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Low rates of bystander cardiopulmonary resuscitation (CPR) were identified as a shortcoming in the “chain of survival” for out-of-hospital cardiac arrest (OHCA) care in the Korean city of Ansan. This study sought to evaluate the effect of an initiative to increase bystander CPR and quality of out-of-hospital resuscitation on outcome from OHCA. The post-intervention data were used to determine the next quality improvement (QI) target as part of the “Plan-Do-Study-Act” (PDSA) model for QI.
The study hypothesis was that bystander CPR, return of spontaneous circulation (ROSC), and survival to discharge after OHCA would increase in the post-intervention period.
This was a retrospective pre/post study. The data from the pre-intervention period were abstracted from 2008–2011 and the post-intervention period from 2012–2013. The effect of the intervention on the odds of ROSC and survival to hospital discharge was determined using a generalized estimating equation to account for confounders and the effect of clustering within medical centers. The analysis was then used to identify other factors associated with outcomes to determine the next targets for intervention in the chain of survival for cardiac arrest in this community.
Rates of documented bystander CPR increased from 13% in the pre-intervention period to 37% in the post-intervention period. The overall rate of ROSC decreased from 18.4% to 14.3% (risk difference −4.1%; 95% CI, −7.1%–1.0%), whereas survival to hospital discharge increased from 3.9% to 5.0% (risk difference 1.1%; 95% CI, −1.8%–3.8%), and survival with good neurologic outcome increased from 0.8% to 1.6% (risk difference 0.8%; 95% CI, −0.8%–2.4%). In multivariable analyses, there was no association between the intervention and the rate of ROSC or survival to hospital discharge. The designated level of the treating hospital was a significant predictor of both survival and ROSC.
In this case study, there were no observed improvements in outcomes from OHCA after the targeted intervention to improve out-of-hospital CPR. However, utilizing the PDSA model for QI, the designated level of the treating hospital was found to be a significant predictor of survival in the post-period, identifying the next target for intervention.
Liszt's first fifteen Hungarian Rhapsodies (which mostly appeared in 1851– 53) immediately draw attention to the pianist-composer's creativity in pianism through his technical innovations and brilliance. Whereas his distinctive approach to notation, layout, and technique is considered his contribution to stylistic innovations in the keyboard idiom, the predominant display of technical brilliance is often thought to cross the line into self-indulgent showmanship. The negative view of him as a showman stems in part from the anti-virtuosity polemics that culminated in the German press of the 1840s. In this intellectual environment, Liszt as the virtuoso of his age became suspicious. His performance of arrangements often radically transformed the original in order to draw attention to spectacle and physicality. Such a style was a target for critics who condemned the virtuosity for its own sake as too corporeal and too sensual, devoid of intellect: in short, “superficial,” “trivial,” “empty,” or simply, in “bad taste.”
In his book Des bohémiens (1859), discussed in chapter 2, Liszt defended his role as a virtuoso who has a duty to give life to the “mute and motionless” creation of a composer. He celebrated Gypsy virtuosity, ornamentation, and improvisation and essentially attributed the major impetus for his creativity to the “exotic” and “natural” elements of Gypsy performance. Yet the controversies surrounding his book—among others, that he gave too much credit to a peripheral group of Gypsy musicians for their contribution to Hungary's national music—have undermined his goal and relegated it to his alleged “falsely interpreted” idealization of Gypsy music. Liszt's imagined, Romanticized, and quixotic representation of Gypsy music affected contemporary reception of both his Des bohémiens and his Rhapsodies, and to some extent that reception has also thwarted research on his reworking methods of capturing Gypsy-band performance styles in realistic detail.
At the other end of the reception spectrum, scholars of Hungarian music have emphasized how faithfully Liszt emulates the elements of Hungarian popular Gypsy bands and reproduces existing tunes and the style of their playing in his Rhapsodies 1–15, lending the impression that it is “as if we heard Gypsy ensembles in them.”
Liszt used the term partition initially for his arrangement of Berlioz's Symphonie fantastique (1834) in a letter to Adolphe Pictet in 1838:
If I am not mistaken, I am the one who first proposed a new method of transcription in my piano score of the Symphonie fantastique. I applied myself as scrupulously as if I were translating a sacred text to transferring, not only the symphony's musical framework, but also its detailed effects and the multiplicity of its instrumental and rhythmic combinations to the piano. The difficulty did not faze me, as my feeling for art and my love of it gave me double courage. … I called my work a partition de piano [piano score] in order to make clear my intention of following the orchestra step by step and of giving it no special treatment beyond the mass and variety of its sound.
