years old I have been a server/ bartender for most of my life, traveled and that's the only thing I care about is seeing the world. I moved to Vancouver from Alberta to start a new job with door to door sales and learned so much but i gave up and I'm back doing the same serving/bartending which I absolutely love and have always loved but it's not enough to fill what's missing. If anyone has advice I would love to hear it thank you ?
I go to conventions every year and meet my favorite actor. After the 3 seconds spent in the photo op, I'm convinced I can feel this psychic energy coming from him that can only be interpreted as "HE HATES ME" is this similar to anything you go through, or does he really maybe just hate me?
I constantly feel like that vibe is given off by the people I meet. it's important to take into consideration that the standard of showing you like someone is different for each person. chances are he doesn't hate you but just has a different personality and way of reacting to things
I very much agree. One should not assume that everyone is going to react in the same way - the human race is far too varied for that.
So funny you would say that because I go to conventions as well to meet my favorite actor and after I thanked him (very briefly) for being so I inspiring he said "thank you for being awesome!" But I was convinced given his tone of voice that he hated me. That's what my mind keeps telling me although he's known for being such a sweet guy who loves everyone and who totally understands negative self talk that comes from anxiety and other things, and would never give off that vibe on purpose to a fan, since he values the fandom so much (it helped save his life). Maybe you know who I'm referencing but my point is your favorite actor does not hate you. They are at conventions because they like to meet fans. Although I know how disappointing it is to do something so fun as a photo op just to have those stupid thoughts try to ruin something good. Don't let it! And next year just enjoy the photo op for all the good things that it is! (And I'll try to do the same)
Thank you for this ariticle. I can relate to what you've written. It is relieving knowing that someone else understands. I'm sorry you have to deal with this and thank you for having the conference to write this.
I feel like this described me in a nutshell and I would like to join
Why don't we put everyone's numbers here and make one whatsapp group then?
I'd like to be part of the WhatsApp group if that's alright. What's the number?
Hello can I join the what's app group I feel the pain anxiety every damn day
I always feel like I have to ask whoever I am talking to if they are on or if they are mad. If someone seems to not have a friendly voice talking to me , I automatically assume they are mad at me. I sit home every single day bc my husband takes our only car to work everyday , I work from home so I don't leave the house. I always feel like I need to make sure everyone has what they need and want before me. I am the first person to say sorry for anything , even if I know for sure that I didn't do anything wrong. I feel lonely all of the time and feel like I just cry and cry. Most of the time I would rather try to sleep then talk to anyone bc I am so afraid that I might say something or do something to make someone angry. I feel like I have to kiss everyone's rear. Deep down inside I know this is not right but I am this way anyways . I always feel that everyone I love and care about are going to leave me . I have no one to talk to , my husband gets mad at me all of the time . He tells me to shut up and get away from him , even when I am just asking if everything is ok. I know I need to find some help somewhere or find someone that can help me through this . I am on 5 mg diazapam twice daily but it makes me so tired . I need help somewhere , I am up for a group if there truly is one. I have trust issues as well and don't mean to.
Please add me. I have taken this one to the highest level
If You're Down For a Whatsapp group then text me on that number.
Send me Your numbers on +254718259060.#What'sapp group.
I would totally be down for a whatsapp group... I don't think I'm comfortable enough to go see a professional since this whole anxiety thing embarrasses me. I'm just so sick of feeling like this all their time. It's so exhausting trying to pretend to not be anxious and being anxious at the same time. Let me know if you start a WhatsApp group Andrew.
Yes please I'll definetly join. I am on the same boat, I wish people knew how exhausting trying to do the simplest task with anxiety n social anxiety ( in my case ). Just making small talk at work I have to force myself to talk to co workers n most of the time afterwards I just feel like I'm just weird :( I'm just so exausted. Only time I feel ok is when I'm alone or sleeping
I would love a Whatsapp group, no one understands what I am going through. Then I can talk to people without worrying it would spread. Anyone down? If so tell me the numbers
Yeah was the what'sapp ever made ? I'd love to join as well
A good idea would be a private group of whatapp for example, where to share and help eachother.
I feel the exact same thing and I have anxiety disorder and I am just 14 but everyone thinks that I lie about my anxiety and do it for attention so I just don't discuss my panic attacks or feelings with anyone anymore. I know I am emotionally strong but recently I have started feeling that everyone hates me because of my personality may be. I feel like they dont need me and even though i help every single person out at school (with homeworks notes etc) because they think that I am smart. Also I am the youngest in my grade as I skipped 3 grades so everyone is older than me. I cant go to any therapist and there is no counselor available at my school currently I dont know what to do. I have been keeping everything to myself but now I just cant take it anymore. Besides my anxiety I have insomnia and depression but I dont share that with anyone either because I dont want them to hate me even more by thinking that I am merely an attention seeker
Can anyone help?
That's how I feel and I have really bad anxiety and it's hard to control sometimes I just dont know what to do anymore im 13 and I have depression and anxiety and I have a therapist
But I dont think it's working, mostly because my parents never take me but like 1 time a month I usually keep everything im feeling to myself I dont talk to my parents, but I have told my mom so many times that there is something wrong with me and I'm always sad I never want to talk to anybody and I stay isolated up in my room all the time I went to the doctor like a month and a half ago maybe two and they put me on medicine for depression and anxiety and it's suppose to help with my ADHD but my mom was too scared to get it for me because I won't take my other medications and she thought that I would miss a day and it has bad side effects like suicidal thoughts and attempts and I went to my therapist and she and my mom made a deal saying that if I took my medicines for 2 weeks she would get me what I needed and so I did exactly and I still haven't got my medicine my mom's a nurse so she always uses the excuse we are packed today and I can't take it. Sometimes I dont even want to live and I feel like nobody cares about me and I hate being this way I can't get the medicine I need and im barely hanging on from a string. I self harmed for a while then I recently am trying to stop, I quit for 2 months and then I slipped but I promise to myself im not going to do it again but when I get really sad and think a different way I always think of doing it. I am trying to stop, I know I shouldn't be this way so I dont talk about it but I can't do this anymore I really need someone to talk to. I have a boyfriend and he is so good to me we have been together for a year this month but he doesn't really understand and he's been through this before but I don't think he understands, I dont think anyone does.
so sad to hear that but atleast there is someone who feels like me. Stay strong and i understand what you are going through. I hope it gets better. May be we can talk about it somewhere else on social media if you dont mind because I think talking can help and I have never shared my feelings with anyone in person before
I feel exactly the same , I usually just put it to the back of my head , but recently it's really starting to bother me I'm a kind person and was very popular had 8 best friends from school but lost all of them due to my anxiety , feeling they didn't like me , or they where taking advantage of me , I am also quite jealous , I'm feeling very depressed at the moment I have no close friends, I have friends in work but today I feel my anxiety kicking in and I'm starting To over think about my friends in work , I hate this ! I get on well with everyone but my mind works overtime and makes me feel like I'm mad .... feel I will be lonely for the rest of my life ..
I feel angry too. I don't like this feeling and want it to stop. It scares me to be so angry. I don't know how I got to this point. I used to be a forgiving person. I didn't get angry I just got hurt and then let it go. At least I thought I did. Now though I'm bitterly angry. I don't know it's from my life experiences or my anxiety. I'm seeing a counselor and he says my anger stems from all of the hurt I feel inside. I wish there was a pill for that. How do you get rid of painful memories. They come flooding into my mind whenever someone says or does something that is similar to the previous hurt. I seem to be overly sensitive and believe everybody hates me. It's crazy. I don't know how I got to this point.
