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Did you know that Beethoven contemplated, however fleetingly, writing more than forty symphonies and that for the Missa solemnis he sought stimulus from a Latin-German dictionary? And what about the underappreciated sociable side of Beethoven's music to set alongside the familiar one of the heroic? Beethoven Studies 4 is a collection of ten chapters that approach the composer and his music from an appealing range of critical standpoints, aesthetic, analytical, biographical, historical and performance. Alongside essays that offer new information on Beethoven's compositional practice and broaden understanding of the music's contemporary and posthumous appeal, there are essays on his interaction with specific environments, Bonn and post-Napoleonic Austria, and vocal and piano performance practice. The volume will appeal to cultural historians and practitioners as well as Beethoven enthusiasts.
Treatment resistance causes significant burden in psychosis. Clozapine is the only evidence-based pharmacologic intervention available for people with treatment-resistant schizophrenia; current guidelines recommend commencement after two unsuccessful trials of standard antipsychotics.
This paper aims to explore the prevalence of treatment resistance and pathways to commencement of clozapine in UK early intervention in psychosis (EIP) services.
Data were taken from the National Evaluation of the Development and Impact of Early Intervention Services study (N = 1027) and included demographics, medication history and psychosis symptoms measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, 6 months and 12 months. Prescribing patterns and pathways to clozapine were examined. We adopted a strict criterion for treatment resistance, defined as persistent elevated positive symptoms (a PANSS positive score ≥16, equating to at least two items of at least moderate severity), across three time points.
A total of 143 (18.1%) participants met the definition of treatment resistance of having continuous positive symptoms over 12 months, despite treatment in EIP services. Sixty-one (7.7%) participants were treatment resistant and eligible for clozapine, having had two trials of standard antipsychotics; however, only 25 (2.4%) were prescribed clozapine over the 12-month study period. Treatment-resistant participants were more likely to be prescribed additional antipsychotic medication and polypharmacy, instead of clozapine.
Prevalent treatment resistance was observed in UK EIP services, but prescription of polypharmacy was much more common than clozapine. Significant delays in the commencement of clozapine may reflect a missed opportunity to promote recovery in this critical period.
Between 1817 and 1824 a new music journal was published in Vienna, one that focused on musical life in that city and Austria generally, the Allgemeine musikalische Zeitung mit besonderer Rücksicht auf den österreichischen Kaiserstaat. Despite being the most long-standing music journal published in Vienna in Beethoven’s lifetime, it has been largely neglected by scholars. It affords a new, revisionist context for the late period, both biographical and musical.
What explains why some Latinos feel strongly tied to their coethnics while others do not? Demographic context is one of the most cited predictors of identity strength, but the size and direction of its effects are disputed. Geographic differences in policy environments may explain the phenomenon. We argue that high levels of immigration enforcement indirectly lead to increased feelings of ethnic linked fate by determining where and how demographic context—in this case, the size of the immigrant population—will be salient. To test this, we combine information from local immigration-enforcement data (obtained via Freedom of Information Act requests) with the Latino Decisions' 2016 Collaborative Multiracial Post-Election Survey. The results suggest native-born Latinos have a stronger sense of ethnic linked fate when they live near large immigrant populations and rates of enforcement are high. When enforcement is low, the presence of immigrants has a negligible effect on native-born attitudes. Foreign-born Latinos' sense of linked fate is unaffected by policy context. These results suggest that as immigration enforcement becomes intensifies, conservative politicians may see increased backlash, at least in certain communities, from native-born Latinos. This is because feelings about ethnic linked fate correlate with increased participation and more proimmigrant policy stances.
This article draws upon six social research studies completed by members of the Dementia and Ageing Research Team at The University of Manchester and their associated networks over an eight-year period (2011–2019) with the aim of constructing a definition of ‘being in the moment’ and situating it within a continuum of moments that could be used to contextualise and frame the lived experience of dementia. Using the approach formulated by Pound et al. (2005) in synthesising qualitative studies, we identified this continuum of moments as comprising four sequential and interlinked steps: (a) ‘creating the moment’, defined as the processes and procedures necessary to enable being in the moment to take place – the time necessary for this to occur can range from fleeting to prolonged; (b) ‘being in the moment’, which refers to the multi-sensory processes involved in a personal or relational interaction and embodied engagement – being in the moment can be sustained through creativity and flow; (c) ‘ending the moment’, defined as when a specific moment is disengaged – this can be triggered by the person(s) involved consciously or subconsciously, or caused by a distraction in the environment or suchlike; and (d) ‘reliving the moment’, which refers to the opportunity for the experience(s) involved in ‘being in the moment’ to be later remembered and shared, however fragmentary, supported or full the recall.
