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OBJECTIVES/GOALS: Insertable devices (IDs) for obstetric fistula (OF) management are feasible, acceptable, but not accessible; implementation determinants in low and middle-income countries (LMICs) are unknown. Thus, the purpose of this study was to understand pre-adoption facilitators and barriers among global stakeholders for a therapeutic ID for OF in LMICs. METHODS/STUDY POPULATION: Stakeholders, including researchers (n = 11), clinicians (n = 4), government officials (n = 2), and administrators (n = 4), were purposefully identified from various sectors involved in understanding and addressing the needs of women with OF: clinical care, academia, international health, civil society, and government. Twenty-one individuals were interviewed about their perceptions of IDs for OF self-management and their implementation. Interviews were audio-recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Thematic analyses were carried out within Nvivo v.12. RESULTS/ANTICIPATED RESULTS: Determinants of implementation of an ID for OF self-management (by CFIR domain) include: (1) intervention characteristics—relative advantage and cost; (2) individual characteristics—knowledge and beliefs about the innovation; (3) inner setting-- organizational culture, implementation climate, tension for change, and compatibility; (4) outer setting-- patient needs and resources and external policy and incentives; (5) process—opinion leaders and collaboration. Facilitators include: tension for change for low-cost, accessible IDs; relative advantage over existing tools; development of partnerships; and identification of implementation champions. Barriers include: need for educational strategies to encourage clinical provider acceptability; lack of evidence of the optimal beneficiary. DISCUSSION/SIGNIFICANCE OF IMPACT: Tools for therapeutic OF self-management could be integrated into comprehensive OF programming. Employing the CFIR as an overarching typology allows for comparison across contexts and settings where OF care occurs and may be useful for clinicians, researchers, and policy-makers interested in implementing IDs for OF self-management in LMICs. CONFLICT OF INTEREST DESCRIPTION: I am working with colleagues at the non-profit Restore Health on developing an insertable cup for therapeutic self-management of obstetric fistula in LMICs
Schizophrenia has since over a hundred years been associated with autonomic dysregulation, but the prognostic importance of this phenomenon is unclear.
To explore measures in electrocardiograms (ECG) reflecting autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent outcome. Three aspects of routine ECG measures were investigated:
1) differences between patients with first-episode schizophrenia spectrum disorders and healthy controls,
2) relations to early discontinuation of first antipsychotic medication and finally
3) associations to symptomatic remission status five years later.
Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization and left ventricular hypertrophy. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.
Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy (hazard ratios 1.3–2.4) and with non-remission five years later (odds ratios 2.9–6.4).
In this longitudinal cohort study, simple ECG measures reflecting autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. However, as this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.
Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited.
To explore suicide risk in relation to prescription of antipsychotics and antidepressants.
Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4,000), patients who died by suicide within five years from diagnosis were defined as cases (n = 84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression.
No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6).
The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk.
To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status.
Subjects and methods
Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.
Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later.
Discussion and conclusion
In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
CPMs differ, for instance, over just what concepts these are. Initially inspired by computer science, their development has reflected changes in artificial intelligence (AI), theoretical psychology, and neuroscience. At first, the focus was on symbolic AI – dubbed GOFAI, or “Good Old-Fashioned AI,” by John Haugeland (1985: 112). Later, some CPMs replaced, or complemented, GOFAI concepts with ideas drawn from connectionism and dynamical systems.
Sexual minority individuals consistently report higher rates of mental disorder than heterosexuals. However, much of the research has methodological limitations related to the classification of sexuality, the use of cross-sectional data and problematic sampling procedures such as using convenience samples.
We used longitudinal data from a birth cohort enrolled in the Christchurch Health and Development Study (n = 1040). Latent class analysis was used to classify participants sexuality based on self-report data of sexual behaviour, attraction, identity and fantasy, gathered over five assessments between the ages of 18 and 35 years. Mental health and substance use outcome data were gathered at four assessments between the ages of 21 and 35 years. Potential covariate variables were collected during childhood.