I am not diagnosed but the symptoms are the same. I always think I bother when I talk, that's why I isolate myself.I don't wanna hang out bc I feeling I'm wasting other's people time and if they suggest me that I don't believe they want to be with me for the fact of doing it, why would thry do that with so many interesting and cool people over there?Even bringing a gift to friend is so painful, I never know when someone is my friend bc I need them to say it.
Im having the same thing, it started when i had to redo a class on school. I was affraid to face my old friends because i felt like they all hated me and all i did was annoy them. I found out something might be wrong 2 days ago. When i randomly started crying in class
Im feeling really depressed because im only 15 AND I CANT DEAL WITH IT.... it ruins everything......social activities to even just going to the mall....i feel like no one wants me.....i feel like that all the time
Sarah, you are young enough that you can train your brain to stop feeling this way. How wonderful for you that you're realizing this now, when you can actually do something about it and retrain your thoughts. Hang in there, and just keep up the 'good' self-talk. Talk back to those bad thoughts and get mad at them!! ;) Just from your comment I can tell that you're a very sensitive person, and realizing that this is just anxiety talking is 99 percent of the battle. xoxo
I never realized that this was an anxiety thing for me, just kinda assumed that it was being lonely except for a couple of friends, and maybe trust issues or something. I don't think that I expirience as much of as other people commenting, but I often feel like when I don't talk to people for a little while,(even just a couple days sometimes) we're just growing apart and I have no control over it, and it just scares the heck out of me.
This is so me. Except I won't keep calling or texting people. I will shut down and not speak to anyone because I am scared that maybe my paranoid thoughts are true. I own my own business and this gets me "in trouble" all of the time.
Im just realizing how much anxiety has affected my life. I think everbody really hates me. They just pretend to like me. Because I feel this way so much I have isolated myself. I dont have any friends that hang out with or talk to on a regular basis. If I do start to talk to someone I tend to find reasons to stop. Im so lonely but to the few people Im around all the time I pretend to be ok. Im tired of pretending I tired of acting stong when Im really falling apart and want to runaway.
I'm exactly the same, and whenever I feel like I'm so done and I'm about to tell someone exactly how I feel, I'm scared and I don't want to take their time. And it's dangerous because I'm always doing things such as driving extremely fast in order to just get away from it all.
I have extreme anxiety I take medication but still freak out in the stores. Fear comes over me and all I want to do is escape. I dread crowed and feel Ill get lost. My heart beats overtime. I also have paranoid schizophrenia. The medicine I'm taking for that is helping, But what to do about the anxiety I don't know take four 1 mg tabs a day of klonopins which helps better than before. What to do?
Im only about 14 years old and i have severe anxiety issues and every time i speak to someone i feel they just dont want to speak to me because they hate me. I really hope it gets btter soon because im not sure i can live with it.
I have been feeling like this ever since my early 20s am now mid 30s and my worst is at work I fear that everyone hates me or talks about me or feels sorry, I fear any time we all have to go in for a meeting or even a lunch can make my anxiety get so bad, I'm coming to realise it may of been from when I was younger and got a little bullied at school was nothing major but I am a sensitive shy person, everyone always comments how gorgeous I am and positive but deep down I have so much doubt and lack of confidence, I also know our minds are such a powerful thing and we are only human , we need to look after ourselves and exercise meditate, eat healthy n hang out with people who make u feel good don't be around toxic people, stay positive friends and let's not let this fear of ours take over our lives, all the best x
All above is there to teach us what need 2 know!Counsolling really does help!With faith &hope we can get onto comfortable squares!One day @ time!
I am releived to find this forum. I feel so alone in this small quaint town..everyone has a place and I am working hard at making genuine connections with people. Its been 3 years of torture isolating in an out..I wear a smile greeting people asking them if they want to hang out after a couple times chatting of course..but nothing seems to go thru. I have alot of anxiety Im thinking its social bc i hate gatherings and fear sweeps over me panic attacks..party or wedding..ect. evn important meetings i studder and say shit i shouldnt..i am so frustrated and sad wondering what is it that people dont like about me? Ive been bullied my whole life school job..I think their right bc its the mesagae ive heard my whole life. Your not good enough or u wont be anything special why try? I grew up with Narsasstic abuse amd its takin a heavy toll on my life health spirit. Ive spoken to counselor but i dont have acess any more. I just feel so isolated alone an need social connection. Tired of fighting the anxiety of it all. Meds dont work for me i am doing meditations now..so hpoefully that makes a postitive impact. Its a whole of darkness..an i jus want out!


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- Research article
- Open access
- Published:
A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals
Arthritis Research & Therapy volume 14, Article number: R21 (2012)
Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis (OA) of the knee (the Osteoarthritis of the Knee Self-Management Program (OAK)) implemented by health care professionals would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group.
Medical practitioners referred 146 primary care patients with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded. Randomisation was to either a control group or the OAK group. The OAK group completed a 6-week self-management program. The control group had a 6-month waiting period before entering the OAK program. Assessments were taken at baseline, 8 weeks and 6 months. The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales on the Short Form 36 version 1 questionnaire (SF-36) Secondary outcomes were Visual Analogue Scale (VAS) pain, Timed Up & Go Test (TUG), knee range of motion and quadriceps and hamstring strength-isometric contraction. Responses to treatment (responders) and minimal clinically important improvements (MCIIs) were determined.
In the OAK group, VAS pain improved from baseline to week 8 from mean (SEM) 5.21 (0.30) to 3.65 (0.29) (P ≤ 0.001). During this period, improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes: WOMAC Pain, Physical Function and Total dimensions, as well as SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains. In addition, from baseline to week 8, the proportion of MCIIs was greater among the OAK group than the control group for all outcomes. For the period between baseline and month 6, WOMAC Pain, Physical Function and Total dimensions significantly improved in the OAK group compared to the control group, as did the SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains, as well as hamstring strength in both legs. During the same period, the TUG Test, range of motion extension and left-knee flexion improved compared with the control group, although these improvements had little clinical relevance.
We recorded statistically significant improvements compared with a control group with regard to pain, quality of life and function for participants in the OAK program on the basis of WOMAC and SF-36 measures taken 8 weeks and 6 months from baseline.
Osteoarthritis (OA) is the most common form of arthritis and the third-leading cause of life-years lost to disability [1–3]. It affects 10% of the population and is more common in women than in men. By age 65 years, 50% of the population have OA [1], and, as the population ages in demographic terms, the prevalence of OA is expected to rise. The knee is a commonly affected joint, with a prevalence of OA of 40% in people age 65 years or older [2].
Self-management (SM) is considered to be an effective strategy in the treatment of chronic illnesses, including OA [4]. Numerous SM programs have been developed for different illnesses, such as diabetes, hypertension, asthma and arthritis. Various models, both disease-specific and generic, have been employed, including individual [5], group-based [6], post and internet programs [7]. Most arthritis SM programs use lay leaders who deliver a scripted program. Face-to-face interaction with health care professionals is an important component of some programs, especially when medication compliance is considered relevant [4].