Through his designation of partition, Liszt explicitly claims that he is ushering in “a new method” for a piano arrangement by underscoring his fidelity to the original. By “following the orchestra step by step,” he determines to remain unremitting in his goal of “scrupulously” rendering the original as if treating it as a “sacred text.” In addition to his adherence to the structure of the symphony (“the symphony's musical framework”), Liszt aims at capturing the nuanced, variegated effects of the orchestral sounds (the “detailed effects” and “the mass and variety of [the orchestra]'s sound”) as well as the intricacy of the orchestral textures (the “multiplicity of its instrumental and rhythmic combinations”).
In the same letter to Pictet, Liszt also continues to discuss the compositional procedure and aesthetic underlying his partition of Berlioz's Symphonie fantastique, from which another group of his partitions of Beethoven's symphonies is extrapolated, relating the two groups of arrangements to each other:
The procedure I followed for Berlioz's symphony I am currently applying to those by Beethoven. The serious study of his works, a profound feeling for their virtually infinite beauty and for the piano's resources, which have become familiar to me through constant practice, have perhaps made me less unfit than anyone for this laborious task.
The name of Beethoven is sacred in the arts. Today his symphonies are universally recognized as masterpieces. Anybody who has a serious desire to expand his knowledge or even to create something new himself, can never analyze and study these symphonies enough. Therefore, every mode of disseminating and making them more widely accessible has a certain merit, and one cannot deny that the many previous arrangements had a certain usefulness, although, on closer evaluation, most prove to be of little value. The worst lithograph, the most erroneous translation, still provides an image, if a vague one, of the genius of a Michelangelo or a Shakespeare. Likewise, in the most inadequate piano reduction, one recognizes now and again the traces, albeit half-smudged, of the master's inspiration. Meanwhile, thanks to the expansion that the piano has achieved in recent times as a consequence of the advances in playing technique and mechanical improvements, it is now possible to accomplish more and better things than had been accomplished before. By means of the vast development of its harmonic intensity, the pianoforte can now, more and more, claim for its own use any and all compositions written for the orchestra. In the scope of its seven octaves, [the pianoforte] is able, with few exceptions, to reproduce all features, all combinations, all figures of the most thorough and most profound composition, all of which leaves to the orchestra with no other advantages than the differences of timbres and massive effects—advantages that certainly are enormous. With this intention I undertook the work that I now hand over to the world. I must admit that I would see it as a rather pointless expense of my time if I had done nothing more than add to the many previous published arrangements of the symphonies a new one done in the usual manner. Yet I hold my time well spent if I have succeeded in transferring to the piano not only the large outlines of Beethoven's composition but also all of its subtleties and smaller features, which so meaningfully contribute to the perfection of the whole. My goal has been achieved when I have done the same as the knowledgeable engraver and the conscientious translator, who can grasp the spirit of a work and thus contribute to the recognition of the great masters and to developing a sense for beauty.
The celebrated engraver Luigi Calamatta reminisced vividly in his memoirs about his process of engraving Leonardo da Vinci's Mona Lisa, the long, drawnout saga of his thirty-year commitment to the project, and his anxiety over the considerable obstacles that lay in the path of a large-scale burin engraving:
I began to engrave the Mona Lisa in 1829 at Loro in the Marche, where I had to go for a change of air. Subsequently for a long period of years I could work on it only during the night, as I had to give my attention to the works that were commissioned from me. I experienced a great difficulty in engraving it, in view of the largeness and the forcefulness of the coloring. This can be obtained easily through broad and heavy cuts [but] in the Mona Lisa there are many details and finesses in the background, very many more in the folds of the veil that covers her and quite a few in the hair that I had to treat all in fine and strict work, and so the difficulty became greater. I know of no object more difficult to be followed in engraving…. The difficulty of the engraving is to be able to obtain, on the basis of an object, that it should be of the same material, of the same stuff and substance, alike in the clear, in the middle tints, and in the dark ones, and this is what I have sought with much effort through the combination of cuts and points. This is the thankless métier of the engraver, which is not appreciated and not even observed by almost anybody: to make it really felt through this work alone that this cloth is of silk, of veil, or of velvet, in all the movements made by the folds, is not an easy thing, any more than all the infinite varieties that a good engraver must express through the burin, to the end that everything can say—I am marble, wool, water, skin, etc.
Among the various techniques and media of printmaking, burin engraving, in which the engraver used a sharp tool to incise an image on copper plate, was the most prestigious, as well as the most labor-intensive and time-consuming, throughout the period under discussion.
