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Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach.
DESIGN
Point-prevalence study.
SETTING
This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility.
PATIENTS
Inpatients on all units excluding psychiatry and obstetrics-gynecology.
METHODS
CRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution.
RESULTS
Of 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%–6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%–6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%–11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5–1.5) and 1.5 (95% CI, 0.9–2.6), respectively. No CRE were identified from the inpatient rehabilitation facility.
CONCLUSION
A baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection.
Herbert Howells (1892-1983) was a prodigiously gifted musician and the favourite student of the notoriously hard-to-please Sir Charles Villiers Stanford. Throughout his long life, he was one of the country's most prominent composers, writing extensively in all genres except the symphony and opera. Yet today he is known mostly for his church music, and there is as yet relatively little serious study of his work. This book is the first large-scale study of Howells's music, affording both detailed consideration of individual works and a broad survey of general characteristics and issues. Its coverage is wide-ranging, addressing all aspects of the composer's prolific output and probing many of the issues that it raises. The essays are gathered in five sections: Howells the Stylist examines one of the most striking aspect of the composer's music, its strongly characterised personal voice; Howells the Vocal Composer addresses both his well-known contribution to church music and his less familiar, but also important, contribution to the genre of solo song; Howells the Instrumental Composer shows that he was no less accomplished for his work in genres without words, for which, in fact, he first made his name; Howells the Modern considers the composer's rather overlooked contribution to the development of a modern voice for British music; and Howells in Mourning explores the important impact of the death of Michael on his father's life and work. The composer that emerges from these studies is a complex figure: technically fluent but prone to revision and self-doubt; innovative but also conservative; a composer with an improvisational sense of flow who had a firm grasp of musical form; an exponent of British musical style who owed as much to continental influence as to his national heritage. This volume, comprising a collection of outstanding essays by established writers and emergent scholars, opens up the range of Howells's achievement to a wider audience, both professional and amateur. PHILLIP COOKE is Lecturer in Composition at the University of Aberdeen. DAVID MAW is Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges. CONTRIBUTORS: Byron Adams, Paul Andrews, Graham Barber, Jonathan Clinch, Phillip Cooke, Jeremy Dibble, Lewis Foreman, Fabian Huss, David Maw, Diane Nolan-Cooke, Lionel Pike, Paul Spicer, Jonathan White. Foreword by John Rutter.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
‘What humanity can endure and suffer is beyond belief’.
Sir Edwin Lutyens, letter of 12 July 1917
An horrible story: one that causes sickening knots of dread to tighten in the pit of any loving parent's stomach. The events unfold simply, inexorably, as if the chill hand of the Erlkönig guided the tragedy. A family is on holiday in Gloucestershire when the youngest child, a bright, resolute, and charming little boy, falls ill. A local doctor is summoned, makes an accurate diagnosis and urges the family to return to London as quickly as possible. On the ride to the train station and on the train hurtling through the darkening countryside, the gasping child, held by his powerless father, struggles to breathe, turning blue and black from lack of oxygen, a sure sign of bulbar poliomyelitis. On arrival in London, an ambulance rushes the little boy to a nursing home; as the doctors debate about what to do – an iron lung, perhaps? – the child proves their irrelevance by dying. The boy, named Michael, left behind a father immured in a grief that time did not assuage; a mother whose feelings were doubtless keen but went virtually unnoticed; and an older sister whose secondary place in her father's affections would be felt again and ever again in the decades to come.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
The music of Herbert Howells is inseparable from counterpoint: indeed, he considered himself to belong to the Tudor period ‘not only musically but in every way’. That was an intensely polyphonic era, and he himself normally thought in counterpoint (a trait he shared with Vaughan Williams). Thus the underlying feeling of ‘H. H. His Fancy’ (written in 1927) is of a meditative and dreamy fugue, the word ‘Fancy’ standing both for the Tudor idea of ‘imitative fantasia’ and for ‘the kind of music most admired by H. H.’ As it happens, ‘Foss's Dump’ (no. 6 in the same collection) is also a fugue, but it is perhaps surprising that the piece written for H. K. Andrews (no. 6 in Book 1 of Howells' Clavichord – HH 237) – that expert on all things pertaining to Palestrina and Byrd – eschews imitative counterpoint in favour of a melodic line with clear roots in Tudor keyboard dances, though with flowing contrapuntal accompaniment. Indeed, Howells's interest in Tudor music appears to have veered more towards the dance and air than towards the imitative fantasia or motet: ‘Master Tallis's Testament’ (from the Six Pieces for Organ of 1939–45 – HH 226) provides a modal tune with modally inflected supporting harmony, but does not use imitative counterpoint (even though Tallis was an expert at writing it); and when Bartök had tea with him in London, Howells demonstrated Tudor keyboard music by playing Farnaby's ‘His Rest’ and ‘Tower Hill’, and two pieces by Byrd (a pavane and ‘The Carman's Whistle’) – but not any of the Tudor imitative fantasias.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
There is a characteristic rhythm that occurs persistently throughout Howells's works. In slow, triple metre, it emanates from his apparent obsession with the sarabande and appears to be associated with elegiac thoughts, both personal and religious. It almost always appears in conjunction with intense, chromatic harmony. What are the origins and characteristics of this manner and mood? Why does Howells keep returning to the sarabande as a vehicle for expression, especially when in melancholy spirits? What is the relationship between instrumental and sung sarabande? And what other, subliminal effects does this modus operandi have on his music? These are the questions I shall attempt to answer in this chapter.