A number of studies have examined the effectiveness of SM for people with arthritis [4, 7, 8]. One systematic review of SM interventions for various chronic diseases found a trend towards a small benefit from arthritis programs, the majority being Stanford University's Arthritis Self-Management Program (ASMP) [9] or derivatives of the ASMP. The results were not significant, and publication bias was suspected [7]. A comparison of lay leaders versus health care professional leaders has also been published [7]; however, the study required all leaders, both lay leaders and health care professionals, to deliver the same scripted program, which limited the capacity for the knowledge and skills of the health care professionals to be optimally utilised [10]. Given the design of the study, it was not surprising that no differences were demonstrated. Despite the popularity of layperson-led SM programs for arthritis, and taking into account possible cost advantages, Taylor and Bury suggested that such programs have little or no advantage in terms of improved self-efficacy or the management of chronic illness [11]. Another study, by Hurley et al. [5], demonstrated positive findings. They compared group and individual rehabilitation programs run by physiotherapists in combination with SM and education (ESCAPE-knee pain (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise)) with normal care in 418 participants with knee OA. The authors found that people in the ESCAPE-knee pain groups had better functioning than those in the normal care group.
Although lay leaders have the potential to be role models (as they often have musculoskeletal conditions themselves), health care professionals, with their knowledge and skills, can also have powerful influence as models. A modelling approach has the potential to transmit knowledge and skills to which people may aspire, particularly if the information is perceived to be important and relevant, resulting in behaviour changes that are more likely to be maintained over the long term [12]. This platform for behaviour change is constrained in layperson-led programs because of the limited knowledge of lay leaders.
Self-efficacy is an integral component of SM, and resilience goes hand in hand with self-efficacy. Resilient people tend to have well-developed self-efficacy and, when confronted with an obstacle, will see it as a hurdle to overcome rather than an insurmountable problem. Furthermore, when repeated problems are encountered, they are more likely to persist longer in attempting to overcome them [13]. Those who attempt and succeed will benefit in terms of improved self-efficacy.
Factors influencing self-efficacy, such as problem-solving, pain management, exercise, modelling, social persuasion, weekly goal-setting and cognitive therapy, are interconnected. Pain management is important because often people are hesitant to undertake new activities for fear of pain, regardless of whether pain has previously been experienced with that particular activity. Many people with OA rely on medication for pain relief, but are reluctant to take medication because of possible side effects. Such people prefer to be aware of the pharmacologic and treatment options available and then decide on a course of management. If knowledge about the available options is lacking, however, the treatment choices are more limited, and, importantly, this may have an impact on adherence to treatment [14].
The lack of demonstrated benefits of SM in patients with arthritis highlights the need to develop and test alternative models of SM. In this report, we describe the evaluation of an SM program for people with OA of the knee, the Osteoarthritis of the Knee Self-Management Program (OAK), which is designed to be delivered by health care professionals.
People with OA may initially resist physical activity due to discomfort, fear of pain, or previous advice to avoid exercise [15, 16]. Many believe that exercise will result in bone and cartilage loss and are therefore resistant to exercise in general [16], yet avoidance of activity is known to contribute to disability long term [17]. The OAK program includes general information about the benefits of exercise and specific advice on joint protection during exercise for those with OA of the knee. The program aims to maximize the benefits of physical activity and promote long-term adherence to an exercise regimen by using structured exercise participation that is linked to weekly 'SMART' goals (Specific, Measurable, Attainable, Realistic, Time-bound) [18]. The program offers the added reassurance that health care professionals are on hand to give advice, and the group dynamics offer incentives for participants to comply with and maintain the exercise regimen. Participants' success in meeting goals each week increases self-efficacy [19], which is the strongest and most consistent predictor of physical activity behaviour and its maintenance over the long term [20]. Although exercise features strongly in the OAK program, OAK is not an exercise school. Exercise is only one component of the program, and it is up to each individual to decide how much emphasis is given to exercise from week to week during the program.
Cognitive symptom management strategies are encouraged to help eliminate 'negative' symptoms associated with OA. Such negativity not only affects individual symptom control but also contributes to and exacerbates the symptoms of OA [21]. Guided imagery, relaxation techniques, positive self-talk and problem-solving are taught to participants. These techniques enable participants to understand how such influences contribute to their symptoms and provide them with the skills necessary to prevent the symptoms' becoming an overwhelming negative influence. Health care professionals also use their knowledge to assist participants with problem-solving to overcome hurdles and promote resilience [22].
Materials and methods
In this study, we sought to determine whether a disease-specific SM program for people with osteoarthritis of the knee (the OAK program), implemented by health care professionals, would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group. This study was approved by the Human Research Ethics Committee at Curtin University of Technology (HR141). Data access and storage were in keeping with National Health and Medical Research Council guidelines [23]. License agreements were obtained for the Short Form 36 version 1 questionnaire (SF-36) and the Western Ontario and McMaster Universities Arthritis Index questionnaire (WOMAC).
The study design adhered to Consolidated Standards of Reporting Trials Statement guidelines and intention to treat principles. This trial was registered with the Australia and New Zealand Clinical Trials Registry no: 12607000080426. The protocol has previously been described in greater detail [24]. Amendments to the trial protocol included analysis to determine participant's response to treatment (responders). This was necessary to meet the requirements suggested in the Osteoarthritis Research International Outcome Measures in Rheumatology (OMERACT-OARSI) guidelines [25]. In addition, the proportion of people attaining minimal clinically important improvements (MCIIs) in WOMAC physical function SF-36 domains, Visual Analogue Scale (VAS) pain (at 8 weeks) and the Timed Up & Go Test (TUG) was determined.
OAK program
The OAK program differs from other arthritis SM programs in a number of respects. It is a disease-specific OA SM education program designed for delivery by health care professionals. Its theoretical framework uses Social Cognitive Theory [22] to enhance participants' self-efficacy and promote long-term changes in behaviour. The results of an uncontrolled quality assurance study of the OAK program were positive in terms of improvement in pain, quality of life and physical function [26]. The program was designed specifically for people with OA of the knee and for implementation in a community-based setting, thus removing the burden of health care at tertiary institutions. The education component of this program is detailed, so delivery by health care professionals is more appropriate than delivery by lay leaders. Principles and theories of SM are used to promote behavioural change. In particular, exercise and disease coping strategies are promoted within a SM construct as a means of improving quality of life and general health as well as reducing pain.
Health care professionals, including nurses, physiotherapists and occupational therapists, who deliver this program must have a minimum level of musculoskeletal education to ensure that they have the necessary knowledge and skills to present information about OA of the knee and respond accurately to complex questions. The fidelity of the OAK program is maintained by the use of a facilitators' manual with modules for program delivery each week that are designed specifically to maintain the consistency and accuracy of the information delivered.
The OAK program is conducted in a group setting with six weekly sessions of 2.5 hours each, with a baseline assessment 1 week before the start of the 6-week SM program and a second assessment the week following the completion of the program. This 8-week period is referred to as the 'clinic phase'. Attendance is voluntary; however, participants are encouraged to attend all sessions. The program is designed so that participants will progress over time by incorporating and consolidating information learned from week to week. In addition to the weekly sessions, participants are given printed information relevant to the course component discussed each week. To facilitate optimum group dynamics, the target group size is 12 participants.
The program is implemented using a holistic approach and addresses multiple aspects of care: osteoarthritis (explanation and implications), SM skills (goal-setting, problem-solving, modelling, positive thinking and improving self-efficacy), medications (types, interactions and current trends), correct use of analgesia (use, therapeutic dosing, types and side effects), pain management strategies (cognitive and pharmacologic), fitness and exercise (strength, flexibility, aerobic and balance), joint protection, nutrition and weight control, fall prevention (balance and proprioception), environmental risks, polypharmacy and coping with negative emotions. The differences between the OAK Program and the ASMP are described in Table 1.
