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In the analysis of late tonal music, analytical approaches which attempt to understand tonal function on the one hand, and harmonic transformation viewed through a neo-Riemannian lens on the other, often stand in an uneasy relation. Through analysis of Act 1, Scene 3 of Götterdämmerung, this chapter attempts to bring neo-Riemannian theory closer to its origin in Hugo Riemann’s functional theory, and so to point the way towards a new theoretical frame for understanding the tonal function of chromatic music. We urge this return to Riemann because it enables twenty-first-century listeners and theorists to appreciate the complex power of tonality as a system which, like the great socio-economic, legal, religious and scientific systems that have endured into the twenty-first century, has an indefatigable ability to subsume anything that might seem to pose a challenge to it back into itself, as a source of further power.
Inappropriate antibiotic use is a key driver of antibiotic resistance and one that can be mitigated through stewardship. A better understanding of current prescribing practices is needed to develop successful stewardship efforts. This study aims to identify factors that are associated with human cases of enteric illness receiving an antibiotic prescription. Cases of laboratory-confirmed enteric illness reported to the FoodNet Canada surveillance system between 2015 and 2019 were the subjects of this study. Laboratory data were combined with self-reported data collected from an enhanced case questionnaire that included demographic data, illness duration and symptoms, and antibiotic prescribing. The data were used to build univariable logistic regression models and a multivariable logistic regression model to explore what factors were associated with a case receiving an antibiotic prescription. The final multivariable model identified several factors as being significantly associated with cases being prescribed an antibiotic. Some of the identified associations indicate that current antibiotic prescribing practices include a substantial level of inappropriate use. This study provides evidence that antibiotic stewardship initiatives targeting infectious diarrhoea are needed to optimize antibiotic use and combat the rise of antibiotic resistance.
Community health workers and promotoras (CHW/Ps) increasingly support research conducted in communities but receive variable or no training. We developed a culturally and linguistically tailored research best practices course for CHW/Ps that can be taken independently or in facilitated groups. The purpose of this study was to evaluate the facilitated training.
Methods:
CHW/Ps were recruited from communities and partners affiliated with study sites in Michigan, Florida, and California. They participated in virtual or in-person training facilitated by a peer in English or Spanish and then completed a survey about their abilities (i.e., knowledge and skills for participating in research-related work) and perceptions of the training. Linear regression analyses were used to examine differences in training experience across several factors.
Results:
A total of 394 CHW/Ps, mean age 41.6 ± 13.8 years, completed the training and survey (n = 275 English; 119 Spanish). Most CHW/Ps were female (80%), and 50% identified as Hispanic, Latino, or Spanish. Over 95% of CHW/Ps rated their abilities as improved after training; 98% agreed the course was relevant to their work and felt the training was useful. Small differences were observed between training sites.
Discussion:
Most CHW/Ps rated the training positively and noted improved knowledge and skills for engaging in research-related work. Despite slight site differences, the training was well received, and CHW/Ps appreciated having a facilitator with experience working in community-based settings. This course offers a standard and scalable approach to training the CHW/P workforce. Future studies can examine its uptake and effect on research quality.
The general outlines of Vaughan Williams’s politics are encapsulated in a remark to Rutland Boughton: ‘Ever since I had a vote I have voted either Radical or Labour’. He was born into considerable financial security, in a family broadly of religiously Nonconformist and politically liberal bent. Despite living as rentier capitalists (with a private income produced from a landed estate, and in the composer’s own case, later, from music royalties), the family and Vaughan Williams himself felt that sensitivity to class difference, and to a harmonious coming together of the classes, were the bedrock of a progressive politics. Hence his musical style, which blends ‘low’ and ‘high’ aesthetics, and ‘folk’ and ‘cosmopolitan’ styles. And hence, too, his professional work with amateurs, both as a composer and conductor, and also as an advocate for the highest quality of musical production (which he felt to be to the benefit of all), both in broadcasting and in competitions he helped to adjudicate. At the national level his was also an important voice on the panels of both the British Council and the Arts Council of Great Britain (as well as its predecessor, the Council for the Encouragement of Music and the Arts).