The latent class analysis identified four groups interpreted as: ‘heterosexual’ 82%, ‘mostly heterosexual’ 12.6%, ‘bisexual’ 3.5% and ‘gay/lesbian’ 1.9%. In the sexual minority groups, women outnumbered men by at least 2:1. Pooled rates for mental health disorders of depression, anxiety disorders, suicidal ideation, cannabis abuse and total disorders, after adjustment for childhood covariate variables, were significantly higher in the sexual minority groups (p < 0.01). The strength of association between sexuality group and mental health outcomes did not differ according to sex. Fluidity in sexuality reports appeared unrelated to risk of mental health outcomes.
Over the life course, membership of a sexual minority group is clearly associated with mental health problems of depression, anxiety and suicidal ideation regardless of the age when same-sex attraction, behaviour, identity or fantasy is expressed.
The extent to which exposure to childhood sexual and physical abuse increases the risk of psychotic experiences in adulthood is currently unclear.
To examine the relationship between childhood sexual and physical abuse and psychotic experiences in adulthood taking into account potential confounding and time-dynamic covariate factors.
Data were from a cohort of 1265 participants studied from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood sexual and physical abuse. At ages 30 and 35, they were questioned about psychotic experiences (symptoms of abnormal thought and perception). Generalised estimating equation models investigated covariation of the association between abuse exposure and psychotic experiences including potential confounding factors in childhood (socioeconomic disadvantage, adverse family functioning) and time-dynamic covariate factors (mental health, substance use and life stress).
Data were available for 962 participants; 6.3% had been exposed to severe sexual abuse and 6.4% to severe physical abuse in childhood. After adjustment for confounding and time-dynamic covariate factors, those exposed to severe sexual abuse had rates of abnormal thought and abnormal perception symptoms that were 2.25 and 4.08 times higher, respectively than the ‘no exposure’ group. There were no significant associations between exposure to severe physical abuse and psychotic experiences.
Findings indicate that exposure to severe childhood sexual (but not physical) abuse is independently associated with an increased risk of psychotic experiences in adulthood (particularly symptoms of abnormal perception) and this association could not be fully accounted for by confounding or time-dynamic covariate factors.
Studies involving clinically recruited samples show that genetic liability to schizophrenia overlaps with that for several psychiatric disorders including bipolar disorder, major depression and, in a population study, anxiety disorder and negative symptoms in adolescence.
We examined whether, at a population level, association between schizophrenia liability and anxiety disorders continues into adulthood, for specific anxiety disorders and as a group. We explored in an epidemiologically based cohort the nature of adult psychopathology sharing liability to schizophrenia.
Schizophrenia polygenic risk scores (PRSs) were calculated for 590 European-descent individuals from the Christchurch Health and Development Study. Logistic regression was used to examine associations between schizophrenia PRS and four anxiety disorders (social phobia, specific phobia, panic disorder and generalised anxiety disorder), schizophrenia/schizophreniform disorder, manic/hypomanic episode, alcohol dependence, major depression, and – using linear regression – total number of anxiety disorders. A novel population-level association with hypomania was tested in a UK birth cohort (Avon Longitudinal Study of Parents and Children).
Schizophrenia PRS was associated with total number of anxiety disorders and with generalised anxiety disorder and panic disorder. We show a novel population-level association between schizophrenia PRS and manic/hypomanic episode.
The relationship between schizophrenia liability and anxiety disorders is not restricted to psychopathology in adolescence but is present in adulthood and specifically linked to generalised anxiety disorder and panic disorder. We suggest that the association between schizophrenia liability and hypomanic/manic episodes found in clinical samples may not be due to bias.
Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.
Our aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.
This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.
Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27–0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43–2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.
Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.
Cancer of the vulva is rare, it is a disease commonly diagnosed in elderly women, however, the incidence in younger women is rising. Many patients diagnosed and treated for vulval cancer face physical, social, sexual and psychological challenges. It is essential that therapy radiographers and members of the wider multidisciplinary team understand such challenges in order to provide patient centred care.
This review aims to highlight the key psycho-social issues experienced by patients with cancer of the vulva, identifying implications for practice in order to improve the holistic care for this patient group.
A search of English literature was performed using Medline, Pubmed, CINAHL and PsycINFO. Search terms included, vulva or vulval cancer, psychosocial, psychosexual impact and quality of life. Articles were excluded if they focussed on cancers other than gynaecological and vulval cancers.