On June 18, 1794, eighteen months after he had arrived in Vienna, Beethoven wrote a letter to his friend in Bonn, Nikolaus Simrock. As well as playing the horn in the court orchestra, Simrock had for some years run a business selling a variety of goods, including carpets, books, stationery, and wine. Music came to be a central feature in his life, with Simrock offering his services as a copyist and as a seller of publications from elsewhere in Europe and of musical instruments. The previous year he had expanded his business to include the engraving of printed music, tentative beginnings of an accelerating process that was to make Simrock one of Europe's leading music publishers. Beethoven had heard from his brother Carl, that Simrock was planning to engrave the composer's Eight Variations on a Theme by Count Waldstein (WoO 67), and Beethoven was irritated that he had not been consulted, pointing out that it might have compromised any plans he had to offer the work to Artaria in Vienna. More constructively, Beethoven suggested to Simrock that he should think about having an agent in Vienna to sell his forthcoming publications: “If so, I would willingly undertake to recommend to you one whom I know to be a first-rate man.”
Two months later, on August 2, the subject matter emerged in a second letter to Simrock. Beethoven had agreed that Simrock could, after all, publish the variations: he had read the proofs, was very complimentary about the quality of the engraving, and promised some further compositions. In addition he wrote, “Regarding an agent [Commissionaire] I have looked around and have found a really excellent and capable man. His name is Traeg. All you have to do is to write to him, or to me, indicating the terms you would like. He requires a discount of a third from you.”
In many ways Johann Traeg was the obvious choice. He was the leading music dealer in Vienna, selling manuscript performing parts and printed music from dedicated premises in the Singerstrasse in the inner city.
The steep rise in the rate of psychiatric hospital detentions in England is poorly understood.
To identify explanations for the rise in detentions in England since 1983; to test their plausibility and support from evidence; to develop an explanatory model for the rise in detentions.
Hypotheses to explain the rise in detentions were identified from previous literature and stakeholder consultation. We explored associations between national indicators for potential explanatory variables and detention rates in an ecological study. Relevant research was scoped and the plausibility of each hypothesis was rated. Finally, a logic model was developed to illustrate likely contributory factors and pathways to the increase in detentions.
Seventeen hypotheses related to social, service, legal and data-quality factors. Hypotheses supported by available evidence were: changes in legal approaches to patients without decision-making capacity but not actively objecting to admission; demographic changes; increasing psychiatric morbidity. Reductions in the availability or quality of community mental health services and changes in police practice may have contributed to the rise in detentions. Hypothesised factors not supported by evidence were: changes in community crisis care, compulsory community treatment and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers.
Better data are needed about the characteristics and service contexts of those detained. Our logic model highlights likely contributory factors to the rise in detentions in England, priorities for future research and potential policy targets for reducing detentions.
Arrows with reproduction medieval heads were shot against multiple layers of woven linen, woven cotton, cotton wadding, woollen felt, and leather. The best protection against bodkin arrowheads was given by woven linen in combination with cotton wadding, but without mail these materials did not give significant protection against arrowheads with sharp-edged blades. Reproduction mail armor was made from mild steel, with alternating rows of solid and riveted rings. Mail alone, without a padded undergarment, did not give adequate protection against arrows shot from bows of moderate strength. Penetration to a potentially lethal depth occurred at almost every shot. The probability and depth of penetration was greatly reduced when the mail was placed over an undergarment consisting of layers of linen, or linen with cotton wadding. It was concluded that mail in combination with a garment meeting an early fourteenth-century specification for gambesons would greatly reduce, but not eliminate, the risk of fatal injury from arrows.
Mail with a padded garment (the “gambeson” or “aketon”) formed the principal armor defense for European men-at-arms until about 1325, when plate proliferated and mail was progressively relegated to protecting only those areas where flexibility was needed. Some writers regard the terms “gambeson” and “aketon” as synonymous, but Ralph Moffat argues that they were distinctly different garments. In his view the gambeson was a padded and quilted jacket that could be worn as an independent defense or over other armor, whereas the aketon, also padded and quilted, was worn under mail and was not intended as an exterior garment.
Little systematic experimental research into the effectiveness of arrows against mail has been published, and padding has often been included as an afterthought or omitted entirely. When it has been given its fair share of the researchers’ attention, it has been concluded that it is at least as important as the mail in determining protection against arrows.
The aim of the experimental work described here was to investigate the role of the gambeson or aketon in protecting against arrows, focusing on the thirteenth and early fourteenth centuries before the widespread adoption of plate armor. The principal objectives were to:
Identify which of the padding materials available in thirteenth-century Europe gave the best protection against arrows shot from a longbow;
We describe a case of delayed COVID-19 diagnosis due to unrecognized community transmission in Atlanta, Georgia in mid-February 2020. This case resulted in transmission of COVID-19 to three of the four healthcare workers present during a diagnostic bronchoscopy procedure where only procedural masks were worn.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.