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Registry-based trials have emerged as a potentially cost-saving study methodology. Early estimates of cost savings, however, conflated the benefits associated with registry utilisation and those associated with other aspects of pragmatic trial designs, which might not all be as broadly applicable. In this study, we sought to build a practical tool that investigators could use across disciplines to estimate the ranges of potential cost differences associated with implementing registry-based trials versus standard clinical trials.
We built simulation Markov models to compare unique costs associated with data acquisition, cleaning, and linkage under a registry-based trial design versus a standard clinical trial. We conducted one-way, two-way, and probabilistic sensitivity analyses, varying study characteristics over broad ranges, to determine thresholds at which investigators might optimally select each trial design.
Registry-based trials were more cost effective than standard clinical trials 98.6% of the time. Data-related cost savings ranged from $4300 to $600,000 with variation in study characteristics. Cost differences were most reactive to the number of patients in a study, the number of data elements per patient available in a registry, and the speed with which research coordinators could manually abstract data. Registry incorporation resulted in cost savings when as few as 3768 independent data elements were available and when manual data abstraction took as little as 3.4 seconds per data field.
Registries offer important resources for investigators. When available, their broad incorporation may help the scientific community reduce the costs of clinical investigation. We offer here a practical tool for investigators to assess potential costs savings.
Terrestrial plant macrofossils from the sedimentary record of Lake Suigetsu, Japan, provide the only quasi-continuous direct atmospheric record of radiocarbon (14C) covering the last 50 ka cal BP (Bronk Ramsey et al. 2012). Since then, new high precision data have become available on U-Th dated speleothems from Hulu Cave China, covering the same time range (Cheng et al. 2018). In addition, an updated varve-based chronology has also been published for the 2006 core from Lake Suigetsu (SG06) based on extended microscopic analysis of the sediments and improved algorithms for interpolation (Schlolaut et al. 2018). Here we reanalyze the radiocarbon dataset from Suigetsu based on the new varve counting information and the constraints imposed by the speleothem data. This enables the new information on the calendar age scale of the Suigetsu dataset to be used in the construction of the consensus IntCal calibration curve. Comparison of the speleothem and plant macrofossil records provides insight into the mechanisms underlying the incorporation of carbon into different types of record and the relative strengths of different types of archive for calibration purposes.
Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both ‘contained energy’. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.
Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers’ self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.
When Mozart died at 12:55 on the morning of December 5, 1791, the score of the Requiem lay unfinished on his desk. In addition, the torsos of over 150 further unfinished works were scattered in his Vienna apartment. Some were the briefest jottings; others represented substantial portions of incipient masterpieces. Among them one finds virtually every musical genre of the late eighteenth century: composi-tions for the church, German and Italian operas, concert arias, Lieder, symphonies, chamber music, concertos, sonatas, and pieces for a colorful variety of instrumental combinations and soloists. Many of these works would certainly have been com-pleted had Mozart lived longer.
Mozart's remarkably long list of unfinished works reflects the poignant fact that his life itself was unfinished—cut off at the height of his powers at the age of not quite thirty-six. It is hard to disagree with the common view that Mozart's early death was probably the most tragic single event in the history of music. And it is understandable that music lovers in their more morbid and whimsical moments wonder: What if he had lived longer? For obvious reasons scholars and biographers are less likely to permit themselves to entertain speculations on a question of this kind. But what if one were to take the question seriously for a moment? Doing so not only has its idle fascination but also its share of surprises and ironies.
To get things started, let us first consider another intriguing hypothetical proposi-tion—in fact the exact converse of our chosen question—namely, what if Mozart had died even earlier, say, when he was Franz Schubert's age? Here there is no need for speculation. Franz Schubert (January 31, 1797, to November 19, 1828) died two months before his thirty-second birthday. If Mozart had died at Schubert's age, he would have departed this world in November 1787. His last work would have been Don Giovanni, K. 527, completed October 28, 1787. This means that the last hundred-plus compositions listed in the Köchel catalog would never have been writ-ten: among them the operas Così fan tutte, La clemenza di Tito, and Die Zauberflöte, and also the Clarinet Quintet, the Clarinet Concerto, the last two piano concertos, the “Prussian” string quartets, the last three symphonies, and, of course, all of the Requiem.