Results and Conclusions
Although there are numerous reports on the psychological and psychosocial problems faced by gynaecological cancer patients; there was a paucity of literature pertaining to patients with cancer of the vulva, this is consistent with previous research. Studies show a significant negative, psychosocial impact experienced by these women. Common themes being isolation, loneliness, stigmatisation and lack of information for patients and their carers, themes spanning over three decades. Nevertheless, it is important to be aware of the findings from recent studies consistent with patient’s needs, highlighting that listening to women’s narratives on living with cancer of the vulva is essential if we are to help with the psychosocial issues experienced by these women. They underline a necessity to raise awareness among healthcare professionals and the general public, to improve holistic support for this particular group of women. This is particularly important in the radiotherapy setting as many of these women undergo lengthy courses of treatment and the appropriately trained therapeutic radiographer can play a vital role in addressing the physical and psychosocial problems.
Few studies have examined the contribution of specific disaster-related experiences to post-traumatic stress disorder (PTSD) symptoms.
To examine the roles of peri-traumatic stress and distress due to lingering disaster-related disruption in explaining linkages between disaster exposure and PTSD symptoms among a cohort exposed to the 2010–2011 Canterbury (New Zealand) earthquakes.
Structural equation models were fitted to data obtained from the Christchurch Health and Development Study at age 35 (n=495), 20–24 months following the onset of the disaster. Measures included: earthquake exposure, peri-traumatic stress, disruption distress and PTSD symptoms.
The associations between earthquake exposure and PTSD symptoms were explained largely by the experience of peri-traumatic stress during the earthquakes (β=0.189, P<0.0001) and disruption distress following the earthquakes (β=0.105, P<0.0001).
The results suggest the importance of minimising post-event disruption distress following exposure to a natural disaster.
1709 Early evidence of ‘friendship and fraternity’ was shown in 1709 when Henry Hall, the Organist of Hereford Cathedral, and his counterpart at Gloucester, William Hine, collaborated in the composition of a morning service, ‘Hall and Hine in E flat’, possibly for a joint celebration at Worcester in 1710. The Te Deum is by Hall, the Jubilate by Hine.
1715(G) The year from which the Music Meetings are counted. It is believed that the annual gatherings were fully established by 1715, albeit that the earliest actually recorded Meeting was held in 1719(W). Wars have interrupted the continuity of the Festival twice, from 1914 to 1920, and from 1939 to 1945. Until the late 1750s only music for services was permitted in the cathedrals, where the Te Deum and Jubilate in D of Purcell, for example, was sung regularly for almost forty years from the inception of the Meetings. Other concerts, including oratorio performances, were held in various secular venues. Even Messiah was not at first admitted within the cathedrals.
1724(G) Thomas Bisse successfully proposed that the Music Meetings should be held for a charitable purpose, i.e. for the benefit of the orphans (later ‘the widows and orphans’) of the poorer clergy of the three dioceses. This remained the principle raison d'etre for the Festival Charity until 1986.
1731(W) William Hayes, a pupil of William Hine at Gloucester and an ardent Handelian, was Organist at Worcester until 1734 but did not conduct at the Meetings during those years. Handel became the dominant composer in the programmes, which from 1733 featured ‘the most eminent performers from the metropolis’. Hayes went on to become Professor of Music at Oxford and to build a national reputation as composer, conductor, singer and organist, appearing at Three Choirs many times in the 1750s and 1760s.
THE 1991 Hereford Festival began on Sunday 18 August. Roy Massey, resplendent in the robes of his Lambeth doctorate, conducted the Festival Chorus and RLPO in a most impressive Opening Service, marred hardly at all by the lady who, during the prayer ‘that through music we may raise man from the sorrows of this world to the joy of Your divine presence’ called out loudly: ‘and women!’ A sign of the times?
The first cathedral concert of the 1991(H) Festival, given in memory of the late Bishop John Easthaugh, who had died in office in 1990, was a performance of the Beethoven Missa solemnis. ‘There was much to admire’, wrote David Hart in the Birmingham Post:
the Festival Chorus was in fine collective voice, with tenors displaying a lively robustness and sopranos thrilling in the stratospheric upper reaches. And Julie Kennard, Catherine Wyn-Rogers, Neil Jenkins and John Noble made an extremely homogenous and tireless solo quartet. But this was largely negated by an orchestral accompaniment [RLPO] of often overwhelming proportions … The result was a performance light on subtlety, but full of grand gestures and a lot of noise.