In his famous conception of the Stildualismus (dualism of styles) that underpinned his Die Musik des 19. Jahrhunderts [Nineteenth-Century Music], published in 1980, Carl Dahlhaus called upon Beethoven and Rossini to make a broader aesthetic claim of the conceptual binary “text” and “event.” He argued that Beethoven and Rossini became symbolic progenitors that epitomize the “two cultures of music” fundamental to Western music. The “dualism of styles” that the two composers embodied presents the contrast between the score-based “text” and the performance-based “event.” The implications of this opposition rapidly develop early nineteenth-century dichotomies between German and Italian musical cultures, instrumental and operatic music, depth and surface, music as text and as practice, and “fidelity to score and improvisation.” The repercussions of Dahlhaus's conception produced a flurry of scholarly responses and critiques. The most recent approach is that leading scholars of both camps of Beethoven and Rossini have been in dialogue with each other. They analyze the philosophical and historiographical inferences of Dahlhaus's text–event dualism while simultaneously challenging the traditional binary constructions, and proposing new ways of understanding Beethoven and Rossini's music by freeing them from the discourse of duality in which they have become entangled.
Where do these modifications of the claimed Beethoven-Rossini text– event dualism leave us for understanding Franz Liszt's case? Liszt was one of the significant observers, practitioners, and participants in shaping and reshaping the legacy of the symbolic duo. He was a genuine, faithful interpreter and adherent of Beethoven through his wide array of roles as performer, composer, financial donor, and conductor, as represented in his deep engagement with the festivals surrounding the erection of the Beethoven monument at Bonn in 1845. Liszt also resolved to become a “conscientious translator” of Beethoven's music through his lifelong project of arrangements of the nine symphonies by Beethoven (1837–41, 1863–65). Liszt's relationship with Rossini is documented scantly, only in some general accounts. Nevertheless, Liszt's project in tribute to Rossini is evident in an array of his compositions “after” Rossini: his variations on excerpts from Rossini's early operas in 1829; his fantasies on songs from Rossini's collection of Les soirées musicales, 8 ariettas, and 4 duets in 1835; and his arrangement of Rossini's Guillaume Tell Overture (1838).
Liszt treated his models with the utmost care. His endeavors to capture the essence of these models attest to his genuine admiration for them. His conscientious and inventive approach to rendering them on the keyboard testifies to his integrity and his indisputable mastery of the piano. By exploring every possible resource available on the piano, he minimized the ostensible disadvantages of the piano, ensuring the most faithful rendering of the model. His reworkings represent the blurring of boundaries between reference and digression, composition and performance, and faithful reproduction and creative artistry. His compositional focus on the texture, sound, and timbre of instruments, in particular, illustrates his combination of detailed attention to the model instruments and his imaginative reconstruction of them.
For all Liszt's orchestral arrangements and Rhapsodies, the musical analyses have focused on his specific compositional techniques in his rendering of instrumental music. His reworking process demonstrates how scrupulously he approached the essence of the model, how effectively he provided solutions to problems in rendering the sounds and effects of the modeled instruments, and how individually he reinvigorated the borrowed material in his own pianistic terms. Despite the completely different source materials for his orchestral arrangements and the Rhapsodies, his reworking methods reveal that certain types of compositional techniques and aesthetics underlying them recur throughout. In what follows, we briefly reconsider the recurring techniques and aesthetics that Liszt deployed that were discussed in chapters 2–5. My goal here is to show how the diverse strands of Liszt's reworkings considered in this study may be compared, contrasted, and linked, ultimately propelling a new vision of the recurring theme that fidelity and creativity are interdependent throughout.
Orchestral Concept of Sound
Focus on Individual Instruments
Liszt's reworking methods in his orchestral arrangements and Rhapsodies reveal his deep interest in the distinctive sounds and effects of individual instruments. The immediately recognizable element is his detailed cues for instruments. The impulse behind these cues, in both the orchestral arrangements and the Rhapsodies, is his faith that the piano is capable of producing the sounds of the instruments. The carefully inscribed cues represent his scrupulousness toward detail as well as his aspiration for pianists to be aware of the original instruments and render them in a nuanced manner with keyboard touch and articulation.
Style in engraving is the preeminence of drawing over color and of beauty over richness. I say “color,” because the engraver, although he has only the limited, monochrome effect of black and white [available to him], has nevertheless his very own way of being a colorist.
In his Grammaire des arts du dessin (The Grammar of Painting and Engraving), the art critic Charles Blanc made the sensational and paradoxical assertion that the engraver, who creates only a “monochrome effect,” is essentially a “colorist.” Along similar lines, he argued that “the engraver having at his disposal, so far as color is concerned, only black and white, ceases to be a copyist and becomes, instead, a translator.” Blanc further described the engraver's endproduct as similar to that of a translator [of a verbal text], in that it “highlights the essential [features], that nonetheless manages to indicate everything and to say everything.” The notion of engraving as translation was well ingrained in the minds of Blanc's contemporary critics. For instance, the outstanding engraver Nicolas Ponce (1764–1831) conceived the engraving as “not a copy of the painting” but “a translation of it, which is different.” He makes the further significant point that the “line” of a print can be translated literally, whereas the “effect, the color and the harmony of a print” are reliant on the engraver's reinterpretation, which requires his “genius.”