Johann Sebastian Bach and Wolfgang Amadeus Mozart represent the antipodes of eighteenth-century musical genius. According to the traditional view, Bach's music was the culmination of the so-called Baroque era during the first half of the century; Mozart's, conversely, was the culmination of the antithetical Classical style, during the second half. The antithesis is not just a technical matter of the contrast between the late Baroque and high Classical styles. It extends into their personal lives as well. We know almost nothing about Bach's private life; we know almost too much about Mozart's. Bach was an orphan; Mozart was all-too-much the son of an autocratic father. Bach was the product of the Lutheran tradition of northern Germany. Mozart was born into the Catholic tradition of Austria; but he clearly belonged even more to the secular, aesthetic, tradition that had its origins in Renaissance Italy. These starkly contrasting personal backgrounds inevitably affected their existential values: their understanding of their “purpose in life,” their artistic missions. This understanding, in turn, inevitably touched on the purpose and, ultimately, the meaning of their music. Why did Bach and Mozart bother to compose at all? What did the effort and the resulting work mean to them? What were their fundamental objectives as artists?
I should like to begin exploring these issues somewhat indirectly. Rather than talking immediately about Bach or about Mozart, let us consider Mozart's Bach—a matter we shall consider even more extensively in chapter 14. As it turns out, Mozart instinctively understood a great deal about the creative impulse informing the music of Bach. In April of 1789, on the occasion of his visit to Leipzig (and his perfor-mance on the organ of the Thomaskirche—Bach's own organ), Mozart experienced a close encounter of the revelatory kind with the church music of J. S. Bach. The event was recorded by Friedrich Rochlitz (1769–1842), a pupil at the Thomasschule at the time of Mozart's visit, and later the founding editor of the influential Leipzig journal Allgemeine Musikalische Zeitung. Rochlitz writes:
On the initiative of the late [Johann Friedrich] Doles, then Kantor of the Thomas-Schule, the choir surprised Mozart with a performance of the double-chorus motet, Singet dem Herrn ein neues Lied [BWV 225], by Sebastian Bach…. Hardly had the choir sung a few measures when Mozart sat up startled; a few measures more and he called out: “What is this?”
During his lifetime, and for sometime thereafter, Bach was a contemporary com-poser. That means, among other things, that he had not yet acquired the status of immortality and was not beyond criticism. In the year 1737, at the very pin-nacle of his career, and only six months after having been conferred the lofty title of “Composer to the Court Chapel of His Royal Majesty in Poland” (Compositeur bey der Königlichen HofCapelle), Bach was taken severely to task, in print, by his former pupil, Johann Adolph Scheibe (1708–76), in the following terms:
This great man would be the admiration of whole nations if [his music] had more charm, if he did not take away the natural element in his pieces by giving them a turgid and confused style, and if he did not darken their beauty by an excess of art…. He demands that singers and instrumentalists should be able to do with their throats and instruments whatever he can play on the clavier…. Every ornament, every little grace … he expresses completely in notes; and this not only takes away from his pieces the beauty of harmony but completely covers the melody throughout. All the voices must work with each other and be of equal difficulty, and none of them can be recognized as the principal voice…. Turgidity has led [him] from the natural to the artificial, from the lofty to the somber; one admires the onerous labor and uncommon effort—which, however, are vainly employed, since they conflict with Nature.
Scheibe's critique, of course, is one of the most famous documents of its kind in the history of music, not least because it was far more than simply one man's opin-ion. It was also an ideological manifesto to which we shall return in due course.
Bach himself was by no means unaware of the unusual difficulty his music posed. Referring to his church compositions in an official document written less than a year before Scheibe's attack, Bach described them as “incomparably more difficult and more intricate” (ohngleich schwerer und intricater) than those by other composers.
In his provocative essay, “Carl Philipp Emanuel Bach and the Aesthetics of Patricide,” Richard Kramer remarks, “Everywhere, Emanuel felt the need to speak of his father. In his music, he fails to do so. The patrimony is not acknowledged there.” Kramer demonstrates this in a perceptive analysis of one of Emanuel's challenging keyboard compositions, the Sonata in C Major, H. 248 (1775).
Coping with that patrimony could not have been a picnic for the male offspring of Johann Sebastian Bach. The towering shadow cast by J. S. Bach on the lives, careers, and ambitions of all five of them was undoubtedly overwhelming. Kramer's comment invites us to ponder the various tactics and strategies these uniquely privi-leged—and uniquely challenged—offspring developed to come to terms with that intimidating legacy. He has also offered an intriguing way to assess and understand the meaning of the careers of the Bach sons: namely, by determining the degree to which—and the manner in which—they succeeded in emerging from their father's shadow. Much of what follows will be conjectural; but very little is not conjectural in historical or biographical writing concerned with comprehending the meaning of events centuries old. On the other hand, much of it will be a matter of reasonably “connecting dots”—that is, documented facts—which we may have become overly reluctant to connect or account for in rather obvious ways.