Study design
We conducted a two-group, randomised (1:1 ratio), controlled, repeated-measures study to examine group differences regarding changes over time. Convenience sampling was employed. The research sample was selected from among people who were referred to the program. Suitable candidates were invited to enrol in the OAK program. Those who agreed to participate and provided their written informed consent were randomised either to an OAK group (immediate start) or to a control group (delayed start). For ethical reasons, those participants who were randomised to the control group were offered the opportunity to enrol in the OAK program at the conclusion of the 6-month study. Independently of the study, all participants were allowed to continue standard medical management for knee OA. Figure 1 shows the design of the study and the time points at which the outcome measures were recorded. All assessments were performed at Arthritis Western Australia.
One hundred forty-six participants (37 male and 109 female) with established OA of the knee and mean (SD) age of 65 (8) years were enrolled into the study from primary care general practices. Inclusion and exclusion criteria are listed in Table 2. All participants who were recruited from the Perth metropolitan area and immediate surrounds provided their written informed consent prior to enrolment.
Socioeconomic status was estimated according to residential postcodes using a method developed by the Australian Bureau of Statistics: the Index of Relative Socio-Economic Disadvantage [27]. The index provides a weighted value, with a low index value representing disadvantage and a high index value representing advantage (Table 3).
During the recruitment phase, the OAK program was actively promoted to general practitioners, rheumatologists and health care professionals through professional societies and to the general public through advertising and media coverage. Invitations were also extended to those people with OA of the knee who made general inquiries to Arthritis Western Australia. The OAK program and all assessments were conducted at Arthritis Western Australia, a community setting that is close to public transport and has available infrastructure to run the program and coordinate the study. This project was funded with in-kind support from Arthritis Western Australia. The research undertaken was independent from the funding body.
Randomisation and blinding
Participants were allocated to study groups using simple randomisation performed in batches of approximately 24 depending on recruitment success. Once a group of 24 volunteers were recruited, they were randomised to either the OAK or the control group. Twenty-four premade cards (twelve interventions and twelve controls) in sealed opaque envelopes were placed in a box. An envelope was drawn from the box by an independent person to determine group allocation. Blinding of participants was not possible, owing to the nature of the intervention; however, the physiotherapists performing the assessments did not participate in the facilitation of the OAK program and thus were blind to group allocation. To maintain blinding, the physiotherapists were asked not to discuss group allocation with the participants during assessments.
Outcome measures
The outcome measures included both primary and secondary measures. The primary measures were health status, measured using the self-administered WOMAC Osteoarthritis Index for OA of the knee (WOMAC LK3.0) [28, 29]; and quality of life, measured using the SF-36 questionnaire [30, 31].
The secondary measures were VAS pain [32, 33] assessed at weekly intervals in the OAK group during the delivery of the knee OA program from baseline to the 8-week assessment, whereas the control group was assessed for VAS pain scores at baseline and at week 8 (see Figure 1). Functional mobility was assessed using a modified TUG test [34–36]. For this study, ascending and descending a 15-cm step was added to the outward walk. Two measurements were performed, and the average of these measurements was used for analysis. Range of motion of the knee joints was measured using a long-armed goniometer [37, 38]. Isometric strength of the hamstrings and quadriceps muscles measured at 90° knee flexion using a Mecmesin force gauge dynamometer (Slinfold, UK) [39]. Parameters for each knee were measured three times. The first (practice) measurement was excluded. The two subsequent measures were averaged for analysis.
The number of responders and MCIIs achieved by participants were calculated in addition to primary and secondary outcome measures to meet the OMERACT-OARSI guidelines [25].
Statistical power calculation
An a priori power calculation based on the quality-of-life outcome as measured by the SF-36 [30] was undertaken. The SF-36 was chosen because it is the least sensitive instrument and requires a greater sample size to detect changes in treatment differences with respect to pain and physical functioning in people with OA [40]. Sample size was calculated according to guidelines in the SF-36 Users Manual to determine differences in changes over time between the intervention and control groups using a repeated-measures design, allowing an intertemporal correlation of 0.60 between scores [30]. Previously, the OAK program quality assurance study SF-36 data showed an average difference of 10 points across the eight domains measured [26]. Assuming that this level of improvement was likely to be achieved in the OAK group and that no change was expected in the control group, and allowing for a 10% dropout rate, the number of participants was calculated to be 60 [30]. In the quality assurance study, the dropout rate was 5% over 3 years, so allowing for a 10% dropout rate was a conservative estimate. Differences in changes in functional ability measured using the WOMAC questionnaire, which were similar in magnitude to those previously documented [41], would also be detectable in a sample of this size.
Data analysis
Data were analysed in a blinded manner using SPSS version 17 for Macintosh software (SPSS, Inc, Chicago, IL, USA). Treatment groups were examined for comparability at baseline. Despite randomisation, there were between group differences in severity at baseline. Therefore, baseline values (recorded in Table 3) were used as covariates in the analyses [42]. This had the effect of the preintervention mean (SEM) values' being the same at baseline in both groups. The main comparisons between groups were performed using an intention-to-treat analysis. All participants were encouraged to attend follow-up measurement sessions, regardless of their level of participation in the program. Where data were missing, the previous value was carried forward. To test the effects of treatment, between-group differences in changes over time (baseline, 8 weeks and 6 months) were examined using repeated-measures analysis of covariance. A separate analysis was conducted for each outcome variable.
For secondary analyses, a favourable response to treatment (responder) was recorded as defined by the OMERACT-OARSI criteria [25]. We used scenario D: an improvement of ≥ 50% and an absolute change of ≥ 20 points on a 100-point scale in pain or function or an improvement in at least two of the following: an improvement of ≥ 20% and an absolute change of ≥ 10 points in two of the three parameters pain, function and global health. Because patients' global health was not recorded in this study, however, only the pain and function sections of the second alternative were available.
Furthermore, the proportion of participants achieving MCIIs independently in terms of health status, quality of life, pain and the TUG test were computed for each group at each observation time point. The criteria for the MCIIs were as follows [43]:
Health status using WOMAC Physical Function (0 to 100)
Absolute change -9.1 points
Percentage change: -26.0%
VAS Pain score
Absolute change -1.99 points
Percentage change -40.8%
Quality of life using the SF-36 questionnaire (Body Pain and Physical Function domains)
Absolute change +5 points
TUG test
Percentage change -9%
The proportion of participants achieving MCIIs and the responder criteria were computed for each group at each observation time. A Pearson's χ2 test not sure what the underscore is here was used to examine the effect of the treatment in terms of the proportion of MCIIs and responders. Statistical significance was inferred at a two-tailed P value < 0.05. The results were not adjusted for multiple comparisons, because all outcomes of interest were nominated a priori and such adjustment would likely have rendered all findings of interest, despite their clinical importance, nonsignificant [44].
Table 3 shows the number, characteristics and distribution of all subjects. The male-to-female ratio was not significantly different between groups (Pearson's χ2 = 2.311(1,146), P = 0.182). Sixty-eight participants from each group were assessed at 6-month follow-up examinations. All participants in the intervention group (OAK group) included in the analyses attended at least four of the six SM sessions. The mean (median) attendance in the OAK group was 5.77 (6) sessions. The reasons cited for withdrawal were overseas relocation; work, family and time commitments; and not having been randomised to the OAK group. Participants from the highest socioeconomic group were overrepresented, and approximately 90% had coexisting disease (Table 3).