On Monday a tremor of apprehension disturbed the festive atmosphere as news came through that in the USSR Mikhail Gorbachev had been toppled in a leadership coup. Were ‘the sorrows of this world’ again to overwhelm the nascent optimism in a new order? Against this background the performance of Morning Heroes on Monday evening was particularly piercing. The largest of the works by Sir Arthur Bliss included in the Festival to mark his centenary year, Morning Heroes was, for Roy Massey and many in his audience, an overwhelming emotional experience. Written by a composer who had seen the brutality of war at first hand through a soldier's eyes, its impact in performance is greater than can be anticipated from the printed score – especially so when the narration of ‘Hector's Farewell to Andromache’ (from The Iliad) and Wilfred Owen's ‘Spring Offensive’ are entrusted to a narrator of Brian Kay's ability.
When recalling impressions of the Opening Service, the one incident which looks biggest in retrospect is that Benjamin Britten's setting of the National Anthem was sung instead of the setting by Elgar, which has hitherto been heard at the opening of the festival for as long as most people can remember.
After hearing that modern setting of the familiar tune, which seemed – perhaps because of key affinity – to fall into place naturally and appropriately, as if it were born of the mood of trust and hope generated by Elgar's prelude to The Kingdom, a new epoch, I felt, had dawned upon the Three Choirs Festival: Christopher Robinson had made his mark!
CHRISTOPHER Robinson was born in 1936 at Peterborough and educated at St Michael's College, Tenbury, then at Rugby, and then Christ Church, Oxford. He was Assistant Organist at Christ Church from 1955 to 1958. During his last year at the university he was Assistant Organist at New College under Meredith Davies, and was then on the music staff at Oundle School for three years before taking the post of Assistant Organist at Worcester Cathedral in 1962. He succeeded Douglas Guest as Master of the Choristers and Organist in 1963, when he also became conductor of the City of Birmingham Choir in succession to Meredith Davies.
In 1966 Robinson brought to Three Choirs not only the impressive and grandiose Grande Messe des morts of Berlioz, but also, and long overdue, the music of Sir Michael Tippett in the year in which he was knighted: A Child of our Time, with Jennifer Vyvyan singing magnificently in the part of the Mother, and with Jean Allister, John Mitchinson and John Carol Case. At the Friday afternoon orchestral concert, Sir Adrian Boult conducted Tippett's Concerto for double string orchestra. There was also the first performance, commissioned by the National Federation of Music Societies, of Changes by Gordon Crosse. Described by the composer as ‘A Nocturnal Cycle for Soprano, Baritone, Chorus and Orchestra’, Changes is intended for large amateur choirs. The title refers to changes from day to night (symbolising life and death) and changes in bellringing, which provide many musical motifs of the work.
THE most frequently asked question about Three Choirs history is a simple one: ‘when exactly did the Festival begin?’ Finding an answer, however, has from the outset proved to be far from simple. The engraver and publisher Valentine Green, writing in 1796, stated that the first Meeting of the Three Choirs took place at Worcester in August 1722, whereas we now know that the inception of the Music Meetings (as they were termed until 1836, when the designation ‘Festival’ was adopted) must pre-date that by some years. Even as long ago as 1812, the Rev. Daniel Lysons, the earliest chronicler of the Festival to write a detailed history, was forced to admit that ‘It is in vain that I have endeavoured … to trace anything like the time of their first establishment.’
Two lengthy suspensions of Three Choirs, both of them caused by war, added to the confusion. The Festival was discontinued for six years during World War I: from 1914 to 1919. In 1920, Sir Ivor Atkins, Organist of Worcester Cathedral, was charged with restarting Three Choirs on the return to peace; he gave official recognition to the year 1715 ‘by reckoning the first Festival after the suspension … as the two hundredth’. This was generally accepted, such that Dennis Stoll, writing in 1938, in his book Music Festivals of Europe, felt able to state with confidence that ‘The three choirs met for the first time in 1715.’ But neither Atkins nor Stoll based his claim upon firm documentary proof. The outbreak of World War II, in 1939, silenced debate on the matter for seven more years: the Festival was again suspended throughout the duration of hostilities.