Bach and His Sons
According to at least one eighteenth-century author, there was an abundance of mutual disdain between Johann Sebastian Bach and his musical sons. Carl Friedrich Cramer (1752–1807), the editor of the important Magazin der Musik, personally knew both Philipp Emanuel and Friedemann. In his autobiography, written in 1792–93, Cramer mentions: “The old Sebastian had three sons. He was satisfied only with Friedemann, the great organist. Even about Carl Philipp Emanuel he said (unjustly!): ‘’Tis Berlin blue! It fades!’—Regarding the London Chrétien, [Sebastian] Bach was wont to cite the verse by Gellert: ‘The boy is sure to thrive owing to his stupidity!’ In fact, among the three Bach sons this one had the greatest success.—I have these opinions from Friedemann himself.”
Interpretive and biographical essays by a major authority on Bach and Mozart probe for clues to the driving forces and experiences that shaped the character and the extraordinary artistic achievements of these iconic composers.
Johann Sebastian Bach's reputation as one of the supreme figures of Western musical history rests primarily on the legacy of his keyboard music. Whereas the composer's church music and ensemble compositions, including such masterpieces as the Mass in B Minor, the Passions, and the Brandenburg Concertos, fell virtually into oblivion after his death, the Inventions and Sinfonias, the harpsichord suites, the Goldberg Variations, the chorale settings, and the preludes and fugues of The Well-Tempered Clavier have been the objects of unbroken study, veneration, and emulation by gen-erations of musicians—amateur and professional—from Bach's day to the present.
During his lifetime Bach had already been celebrated as the greatest living keyboard player. But it is essential to recognize that for Bach and his contempo-raries, harpsichordists and organists were, more often than not, the same people. In the early eighteenth century, as throughout the seventeenth, the term “clavier” was generic and embraced all keyboard instruments, whether they were attached to strings or pipes. And it followed that a “clavier” player was equally at home on all the available keyboard instruments.
Defining the Repertoire
Naturally enough, during the Baroque era the various keyboard instruments, includ-ing the organ, shared a common repertoire to a significant extent. This is true not only for the earlier masters but also—far more than has generally been acknowl-edged—for much of the “clavier” music of Bach. This means specifically that we must abandon the deeply entrenched “binary” categorization that is literally cen-turies old but nonetheless an anachronistic one. We must recognize, rather, that with regard to performance medium, Bach's keyboard compositions do not fall into two strictly separated categories—consisting of works either for the organ or for the stringed keyboard instruments—but rather into three: works exclusively or primarily for organ, works exclusively or primarily for harpsichord, and works for “clavier,” that is, for any keyboard instrument. Only such a three-part division of Bach's keyboard repertory does full justice to the explicit designations contained in the sources and to the historical circumstances of keyboard performance in the Baroque era.
In the autumn of 1966, my first term as a teacher, it fell to me to offer a gradu-ate course called “Music in the Eighteenth Century.” It was part of a two-year-plus sequence of courses at the University of Chicago, conceived as a comprehensive, if basically conventional, history survey. The first year, covering the thousand-odd years from the birth of Christian chant to 1600, was divided into three parts in accordance with traditional historical and compositional categories: medieval monophony, medieval polyphony, and music of the Renaissance. The remainder of musical history, though, was not similarly divided according to the well-established stylistic categories into courses on Baroque, Classical, Romantic, and Modern music, but rather—largely as a matter of scheduling convenience—into more or less even slices of time as suggested by the calendar: with ten-week courses devoted in turn to the music of the seventeenth, eighteenth, nineteenth, and twentieth centuries. While this may not have made much difference in the case of the other style periods, the division into calendrical centuries certainly seemed arbitrary, even unnatural, in the case of the eighteenth century. For the central musical fact about the eighteenth century—as every music student knows (even before entering graduate school)—is that it was split almost precisely in half into two distinct, and virtually antithetical, “music-historical epochs.”