Mean differences
Primary measures
WOMAC Pain, Physical Function and Total scores improved more significantly in the OAK group than in the control group (Table 4). The advantage in between-group differences in changes was evident in the Physical Function and Total scores at posttreatment and 6-month follow-up; by 6 months posttreatment, however, the improvements in Pain scores were comparable between groups. There were improvements from baseline to 8 weeks in the SF-36 scales Physical Function, Role Physical, Body Pain, Vitality and Social Function in the OAK group compared with the control group. These differences were maintained at 6 months (Table 4).
Secondary measures
A trend in pain improvement that corresponded with an increase in exercise was noted in the quality assurance study. Therefore, VAS scores were assessed during the intervention phase of the study to track pain during the OAK course.
In the OAK group, VAS pain decreased 30% during the 8-week intervention phase (mean (SE) 5.21 (0.30) to 3.65 (0.29), P ≤ 0.001), and the control group had a 17% increase in pain (5.27 (0.30) to 6.19 (0.32), P ≤ 0.001) during the same period. The difference in the mean change between groups, from baseline to week 8, was 2.54 cm (95% CI = 1.66 to 3.41). The TUG test results showed a significant improvement in the OAK group compared with the control group postintervention and at 6 months; however, the improvement was small (Table 5) [45]. A MCII for TUG was observed in three times as many OAK group participants as control group participants at 8 weeks (OAK = 46 and control group = 15); however, this ratio was appreciably lower at 6 months (OAK = 38 and control = 26).
Hamstring strength improved in both right and left legs in the OAK group compared with the control group. In the right hamstrings, there was a 34% improvement postintervention and a 29% improvement at 6 months. In the control group, improvements of 10% postintervention and 14% at 6 months were achieved. Similar improvements were observed in the left hamstrings (Table 5). Despite the significance of these results, they have little clinical meaning because of the limited magnitude of the improvement. There was no significant difference between groups in quadriceps strength in either the left or right legs.
Small increases in range of motion were observed. Extension in both knees and flexion of the left knee in the OAK group improved significantly compared with the control group; however, these improvements also were of questionable clinical significance because of the magnitude of the improvement.
Following the intervention, the proportion of responders in the OAK group at 8 weeks was more than three times that in the control group (Table 6). At this posttreatment assessment, 26 people from the OAK group and 8 from the control group were classified as responders according to the prespecified criteria for response to treatment [46]. There were 22 responders in the OAK group compared to 14 in the control group at 6 months; however, the difference between groups was not statistically significant at that time point.
Minimal clinically important improvements
The OAK group had a greater proportion of MCIIs on all outcome measures at all time points compared with the control group. The differences were significant for all variables apart from SF-36 Body Pain scale at 8 weeks and the SF-36 Physical Function and Body Pain scales at 6 months (Table 6). The proportion of MCIIs between the OAK and control groups was greatest immediately after intervention. In the OAK group, approximately three times as many participants were achieved a MCII compared with the control group at 8 weeks and almost twice the number at 6 months.
In this randomised controlled trial, we have demonstrated that participants in a SM program designed specifically for people with OA of the knee and delivered by health care professionals experienced improvements in a number of health domains that people with OAK have identified as important problems associated with their condition [47].
SM aims to motivate people to undertake the changes in behaviour necessary to improve their condition. The priorities of people with OA knee have been identified as problems with pain and activities of daily living, and their preference is to actively manage their condition [14, 47]. The OAK program was designed as a community-based SM education program that aims to improve pain, function and quality of life and to empower people to address these preferences with the support of health care professionals who have expertise in this area. The OAK program incorporates education with an emphasis on OA-related information and the benefits of exercise within SM constructs to promote improved self-efficacy and changes in behaviour. Utilising the knowledge and skills of health care professionals is a chief component of the OAK program because knowledge is an important part of self-efficacy in that no amount of confidence will produce success unless the required knowledge and skills are present [48].
The mechanisms involved in successful SM are not well-understood. The highly structured nature of the intervention may be important, and other nonspecific mechanisms such as group dynamics may be contributory. Nevertheless, there appears to be consensus that the efficacy is likely to be due at least in part to increased adherence to medications [4]. This is a positive effect, especially in people with chronic diseases, for whom compliance (adherence and persistence) with all measures, including pharmacologic ones, are important in optimal management. It should be noted that in the OAK program, educational material concerning pharmacologic therapy and pain relief are included in the syllabus.
The WOMAC and SF-36 questionnaires are both tools that can demonstrate improvements in pain and in overall health status [49]; in people with OA, however, the WOMAC questionnaire is more sensitive than the SF-36 to changes in pain and physical function [40]. Improvements in pain scores demonstrated on the VAS (weeks 1 to 8) were also reflected on the WOMAC and SF-36 questionnaires in the OAK group compared with the control group, and, moreover, they were maintained to 6 months.
Similarly, in the OAK group, a significantly greater proportion of responders were observed at 8 weeks compared with the control group, though by 6 months this proportion did not differ significantly between groups. Reviews of SM show that there is a decline in the extent of improvements by 6 months. This decline is commonly observed in such studies and highlights the limited duration of the benefit that accrues due to SM in the management of OA of the knee, which, of course, requires long-term care [8, 11, 50]. These and other observations attest to the need for more research in this area, especially studies which investigate the differences in cost between SM programs that utilize health care professionals and layperson-led SM programs.
Determining the value that patients place on improvements in pain can be difficult. In studies in which patients were treated with nonsteroidal anti-inflammatory drugs (rofecoxib or ibuprofen), patients have perceived improvements of 9% to 10% in WOMAC scores as beneficial for OA of the knee [51]. The OAK group demonstrated better improvements in WOMAC pain of 23% between pre- and postintervention and of 13.7% from preintervention to 6 months. By contrast, at the same time points, the control group had improvements of 2.3% and 7% in WOMAC pain.
One limitation of the OAK/control study is that it compared a treatment program with a no-treatment control group. Therefore, the only blinding that could be maintained was assessor blinding, an important consequence of which is the risk of reporting, attrition and other types of bias. In addition, self-reported pain may be affected by bias, as patients are keen to 'do well' and to please health care providers by reporting an improvement when there may not have been one. Moreover, the perception of the efficacy of the treatment by the health care providers may influence how the patients perceive their pain and thus may result in an improved pain rating [52], suggesting that the bias related to no-treatment control groups is generally underestimated [53].
As with pain, there were significant improvements in quality of life and function in the OAK group compared to the control group, with improvements seen in WOMAC and SF-36 scores maintained to 6 months. Physical improvements were also maintained at 6 months compared with the control group. Self-reported functional outcome measures tend to be influenced by pain, so it is important to have functional as well as self-reported outcome measures because the combination allows a more realistic appraisal of functional ability than self-reported outcome alone [54].
The control group also demonstrated improvements in many outcomes. It is difficult to explain these improvements other than patient-provider interactions at assessments. Patients in untreated control groups may interact with health care providers. Hróbjartsson and Gøtzsche [53] suggested that the possibility of patient-provider interactions could have clinically useful effects. For example, there may have been a 'Hawthorne' effect, which is described as the awareness of being involved in a trial with resulting altered (that is, improved) behaviour or performance [55]. There was also an unexpected improvement in the number of responders in the control group from 8 weeks to 6 months. Using last value carried forward (LVCF) to replace missing data assumes that the participant's responses would have been constant from the beginning to the end of the study, and this assumption can result in the false conclusion that a difference exists when in fact there is none [56]. Using the LVCF creates the impression that the participant is in a state of equilibrium, neither better nor worse, an outcome that could be perceived as beneficial in terms of disease progression in OA because OA is a condition that generally deteriorates over time. This has the potential to bias the estimates of treatment effect [57].