As late as 1966, in an historical note for a Worcester Festival programme book, the music critic A. T. Shaw pronounced that ‘any attempt to fix the date of the [first] meeting is predestined to failure’. But even so, the search for a start-date has continued. Dr Percy M. Young (1912–2004) – musicologist, writer, conductor, authority on Elgar, frequent lecturer at Three Choirs Festivals, and a distinguished scholar of English music of the eighteenth and nineteenth centuries – contributed a valuable essay, ‘The First Hundred Years’, to a booklet published in 1977 in association with the celebrations at Gloucester marking 250 years of the Festival.
ALTHOUGH the committees of the Gloucester, Hereford and Worcester Festivals had met together from time to time, usually to discuss financial problems, no satisfactory arrangements had been made for regular meetings and cooperation until 1946. On 14 March in that year, representatives from the three cities met at the deanery in Hereford to discuss a proposition made by the Dean of Gloucester, Dr H. Costley-White. There was, he said, a real need for a central body to advise and assist, financially and otherwise, the diocese holding the Festival. That need became particularly apparent at Hereford in 1946 when a decision had to be made on whether or not to revive the Festival. A new joint advisory body was formed and continued to meet for the next ten years – and financial problems continued to dominate the agenda.
Alarm bells began to ring following Hereford's small deficit in 1952. Then, in 1953, the LSO put the Festival on notice that its charges would be increased by one fifth. Doubts were expressed about the ability of Worcester and Hereford to continue to hold the Festival unless Gloucester was able to provide a subsidy. The Gloucester balance sheet showed a total surplus of L2,870 at the beginning of 1954 (collections for the charity amounted to L1,292 of this) but the total surplus was down L730 on 1950. Worcester had been obliged to make alterations in the programme of the 1954 Festival in the interests of economy, and Hereford was anticipating a loss of as much as L1,000 in 1955.
Under these circumstances the Joint Standing Committee agreed that a reserve fund was essential, and at Gloucester it was recommended that a quarter of the 1953 Festival profits should be placed to a general reserve subject to the other two Festivals agreeing to do the same in their turns.
IT was a double celebration: the silver jubilee of Her Majesty the Queen and, dating Three Choirs from 1715, the commemoration of 250 years of musicmaking in Gloucester, Hereford and Worcester. In that same year Edinburgh was mounting only its thirty-first Festival and Cheltenham its thirty-third. The occasion was marked with six orchestras, more than thirty soloists, seven conductors, instrumental and choral groups, and a Festival extending over eight days from 20 to 28 August. There was a strong Commonwealth flavour with performers from Australia, New Zealand and Canada. Documentaries on Three Choirs were broadcast on radio and television. There were new works from Harrison Birtwistle, Peter Maxwell Davies, Rory Boyle, Ronald Tremain and Tony Hewitt-Jones, and the centrepiece – Mass of Christ the King, a large choral composition from Malcolm Williamson, Master of the Queen's Music – was dedicated to the queen for her jubilee. Certainly, the 1977 Gloucester Festival was an ambitious musical feast.
The programme had been planned to feature the music of composers who have had a major influence on the Festival during its long history: Bach's Mass in B minor; the Verdi Requiem; Kodály's Jesus and the Traders; Handel's Messiah; Holst's The Hymn of Jesus; Vaughan Williams's Fantasia on a Theme by Thomas Tallis; Beethoven's Fantasia, op. 80 (the ‘Choral Fantasy’); Britten's Cantata academica and Missa brevis; Penderecki's Stabat Mater, and, of course, Elgar – the Cello Concerto, Caractacus and Gerontius. Herbert Howells was present to hear Hymnus Paradisi and had been commissioned to write a Festival Fanfare for the Opening Service, during which the first performance of Tony Hewitt- Jones's anthem Let us now praise famous men was also given. A wide sweep of musical history was embraced, from French medieval ballads, secular and sacred music of the English Renaissance and anthems by Victoria, Schütz and Gabrieli, to sounds with the freshness of new paint: Peter Maxwell Davies's A Mirror of Whitening Light and Harrison Birtwistle's Silbury Air, both played in a Contemporary Music Network concert by the London Sinfonietta.