The clinical and translational research workforce involved in social and behavioral research (SBR) needs to keep pace with clinical research guidance and regulations. Updated information and a new module on community and stakeholder engagement were added to an existing SBR training course. This article presents evaluation findings of the updated course for the Social and Behavioral Workforce.
Methods and Materials:
Participants working across one university were recruited. Course completers were sent an online survey to evaluate the training. Some participants were invited to join in a focus group to discuss the application of the training to their work. We performed descriptive statistics and conducted a qualitative analysis on focus group data.
Results:
There were 99 participants from diverse backgrounds who completed the survey. Most reported the training was relevant to their work or that of the study teams they worked with. Almost half (46%) indicated they would work differently after participating. Respondents with community or stakeholder engaged research experience vs. those without were more likely to report that the new module was relevant to study teams they worked with (t = 5.61, p = 0.001), and that they would work differently following the training (t = 2.63, p = 0.01). Open-ended survey responses (n = 99) and focus group (n = 12) data showed how participants felt their work would be affected by the training.
Conclusion:
The updated course was rated highly, particularly by those whose work was related to the new course content. This course provides an up-to-date resource for the training and development for the Social and Behavioral Workforce.
Community health workers and promotoras (CHW/Ps) have a fundamental role in facilitating research with communities. However, no national standard training exists as part of the CHW/P job role. We developed and evaluated a culturally- and linguistically tailored online research best practices course for CHW/Ps to meet this gap.
Methods:
After the research best practices course was developed, we advertised the opportunity to CHW/Ps nationwide to complete the training online in English or Spanish. Following course completion, CHW/Ps received an online survey to rate their skills in community-engaged research and their perceptions of the course using Likert scales of agreement. A qualitative content analysis was conducted on open-ended response data.
Results:
104 CHW/Ps completed the English or Spanish course (n = 52 for each language; mean age 42 years SD ± 12); 88% of individuals identified as female and 56% identified as Hispanic, Latino, or Spaniard. 96%–100% of respondents reported improvement in various skills. Nearly all CHW/Ps (97%) agreed the course was relevant to their work, and 96% felt the training was useful. Qualitative themes related to working more effectively as a result of training included enhanced skills, increased resources, and building bridges between communities and researchers.
Discussion:
The CHW/P research best practices course was rated as useful and relevant by CHW/Ps, particularly for communicating about research with community members. This course can be a professional development resource for CHW/Ps and could serve as the foundation for a national standardized training on their role related to research best practices.
The objective of this qualitative assessment, utilising the constant comparative method, was to identify satisfiers and dissatisfiers that influence paediatric cardiac ICU nurse retention and recognise areas for improvement. Interviews for this study were performed in a single, large academic children’s hospital from March of 2020 through July of 2020. Each bedside paediatric cardiac ICU nurse underwent a single semi-structured interview. Among 12 interviews, four satisfiers were identified: paediatric cardiac ICU patient population, paediatric cardiac ICU care team, personal accomplishment, and respect. Four dissatisfiers were identified: moral distress, fear, poor team dynamics, and disrespect. Through this process of inquiry, grounded theory was developed regarding strategies to improve paediatric cardiac ICU nurse retention. Tactics outlined here should be used to support retention in the unique environment of the paediatric cardiac ICU.
Long-term sequelae of severe acute respiratory coronavirus-2 (SARS-CoV-2) infection may include increased incidence of diabetes. Here we describe the temporal relationship between new type 2 diabetes and SARS-CoV-2 infection in a nationwide database. We found that while the proportion of newly diagnosed type 2 diabetes increased during the acute period of SARS-CoV-2 infection, the mean proportion of new diabetes cases in the 6 months post-infection was about 83% lower than the 6 months preinfection. These results underscore the need for further investigation to understand the timing of new diabetes after COVID-19, etiology, screening, and treatment strategies.