Strategies to retain the study population included telephone and written notification of follow-up assessments, offers to reschedule missed assessment appointments and telephone contact to encourage rescheduling of assessments. Attendance at assessments at week 8 was 96% in the OAK group and 85% in the control group. The difference may be explained by some participants in the control group assuming that because the control period was 6 months, their participation was not required until that point. At 6 months, participation was relatively unchanged, with the OAK group's attendance being 93% and the control group's being 85%. All nonattending participants received posted self-report questionnaires with postage-paid, self-addressed envelopes enclosed. Not all participants returned the questionnaires. Although the posted questionnaires captured self-reported outcomes, they did not capture physical assessments, and other missing values were recorded with the LVCF, which is consistent with an intention-to-treat analysis.
Within-group improvements were evident on the WOMAC (Stiffness and Total scores) and the SF-36 (Physical Function, Role Physical, General Health and Vitality). The significant improvements seen in hamstring strength, but not quadriceps strength, are difficult to explain. The OAK program is not an exercise program, and, although participants are encouraged to exercise, the exercises are delivered within a SM format that requires individuals to adopt an exercise regimen that best meets their needs.
The highest socioeconomic group was overrepresented in this study. It is possible that the study results might overstate their likely impact on the wider community, because there is the potential for people with higher education levels to have better outcomes. Arthritis Western Australia is located in a middle socioeconomic area. Previous attempts to recruit from lower socioeconomic areas had limited success. Strategies for outer metropolitan and rural clinics were discussed and may be pertinent for future studies. Another possible limitation of this study is the self-initiated enrolment, which might produce potential bias because those people who volunteer may already be positively predisposed to SM [11, 50].
These results reflect the improvements seen in a previously reported quality assurance study in which the OAK program was tested [26]. The use of a more rigorous study design further strengthens the earlier findings. The combined information should prove useful for planning future models of SM in arthritis care. Although the use of health care professionals as facilitators will add to the cost of such care, there is only weak evidence to support SM programs that use lay leaders. Cost analysis was not within the scope of this study. Future research comparing the OAK program with a lay leader SM program should be undertaken to determine the most effective model.
In participants with OA of the knee, statistically significant improvements in pain, quality of life and function were observed in the group randomised to an OAK intervention program delivered by health care professionals compared with those randomised to a control group. The number of participants achieving MCIIs and responder criteria at 8 weeks and 6 months in the OAK group compared with the control group adds strength to these findings.
Future research is recommended to compare and estimate the cost of the OAK program in comparison to other SM models, in particular the ASMP. A comparison with ASMP would help to determine whether a policy shift between lay leaders and health care professionals is justified. Comparison of the OAK program and an exercise-alone program may provide useful information regarding the improvements noted in the OAK group. Such studies should incorporate longer follow-up assessments.
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The authors extend special thanks to Hannah Goldstone for assistance with data entry and to Jessica Rose for editorial assistance. This study was supported by Arthritis Western Australia.
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SC collected the data. SC and KB were responsible for data analysis and writing the manuscript. GC, CI, NC and JM assisted with the study design and provided comments on the drafts. All authors approved the final version of the manuscript.
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Coleman, S., Briffa, N.K., Carroll, G. et al. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Res Ther 14, R21 (2012). https://doi.org/10.1186/ar3703
DOI: https://doi.org/10.1186/ar3703


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Join us for our client-centred and trauma-informed hybrid doula course as we guide you through interactive teaching and hands-on demonstrations! The in-person workshop creates the opportunity for students to learn, hold space, and boost their confidence alongside peers and our experienced team of instructors.
The workshop will be held from 9:00 a.m. to 5:00 p.m. local time every day. Please note you must be in attendance all days in order to qualify for the in-person course requirements.
As part of your doula certification, you will be expected to complete online learning modules and related assignments alongside in-person training attendance.
*If you'd like to register for the Birth Doula AND Postpartum Doula please select that ticket.
Your presence at the event in its totality, agreement to participate in a professional manner throughout the training. No partial credit can be awarded.
Training Information & Eligibility:
You have read through the Resources and policies at www.doulatraining.ca, including but not limited to our Cancellation Policy, Equity & Inclusion Policy, Harassment and Discrimination Policy, and Complaint Policies & Procedures prior to registering. You acknowledge that all materials are taught in an in-person format and that the training is a part of the full course, including modules, quizzes, practicum, and exams.
There are no age or educational prerequisites for taking this program and DTC works with providers across many countries, with only limited exceptions. If you are a provider outside of Canada or the United States we recommend that you contact any local doula associations to ensure that our programs can be used for any required authorization.
You will show up on time and be fully present for all days that you are expected to attend, and always in the spirit of professionalism You will reach out to our faculty or any staff if any unexpected issues arise. You agree to take full responsibility for addressing your needs in the area of accessible learning, self-care, and compassionate treatment of peers and DTC staff. The faculty and staff reserve the right to remove trainees at any time if the trainee creates an unsafe or unprofessional environment for you or other trainees, or for any reason that does not represent the policies of DTC.
Doula Training Canada follows the Accessible Canada Act (ACA). We ask that if you are in need of any special accommodations that will allow you to take your training with us, please email us with special requests at least fourteen (14) days before the scheduled training. If, during the training, a need for an accommodation arises, you are expected to communicate with your instructor and/or DTC staff immediately and we will work with you to discuss the best possible solution.
You are asked to respect the confidentiality of other trainees and our staff during your time with DTC. Confidentiality with clients will be discussed by your trainer/s. Trainees who observe a problem with another trainee are asked to bring the problem to the lead trainer for the specific session or DTC administration, as per the set policies and guidelines. Similarly, if a staff member acts unprofessionally we ask that you email DTC administration as soon as possible.
Preparedness for doing your own work:
Throughout your training, you will be expected to participate in working through the training activities as a representative in the role of doula support or perinatal support. You are responsible for scheduling, discipline, and following through on projects and module expectations outside of this training session. In registering you recognize the set amount of time that you have access to the program and agree to work towards completion in the timeframe set forth by DTC and its vocational expectations. Mentoring can be accessed by emailing our staff at email@example.com and we are always prepared to assist you if you communicate your questions or needs. Each program at DTC may have a slightly different timeframe and we encourage you to review these details prior to registering.
Please note that registration ends 2 days prior to the event


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It would be presumptuous to think that I could adequately summarize a very active year of evolution among a huge inventory of search technologies. This entry is more about what I have learned and what I opine about the state-of-the-market, than an analytical study and forecast.
The weak link in the search market is product selection methods. My first thought is that we are in a state of technological riches without clear guideposts for which search models work best in any given enterprise. Those tasked to select and purchase products are not well-educated about the marketplace but are usually not given budget or latitude to purchase expert analysis when it is available. It is a sad commentary to view how organizations grant travel budgets to attend conferences where only limited information can be gathered about products but will not spend a few hundred dollars on in-depth comparative expert analyses of a large array of products.