While some early works contain the seeds of Howells's fixation, from 1940 he wrote a steady flow of stylised dances in sarabande form, spanning more than thirty years:
(a) ‘Saraband (for the Morning of Easter)’ (HH 226ii – 1940)
(b) ‘Saraband (in modo elegiaco)’ (HH 226v – 1945)
(c) ‘Dart's Saraband’ (HH 237iv – 1956)
(d) ‘Malcolm's Vision’ (Quasi alla sarabanda) (HH 237xvi – 1956)
(e) ‘Eia mater’ (Espressivo: alla sarabanda), from Stabat mater (HH 309 – 1959–61)
(f) ‘Ile's Interlude’ (Poco lento, quasi come Sarabanda, molto serioso), from Three Figures (1960 – HH 297ii)
(g) II (Quasi adagio: serioso ma teneramente), from Sonatina (HH 333 – 1971)
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
The compositional style of Herbert Howells, the essence of which is admittedly difficult to articulate, seems to generate scholarly descriptions that fall into two categories. The first may be illustrated by some phrases of Christopher Palmer, taken from his discussion of Howells's impressionistic tendencies: ‘… the lines indeterminate and soft-drawn, the sum-total of texture a complex seen mistily through a haze of water or light … effortless interweaving of myriad coloured strands, fluid, self-generating, kaleidoscopic …’. Such lofty and picturesque language, with an emphasis on visual metaphor, is common in attempts to describe a sound-world that can be mystifying even to the most astute listener. Then there is the contrasting clinical assessment, exemplified by a report of Howells's ‘basic style’ as ‘tonal … but with modal incursions, diatonic dissonance, cross-relations, pedal points and suspensions, as well as asymmetrical phrases, rhythmic vitality, and confident melodies’. Assured that the devil is in the details, proponents of this perspective dissect and parse the music note by note, chord by chord, phrase by phrase, anticipating an epiphany. But neither the ‘laundry list’ of techniques nor Palmer's abstract portrait fully succeeds in capturing Howells's stylistic identity or explicating his achievements. A synthesis of these contrasting methodologies is necessary, and collections like the Six Pieces for Organ (HH 226) provide fertile ground for study of Howells's own integration of macrocosmic and microcosmic approaches to composition. These pieces offer an excellent window into Howells's style, with all the complexity that such a style embraces, yet without the intimidating vastness of a larger-scale work.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
British chamber music during the first half of the twentieth century was convulsed with a ‘phantasy mania’. The competition for ‘phantasies’ inaugurated by W. W. Cobbett in 1905 was enthusiastically received and became the first of a series that continued under differing aegises through the next four decades. The genre that it spawned was also taken up outside this context, both through Cobbett's own commissioning and through the independent interest of composers beyond his sphere. In a short period of time, the genre had established itself; yet it did not long survive Cobbett's death in 1937 and had all but entirely vanished in the postwar period.
Cobbett's idea with the competitions was to encourage the writing of short chamber works of modest technical demands. The first competition specified a string quartet in one movement not exceeding twelve minutes in length: ‘The old English Fantasy may be suggested as a typical form which presents possibilities of modern development.’ Cobbett intended the phantasy label to refer to the Tudor-Jacobean consort-and-keyboard genre, the fantasy; the initial ‘ph’ was his own faux-archaising touch. he later confessed that at the time of advertising his first competition, his own knowledge of the ‘old English Fantasy’ was ‘very restricted’; and it is highly unlikely that those taking part in the early competitions were any better informed. The fantasy repertoire was not yet published, and knowledge of the works in early sources was limited to a very small number of experts.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
The Oboe Sonata (HH 239 – 1942) and Clarinet Sonata (HH 251– 1946) are the only substantial chamber works dating from Howells's later period, providing an opportunity to observe his mature musical language from an alternative perspective to that presented by the choral and orchestral works. The extended forms and limited textural range facilitate an examination of elements such as thematic working, harmonic procedures at all hierarchical levels and their articulation of structural relationships, as well as the aesthetic priorities they imply. The latter will be contextualised further through a consideration of wider trends in British music and culture, drawing on comments by Howells and several of his contemporaries.