There is some evidence that rats benefit from social housing and from some forms of environmental enrichment, such as platforms and shelters. It is less clear whether they benefit from more spacious cages. There is a lack of information about the relative benefits of social contact, enrichment and increased space, because existing studies tend to concentrate on only one of these variables at a time. The current experiment used economic demand procedures as a method to compare, on a single scale, qualitatively different environments with a standard home cage. The data indicate that rats show a high demand for social contact, and a low demand for a larger cage or one containing pillars or novel objects. This finding suggests that social housing of laboratory rats should be strongly advocated.
Stereotypic behaviours (SBs) are linked with behavioural inflexibility and resemble symptoms of autism, suggesting that stereotypic animals could have autistic-like social impairments. SBs are also common in caged mice. We therefore hypothesised relationships between stereotypic and social behaviours, predicting that highly stereotypic mice would give/receive more agonism and be less effective in social learning tasks. Experiment One used C57BL/6 and DBA/2 mice in non-enriched or enriched housing (15 cages each); Experiment Two, more cages (six non-enriched, 44 enriched) plus a third strain (BALB/c). Across both experiments, enrichment reduced SB and agonism (aggression, plus ‘displacements’ where one mouse supplants another at a resource). These effects appeared related: housing effects on agonism became negligible when SB was statistically controlled for, and, at least in enriched cages, SB covaried with receiving aggression. In Experiment Three, 20 DBAs varying in SB from Experiment Two acted as demonstrators in a ‘social transmission of food preferences’ task. They were fed a novel flavour (shatavari powder), then each mingled with a familiar but flavour-naïve C57 observer. Observers were subsequently offered two novel flavours: shatavari or marjoram. Those spontaneously choosing more shatavari (n = 10) tended to have had less stereotypic demonstrators than the other ten observer mice. Overall, highly stereotypic mice thus received more agonism — an effect with obvious welfare implications that can be reduced with enrichment — and seemed potentially less effective at inducing flavour preferences in conspecifics. Such effects are consistent with social impairment, suggesting that reducing SB may perhaps enhance interactions between conspecifics.
Candida auris is an emerging fungal pathogen causing outbreaks in healthcare facilities. Five distinctive genomic clades exhibit clade-unique characteristics, highlighting the importance of real-time genomic surveillance and incorporating genotypic information to inform infection prevention practices and treatment algorithms.
Methods:
Both active and passive surveillance were used to screen hospitalized patients. C. auris polymerase chain reaction (PCR) assay on inguinal-axillary swabs was performed on high-risk patients upon admission. All clinical yeast isolates were identified to the species level. C. auris isolates were characterized by both phenotypic antifungal susceptibility tests and whole-genome sequencing.
Results:
From late 2019 to early 2022, we identified 45 patients with C. auris. Most had a tracheostomy or were from a facility with a known outbreak. Moreover, 7 patients (15%) were only identified through passive surveillance. Also, 8 (18%) of the patients had a history of severe COVID-19. The overall mortality was 18%. Invasive C. auris infections were identified in 13 patients (29%), 9 (69%) of whom had bloodstream infections. Patients with invasive infection were more likely to have a central line. All C. auris isolates were resistant to fluconazole but susceptible to echinocandins. Genomic analysis showed that 1 dominant clade-III lineage is circulating in Los Angeles, with very limited intrahost and interhost genetic diversity.
Conclusions:
We have demonstrated that a robust C. auris surveillance program can be established using both active and passive surveillance, with multidisciplinary efforts involving the microbiology laboratory and the hospital epidemiology team. In Los Angeles County, C. auris strains are highly related and echinocandins should be used for empiric therapy.
The relation between Britten’s sexuality and his music has been an abiding fascination for biographers and music scholars in recent decades. The fact that homosexuality was illegal in the UK until 1967, and that he and his long-term partner, Peter Pears, therefore had to live a homosexual life as an ‘open secret’ for most of their lives, often lends this critical emphasis a kind of heroic poignancy. This chapter contrasts Britten and Pears’s upper-middle-class experience of forbidden sexuality with that of the overwhelming majority of twentieth-century British men and women, to paint a more rounded picture of the politics of the closet. It shows how early twenty-first-century ideas about sexual ‘identity’ obscure the differences between class experience, and distort our understanding of the issue.