My sources for this observation are numerous, confirmed by speakers in our Gilbane conference search track sessions in Boston and San Francisco. As they related their personal case histories for selecting products, speakers shared no tales of actually doing literature searches or in-depth research using resources with a cost associated. This underscores another observation, those procuring search do not know how to search and operate in the belief that they can find "good enough" information using only "free stuff." Even their review of material gathered is limited to skimming rather than a systematic reading for concrete facts. This does not make for well-reasoned selections. As noted in an earlier entry, a widely published chart stating that product X is a leader does nothing to enlighten your enterprise's search for search. In one case, product leadership is determined primarily by the total software sales for the "leader" of which search is a miniscule portion.
Don't expect satisfaction with search products to rise until buyers develop smarter methods for selection and better criteria for making a buy decision that suits a particular business need.
Random Thoughts. It will be a very long time before we see a universally useful, generic search function embedded in Microsoft (MS) product suites as a result of the FAST acquisition. Asked earlier in the year by a major news organization whether I though MS had paid too much for FAST, I responded "no" if what they wanted was market recognition but "yes" if they thought they were getting state-of-the-art-technology. My position holds; the financial and legal mess in Norway only complicates the road to meshing search technology from FAST with Microsoft customer needs.
I've wondered what has happened to the OmniFind suite of search offerings from IBM. One source tells me it makes IBM money because none of the various search products in the line-up are standalone, nor do they provide an easy transition path from one level of product to another for upward scaling and enhancements. IBM can embed any search product with any bundled platform of other options and charge for lots of services to bring it on-line with heavy customization.
Three platform vendors seem to be penetrating the market slowly but steadily by offering more cohesive solutions to retrieval. Native search solutions are bundled with complete content capture, publishing and search suites, purposed for various vertical and horizontal applications. These are Oracle, EMC, and OpenText. None of these are out-of-the-box offerings and their approach tends to appeal to larger organizations with staff for administration. At least they recognize the scope and scale of enterprise content and search demands, and customer needs.
On User Presentations at the Boston Gilbane Conference, I was very pleased with all sessions, the work and thought the speakers put into their talks. There were some noteworthy comments in those on Semantic Search and Text Technologies, Open Source and Search Appliances.
On the topic of semantic (contextual query and retrieval) search, text mining and analytics, the speakers covered the range of complexities in text retrieval, leaving the audience with a better understanding of how diverse this domain has become. Different software application solutions need to be employed based on point business problems to be solved. This will not change, and enterprises will need to discriminate about which aspects of their businesses need some form of semantically enabled retrieval and then match expectations to offerings. Large organizations will procure a number of solutions, all worthy and useful. Jeff Catlin of Lexalytics gave a clear set of definitions within this discipline, industry analyst Curt Monash provoked us with where to set expectations for various applications, and Win Carus of Information Extraction Systems illustrated the tasks extraction tools can perform to find meaning in a heap of content. The story has yet to be written on how semantic search is and will impact our use of information within organizations.
Leslie Owens of Forrester and Sid Probstein of Attivio helped to ground the discussion of when and why open source software is appropriate. The major take-way for me was an understanding of the type of organization that benefits most as a contributor and user of open source software. Simply put, you need to be heavily vested and engaged on the technical side to get out of open source what you need, to mold it to your purpose. If you do not have the developers to tackle coding, or the desire to share in a community of development, your enterprise's expectations will not be met and disappointment is sure to follow.
Finally, several lively discussions about search appliance adoption and application (Google Search Appliance and Thunderstone) strengthen my case for doing homework and making expenditures on careful evaluations before jumping into procurement. While all the speakers seem to be making positive headway with their selected solutions, the path to success has involved more diversions and changes of course than necessary for some because the vetting and selecting process was too "quick and dirty" or dependent on too few information sources. This was revealed: true plug and play is an appliance myth.
What will 2009 bring? I'm looking forward to seeing more applications of products that interest me from companies that have impressed me with thoughtful and realistic approaches to their customers and target audiences. Here is an uncommon clustering of search products.
Multi-repository search across database applications, content collaboration stores document management systems and file shares: Coveo, Autonomy, Dieselpoint, dtSearch, Endeca, Exalead, Funnelback, Intellisearch, ISYS, Oracle, Polyspot, Recommind, Thunderstone, Vivisimo, and X1. In this list is something for every type of enterprise and budget.
Business and analytics focused software with intelligence gathering search: Attensity, Attivio, Basis Technology, ChartSearch, Lexalytics, SAS, and Temis.
Comprehensive solutions for capture, storage, metadata management and search for high quality management of content for targeted audiences: Access Innovations, Cuadra Associates, Inmagic, InQuira, Knova, Nstein, OpenText, ZyLAB.
Search engines with advanced semantic processing or natural language processing for high quality, contextually relevant retrieval when quantity of content makes human metadata indexing prohibitive: Cognition Technologies, Connotate, Expert System, Linguamatics, Semantra, and Sinequa
Content Classifier, thesaurus management, metadata server products have interplay with other search engines and a few have impressed me with their vision and thoughtful approach to the technologies: MarkLogic, MultiTes, Nstein, Schemalogic, Seaglex, and Siderean.
Search with a principal focus on SharePoint repositories: BA-Insight, Interse, Kroll Ontrack, and SurfRay.
Finally, some unique search applications are making serious inroads. These include Documill for visual and image, Eyealike for image and people, Krugle for source code, and Paglo for IT infrastructure search.
This is the list of companies that interest me because I think they are on track to provide good value and technology, many still small but with promise. As always, the proof will be in how they grow and how well they treat their customers.
That's it for a wrap on Year 2 of the Enterprise Search Practice at the Gilbane Group. Check out our search studies at https://gilbane.com/Research-Reports.html and PLEASE let me hear your thoughts on my thoughts or any other search related topic via the contact information at https://gilbane.com/


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Way of the Shaman Documentary
The story of Michael and Sandra Harner in the history and development of core shamanism, the universal, near universal, and common practices of shamanism worldwide. This documentary movie takes us through Michael's early expeditions as a young anthropologist in the jungles of the Ecuadorian and Peruvian Amazon and his life-altering insights into shamanic power. The Harners established the Foundation for Shamanic Studies to preserve, study, and teach shamanism for the benefit of all, leading to a worldwide renaissance of shamanism and shamanic healing through the Foundation's premiere international training programs. The film is an informative and inspiring look at the people behind the evolution of this groundbreaking spiritual healing methodology that honors and builds upon the ancient knowledge of the world's shamans. Through these methods, thousands of students have discovered hidden spiritual resources, transformed their lives, and learned how to help others and our precious Earth.
in order of appearance
Michael Harner
Jack Kornfield
Amanda Foulger
William S. Lyon
Sandra Harner
Roger Walsh
Jeffrey D. Ehrenreich
Stanislov Grof
Susan Mokelke
Larry Peter
Producer: Wisdom Dreaming
Director: Coleen LeDrew Elgin
Running time: 1:07:42
Released: July 2017


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The Jason Smith Show with Mike Harmon
Jason Smith brings his extensive experience in sports talk entertainment to late nights on FOX Sports Radio. Joined by MIke Harmon, the duo provides analysis on the day in sports and updates on the games in play, while engaging in entertaining conversations with listeners to close out the day and prepare for tomorrow.