It was possible, of course, to ignore the fundamental historiographical problem and simply treat the musical events that occurred between circa 1700 and circa 1800 as a chronicle, taking up, one after the other, the topics and issues associated with the music of the Late Baroque, Pre-Classical, and Classical periods. The sylla-bus attempted to trace the general stylistic history of the eighteenth century as well as could be done in ten weeks (i.e., twenty ninety-minute class sessions)—which inevitably was not well at all. To begin with, the repertoire was enormous: more composers (both amateur and professional) no doubt having written more music during the eighteenth century than in any other. Moreover, the century obviously bore witness to a disproportionate number of great composers and great compo-sitions—arguably the most impressive such concentration in the history of music. This fact in turn made it necessary to consider two fairly distinct, parallel, reper-toires: the “great works” that every informed musician simply has to know, as well as the historically important and “typical” works.
For admirers of Johann Sebastian Bach, the year 2000 did not just mark the 250th anniversary of the composer's death. It was also the fiftieth anniversary of the modern era of Bach research—a period that produced some of the most impressive achieve-ments ever recorded in the annals of musical scholarship. This “golden age” of Bach scholarship—if we, the participants in it, may so smugly refer to it thus—began in 1950, the two-hundredth anniversary of Bach's death, with the publication of Wolfgang Schmieder's Bach-Werke-Verzeichnis (BWV) and the decision to prepare a new complete critical edition of Bach's works, the Neue Bach-Ausgabe (NBA). Work on the NBA led in turn to the development of new empirical methods—methods such as paper, ink, and handwriting analysis (previously more typical of disciplines like criminology than musicology)—in order to organize the materials and lift from the realm of largely subjective impression the indispensable tasks of establishing authenticity and dating sources. They have since become indispensable for all “basic” musicological research.
An unexpected and, as it turned out, epochal consequence of this sorting activity was logged before the end of the 1950s when Alfred Dürr and Georg von Dadelsen (the Crick and Watson of Bach research), working in friendly rivalry, succeeded in constructing a chronology of virtually the entire corpus of Bach's vocal music precise enough to date the majority of Bach's vocal compositions to within a week. In dem-onstrating that the vast majority of Bach's surviving Leipzig church music, consisting of some 150 compositions, had been written between 1723 and 1727, Dürr and Dadelsen had completely overturned the conventional view of how a major stretch of Bach's career had unfolded. It seemed almost as if Bach had been in a hurry to get the job of composing cantatas over with. And if he had not been spending a substantial portion of his twenty-seven years as Thomaskantor composing church music, then what had he been doing? The prevailing understanding of Bach's life and outlook and artistic development clearly had to be reconsidered.
It was not long before the gauntlet was thrown down by Friedrich Blume, argu-ably the preeminent German musicologist of the postwar period.
Beethoven famously declared that Bach's name was a misnomer: “His name ought not to be Bach [brook] but Meer [ocean].” Who would disagree! It is no surprise that the oceanic, qualitative immensity of Bach's achievement is matched by a com-parably oceanic, if quantitative, immensity of the literature devoted to it—and to the composer himself. The indispensable on-line database, Bach Bibliography, com-piled by Yo Tomita (Queen's University, Belfast) under the auspices of the Bach-Archiv, Leipzig, records, at present (2018), some 73,000 publications devoted to the composer and his works. About the B-Minor Mass the bibliography reveals that it is easily Bach's most written-about work. So much has already been said about it that it is hard to imagine that there is still more to add. In the twenty years from 1997 to 2017 over 150 publications devoted to the Mass had appeared—easily outpacing the number devoted to the St. John and St. Matthew Passions in the same time span (110 and 106 publications, respectively). As for Bach's instrumental works: there had been an even hundred dedicated publications to The Well-Tempered Clavier, and a mere twenty-one to the Brandenburg Concertos in that period. These statistics, incidentally, did not include all the discussions of these works in general treatments of Bach's music.
The extensive scholarly attention to the Mass reflects its immense, long-standing popularity with the musical public—a popularity readily explained: it is in the supra-national Latin rather than German and sets a universally familiar, effectively supra-denominational (if undeniably religious) text. The composition, moreover, taken as a whole (and in contrast to the Passions, for example), is colorful, lively, and— measured against the composer's own standards—much of the time remarkably euphonious, even jubilant. None of this, of course, denies its pervasive seriousness and—once again, measured against the composer's own standards—extraordinary compositional complexity.
The B-Minor Mass's immediacy of appeal is an anomaly among late works by great composers. Thanks to Theodor Adorno, the concept of “late style” in music has largely come to be equated with that of Beethoven. Indeed the very term, “late style” (Spätstil), was coined by Adorno in his 1937 essay, “Spätstil Beethovens,” and pursued by him further in his “Verfremdetes Hauptwerk: Zur Missa Solemnis” (1959).