The Oboe Sonata was written for Leon Goossens, but when the oboist raised some doubts about the work's structure, Howells recalled it, saying that he would ‘have another go at it’. This was the last that was heard of it until Christopher Palmer borrowed the manuscript while working on Herbert Howells: A Centenary Celebration; luckily he made a photocopy, as the manuscript later disappeared, and the work was not performed until 1984. The Clarinet Sonata was written four years after the oboe work, for Frederick Thurston, and it resumes some of the concerns of the earlier sonata. Superficially, the Clarinet Sonata seems tighter in construction than its predecessor, avoiding some of the earlier complexities in favour of more obvious structural divisions and relationships.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
The Diamond Jubilee of Queen Elizabeth II is a fitting time to take stock of Herbert Howells's compositional achievement and legacy. He was one of the distinguished British composers commissioned to write for the coronation ceremony; and his work for this occasion, the Introit ‘Behold, O God Our Defender’(HH 276), composed by his account on Christmas Day in 1952, seemingly epitomises his position. Aged sixty, he was a doyen of the English musical establishment. A professor at the Royal College of Music (RCM) since 1920, he was an accomplished and highly respected composer of church music who could be counted on to write something that would fit a state ceremonial occasion: music that would reflect national pride and identity before the world; music that would blend with the ceremonial, being part of it and not raising its voice beyond the pageantry.
If the muted tone and warm sound-world of the piece seem on the surface to manifest the respectability that would be expected for such an occasion, they sit oddly with the ecstatic turn the music continually takes. There are just three clauses in the text (one and a half verses of Psalm 84), yet by taking each as the basis of a separate section of music, Howells stretches them into a piece of almost four minutes' duration. In a way scarcely prompted by either the words or the occasion, each of the three sections builds from a soft initial dynamic to an effulgent climax before dying down again.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Many years ago, in the 1960s, when even Howells's chamber music was little known, the present author attended a rehearsal of the Piano Quartet (HH 66), which bears the dedication ‘To the Hill at Chosen and to Ivor Gurney who knows it’. The music was unfamiliar to the performers, and the pianist read this dedication out to his colleagues and they all smirked in a condescending way before going on to play the music quite beautifully. Certainly there was a time when such an association by a composer would not be treated seriously, yet landscape had a profound impression on Howells's early music and we need to consider quite what he meant by such statements in respect of these evocative scores. Writing to his brother in 1922 he asserted that he could translate a feature of landscape ‘into musical terms, and be so expressed’. In an article on Howells in 1920 the critic Edwin Evans wrote about his music: ‘the Gloucestershire countryside is a better school than any academy’, finding a ‘sense of open-airishness combined with a feeling for distance that engenders a strain of mysticism’.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
The release in May 2000 of not one but two piano concertos by Herbert Howells was hailed as ‘an astonishing revelation’. Both technically advanced and well crafted, Howells's piano concertos make a significant contribution to British music at the start of the twentieth century and, although discarded by the composer, demand a central position in any reassessment of Howells. For the scholar of British music, these are major artistic statements that function as significant commentaries on their period; and as an increasing number of publications emerge critiquing the ways in which British composers adapted and reacted to Continental Modernism, Howells, in particular, demands attention.
The piano concertos date from 1913 and 1924. The first (HH 31), written during Howells's initial year of study at the Royal College of Music (RCM), could arguably be regarded as the last Romantic British piano concerto, focusing heavily on models of Elgar, Stanford and Parry. The second (HH 152), premiered in 1925, could equally be considered the first British Modernist piano concerto. The piano concertos (and specifically Howells's journey from the first to the second) give us a vivid picture of Howells the modernising composer, working through a period Constant Lambert labelled ‘The Revolutionary Situation’. Their reception, like-wise, demonstrates much about the critical press and general state of music in Britain at the time.
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges
Edited by
Phillip A. Cooke, Lecturer in Composition at the University of Aberdeen,David Maw, Tutor and Research Fellow in Music at Oriel College, Oxford, holding Lectureships also at Christ Church, The Queen's and Trinity Colleges