About FOX Sports Radio
FOX Sports Radio is a division of Premiere Networks in partnership with FOX Sports, and is a complete extension of the FOX Sports brand with on-air coverage from 12am - 12am ET Monday through Sunday.The outstanding coverage, attitude and personality of FOX Sports comes to life on radio daily, as the FOX Sports Radio Network brings you the very best in personality radio targeted to Men 18-49. Delivering more than just stats and box scores, FOX Sports Radio serves up sports talk from industry veterans who know what your listeners want to hear, and it's brought to you by the most-dominant sports media brand worldwide -- FOX Sports. Available to listeners on multiple platforms, including more than 400 affiliates, iHeartRadio, FOXSportsRadio.com and social media sites, the network interacts with listeners extensively, and provides relatable sports and lifestyle conversation 24/7.
* Passionate opinions and in-depth coverage from seasoned professionals
* Insightful commentary from the experts
* Exclusive interviews and access to today's hottest players, coaches and owners
* Enthusiastic callers and lively discussions
* All the topics that matter to today's guy
The Jason Smith Show
11:00 p.m. - 2:00 a.m. Eastern / 8:00 p.m. - 11:00 p.m. Pacific, Monday - Friday


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HMRC has had considerable success in using third party data to better target compliance activity and to tackle the hidden economy. A current consultation by HMRC proposes that these data gathering powers be extended in order to combat tax evasion. We have extracted the following comments from the formal consultation document.
Many businesses use intermediaries to handle transactions and route custom through to their businesses. With the development of the digital economy, there has been a proliferation of such business models. Intermediaries operate across many industries, for example for restaurants supplying take away food; for hotel bookings; or to enable ticket resale for events. These intermediaries provide a framework for smaller businesses to trade.
Where a business is using an intermediary to offer goods and services, HMRC believes that the intermediary will be able to provide valuable information that can identify sellers that have not registered with HMRC or who have not declared the full value of their sales. Using such data will allow HMRC to match data received with registration data and compliant business' tax returns, helping to identify unregistered businesses and target resources more effectively on the
non-compliant. This will support the growth of compliant businesses, protecting them against unfair competition from a minority who do not register for and pay the tax they owe.
The types of intermediary which are likely to hold such data include:
- Advertising boards or platforms provide a service where advertisements for goods or services are displayed with the intention of linking a supplier with a potential customer.
- App stores provide a platform to advertise applications for devices such as smart phones or tablets. Customers set up a store account with a connecting payment method attached. Some apps also provide in-app purchases which are paid for via the app store.
- Booking and Reservation Intermediaries facilitate a booking or a reservation of goods or services, and may facilitate taking of deposits or other payment in respect of the goods or services booked and or reserved.
These increased powers will provide HMRC with much needed information to better target taxpayers who may not be declaring all their income.
The powers will also be an additional compliance burden for the organisations that provide the information to HMRC.


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Ideal Marine VHF for mariners who already have an AIS Transponder or AIS black box receiver onboard.
Marine fixed mount VHF with AIS receiver or transponder input, Waypoint navigation and 30W loud hailer. RAM3+ second station compatible.
*when connected to an optional AIS receiver or transponder
**when connected to an optional GPS
AIS Input
Have an AIS receiver or transponder on your vessel? The GX2000 MATRIX is the perfect radio of choice for you! When the MATRIX is connected to a AIS receiver or transponder (with VDM AIS sentence output at 38400 baud) the display will show AIS targets simply by pressing the dedicated AIS key. The MATRIX will display AIS MMSI, Call Sign, Ship Name, BRG, DST, SOG and COG and will allow you to contact an AIS Ship directly using DSC, show your vessels position in relation to AIS targets and alert you when an AIS ship may be approaching to close to your location via the Closest Point of Approach (CPA) Alarm.
Navigate to Waypoints
The MATRIX is capable of entering and saving up to 100 waypoints. These waypoints may be selected and navigated to by using a unique navigation compass display that shows your vessels SOG, COG, BRG (Bearing) and DST (Distance) to the waypoint when connected to an external GPS.
Digital Selective Calling (DSC)
The MATRIX is Class D class DSC VHF with a separate Channel 70 receiver, which allows DSC calls to be received even when listening to traffic on Marine VHF channels.
The DSC DISTRESS function when activated transmits a digital MAYDAY including vessel identification, Latitude / Longitude and time (with GPS connected), to facilitate prompt response. Additional calls that can be made are Individual, All ship - Urgency and Safety, Group, Position report and position request calls.
DSC Position Polling and NMEA in/output
Easily share position information with other DSC equipped vessels using the position request and position reporting functions. With the push of a few buttons you can request the position of another vessel, or simply send your position information to the vessel you select.
The GPS Position of a received DSC Distress or Position Request call can be shown on a compatible GPS Chart plotter simply by connecting 2 NMEA wires.
ClearVoice noise reduction technology speaker microphone
The MATRIX features Clear Voice Noise Reduction Technology eliminating unwanted background noises like engines and wind during transmission. This assures transmissions are crystal clear along with dedicated 16/9 key and channel selection. In addition the microphone includes a speaker for crystal clear reception of transmissions.
Commercial grade 80dB receiver
Advanced receiver technology rejects the reception of unwanted signals from pagers and other unwanted VHF frequencies. In addition the MATRIX has an receiver attenuator to further reduce noise in busy harbors and marinas.
30W PA and Fog signaling
The MATRIX includes a 30W Loud Hailer with Fog signals; Bells and Whistles. For added benefit, the last selected VHF channel can be heard when in the PA or Fog modes.
Big, bold display
There is no question about it. With a big, bold display there is no mistaking the information. The contrast and brightness can be adjusted for situations where the radio cannot be mounted directly in front of you.
Programmable Channel Names
The MATRIX is supplied from the factory preloaded with description of the use of Marine channels (16-Distress, 22A-USCG, 71-Pleasure...). The channel names may be customized by the user to easily understand the use of each channel.
GPS repeating
By connecting a GPS to the MATRIX; Position, date, and time are also displayed when interfaced with a GPS receiver.
Optional RAM3+ capable
Need to remotely control the VHF from your cockpit of fly bridge? The MATRIX is RAM3+ remote mic capable to control all VHF, DSC and AIS* functions at a second station.
***AIS receiver or transponder connection required.
Programmable Scan, Priority Scan and Dual Watch
Scanning is not an issue with the MATRIX. The radio can be setup to scan any number of channels with or without a priority channel or simply can be setup to scan between a priority channel and on other channel (dual watch).
NOAA Weather channels and Weather Alert
10 NOAA and Canadian Weather channels are pre-programmed and easily selectable using the dedicated WX key. In addition, the MATRIX can be set to monitor WX channels and provide an audible alert to inform of pending storm advisories.
It's built better so backed better
Because the MATRIX is built better, it's back better. If your Standard Horizon MATRIX ever fails for any reason including water damage during normal use in the first three years, STANDARD HORIZON will repair or replace it free, without hassle or charges…period! If it fails thereafter in normal use it for the life time of the product it is covered by Standard Horizon's Lifetime Flat Rate Service and Customer Loyalty Programs.


text: Home to Mt. Everest and a wide range of ethnic groups speaking almost 100 languages and dialects, Nepal is a study in diversity. Climate ranges from sub-tropic to arctic, offering an unparalleled variety of ecosystems – humid plains, tropical jungles, forested hills, frozen valleys, and of course the Himalayas. Hinduism is the major religion although Siddhartha Gautama, the Buddha, was born in the south of the country and Buddhism has a strong tradition in Nepal as well.


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