Blanc and Ponce brought up the widespread nineteenth-century qualms about one critical limitation of engraving: the lack of color. Around the same time, music critics and reviewers also often made an analogy between the piano transcription and its visual counterpart of engraving by focusing primarily on their mutual deficiency: the inability to transport the original “colors” literally. E. T. A. Hoffmann's famous comparison of a piano transcription to a black-and-white sketch of an oil painting conceives transcription as an outline of the original music, incapable of conveying its colors and sounds in depth. At the same time both camps of music and art critics understood how art reproduction stimulates the executor's imagination in translating the original colors. As we observed above, Blanc and Ponce considered the limitation as compelling the engraver to “highlight the essential aspects” of the original and “create the effect and harmony of his print,” respectively.
Depressive symptoms are common in bereaved caregivers; however, there have been few prospective studies using a structured interview. This study investigated the prevalence and preloss predictors of major depressive disorder (MDD) in bereaved caregivers of patients in a palliative care unit.
This prospective cohort study collected caregiver sociodemographic and psychological data before the death of a palliative care unit patient, including MDD, care-burden, coping style, and hopeful attitude. Postloss MDD was assessed 6 and 13 months after death, and a multivariate logistic regression analysis was conducted to identify its predictors.
Of 305 caregivers contacted, 92 participated in this study. The prevalence of preloss MDD was 21.8%; the prevalences of postloss MDD were 34.8% and 24.7% at 6 and 13 months, respectively. Preloss MDD predicted postloss MDD at 6 months (odds ratio [OR] = 5.38, 95% confidence interval [CI95%] = 1.29, 22.43); preloss nonhopeful attitude and unemployment status of caregivers predicted postloss MDD at 13 months (OR = 8.77, CI95% = 1.87, 41.13 and OR = 7.10, CI95% = 1.28, 39.36, respectively).
Significance of results
Approximately 35% of caregivers suffered from MDD at 6 months postloss, but the prevalence of MDD decreased to about 25% at 13 months. Preloss MDD significantly predicted postloss MDD at 6 months, whereas hopeful attitude and unemployment at baseline were significantly associated with postloss MDD at 13 months.
To analyse the relationship of pre-operative body mass index with surgical complications and oncological outcomes in patients undergoing microvascular reconstruction for head and neck squamous cell cancer.
A retrospective review was conducted of 259 patients who underwent microvascular free flap reconstruction after head and neck ablative surgery.
Mean body mass index was 22.48 kg/m2. There were no correlations between body mass index and: flap failure (p = 0.739), flap ischaemia (p = 0.644), pharyngocutaneous fistula (p = 0.141) or wound infection (p = 0.224). The five-year disease-specific survival rate was 63 per cent. On univariate analysis, the five-year disease-specific survival rate was significantly correlated with pre-operative body mass index, based on Kaplan–Meier survival curves (p = 0.028). The five-year disease-specific survival rates in underweight, normal weight, overweight and obese groups were 47 per cent, 55 per cent, 65 per cent and 80 per cent, respectively.
Pre-operative body mass index was a useful predictor for recurrence and survival in patients who underwent microvascular reconstruction for head and neck squamous cell cancer.
A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea’s disaster medical assistance system. We report these changes here.
Reports about these incidents, revisions to laws, and the government’s revised medical disaster response guidelines were reviewed.
The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled.
Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system’s response capacity. (Disaster Med Public Health Preparedness. 2017;11:526–530)
Hyperlipidaemia is a major cause of atherosclerosis and related CVD and can be prevented with natural substances. Previously, we reported that a novel Bacillus-fermented green tea (FGT) exerts anti-obesity and hypolipidaemic effects. This study further investigated the hypotriglyceridaemic and anti-obesogenic effects of FGT and its underlying mechanisms. FGT effectively inhibited pancreatic lipase activity in vitro (IC50, 0·48 mg/ml) and ameliorated postprandial lipaemia in rats (26 % reduction with 500 mg/kg FGT). In hypertriglyceridaemic hamsters, FGT administration significantly reduced plasma TAG levels. In mice, FGT administration (500 mg/kg) for 2 weeks augmented energy expenditure by 22 % through the induction of plasma serotonin, a neurotransmitter that modulates energy expenditure and mRNA expressions of lipid metabolism genes in peripheral tissues. Analysis of the gut microbiota showed that FGT reduced the proportion of the phylum Firmicutes in hamsters, which could further contribute to its anti-obesity effects. Collectively, these data demonstrate that FGT decreases plasma TAG levels via multiple mechanisms including inhibition of pancreatic lipase, augmentation of energy expenditure, induction of serotonin secretion and alteration of gut microbiota. These results suggest that FGT may be a useful natural agent for preventing hypertriglyceridaemia and obesity.