MUSIC HISTORY SINCE 1789 is a series of footnotes to Beethoven, and in some respects this book simply adds to their number. The chapters that follow offer a new theory of music historiography, one that builds on antagonistic interpretations of Beethoven, and then instantiate this critically and analytically grounded historical theory in a sequence of essays on Beethoven.
It is a truth universally acknowledged by concertgoers and listeners at home that Beethoven's music was a significant event in the history of human art, comparable to the work of Homer, Dante, or Shakespeare. It may surprise such people, whose views must be taken to be overwhelmingly the majority, democratic view on classical music, that many musicologists would consider their Ludwigolatry ‘problematic’, ‘Eurocentric’, ‘tediously canonical’, and ‘elitist’. As a member of the band of elite consumers of classical music, there is a considerable irony, as well as an abundant lack of humility, in the fact that so much as one musicologist could hold such jaundiced views of the general population, but this is the world we inhabit. The author of a recent study, Beethoven: The Relentless Revolutionary, who has (from one musicological perspective) the brazen gall to argue for a political as well as a musical revolutionary quality – i.e. an anti-elitist, progressive quality – to Beethoven's music writes apologetically, ‘as must surely be evident by now, I am not a musicologist’, and while ‘I hope this study will be of interest to music professionals, I have presented my perspective on Beethoven so as to be accessible to lay readers’ (Clubbe 2019, xviii). Such is the anxiety this discipline of musicology causes among the scholarly population.
I am utterly at ease with calling artists like Beethoven ‘geniuses’, and enjoying with the rest of classical-music-loving humanity the ‘transcendent’ experience that his and other composers’ music can bring. Such reprobate behaviour befits my station as a low-born scion of a family in which only three men (I am the third) who have lived since the premiere of the ‘Eroica’ Symphony were not coal or tin miners.
SHORTLY BEFORE THE RECAPITULATION in the first movement of Beethoven's Violin Sonata in A major, op. 47, the so-called ‘Kreutzer’ Sonata, the pianist plays a pp chord of G– (see Example 6.1).
This chord (bb. 324–5) barely merits a mention in two recent analyses of the movement, one that appears in a broader study of musical ‘becoming’ by Janet Schmalfeldt (Schmalfeldt 2011, chapter 4) and one by David Damschroder which is written in conscious dialogue with hers (Damschroder 2016, chapter 10). Both are worth examining in detail. Although she explains what it leads to, Schmalfeldt says nothing about the pp G– chord itself:
Beethoven … [gives] the violinist a sequential repetition of the pianist's cadenza, here prolonging the dominant of the subdominant (iv) – that is, the dominant of the very harmony with which the exposition eccentrically began. The violinist's sequence in turn motivates a full-fledged statement (at mm. 326–35) of the main theme's first phrase, but now in D minor; this is of course the ‘wrong’ key for a conventional recapitulation, but the right key, the subdominant, for a false recapitulation in this movement. A great advantage of this maneuver is that it lands the phrase on an F-major chord at m. 334 – one more opportunity to reinforce the role of F♮ as a pivotal tone in this movement. The semitone with which the false recapitulation began – A–B♭ – then serves (at mm. 336–40) as the impetus for the move toward the true home-key recapitulation; but note that the chord on F (at mm. 340–43) plays the penultimate role in this modulation (Schmalfeldt 2011, 103).
Schmalfeldt is so keen to describe the gesture which establishes a false recapitulation, and its conversion to a true recapitulation, that she fails to mention the G– chord which is strangely interposed between the dominant she highlights and the tonic that it indicates. Her point is well made that D– is the ‘right key … for a false recapitulation in this movement’, because the exposition's P theme starts on that chord, which (as she has already noted earlier in her analysis) is prepared at length in the preceding slow introduction.