An Alien Foundation : The Eclectism of Antonin Dvorak\u27s American Period

In 1891 Bohemian composer Antonin Dvorak (1841-1904) was offered a position as the Director of the American Conservatory in New York City by Jeanette Thurber (1850-1946) due to his reputation as a nationalistic composer. Thurber was intending to create a national music for America and hired Dvorak to not only promote the American Conservatory, but help her achieve her goal of an American style. By early 1892 an agreement was reached between the two parties, and Dvorak assumed his role as Director of the Conservatory in October of 1892, a tenure which lasted until May 1895. This three year period, identified as Dvorak\u27s American period, has ignited debate over his identification of source materials for composers to utilize as a possible source of influences to create an American nationalistic style of compositions. Based on Dvorak\u27s public writings during this periods, one might conclude that Negro Spirituals and music of Native Americans should form the basis of an American nationalistic style, but practice Dvorak\u27s compositions suggests a different direction entirely. Indeed previous scholars who have examined Dvorak\u27s American works have reached no consensus regarding the extent of influence that Negro Spirituals and Native American music in these works. In this paper I will suggest an alternative to the influence of the Negro Spiritual and Native American music on the creation of Dvorak\u27s American period, and assert that it was, in fact, the influence of the Indianist and Progressive Movements that helped shape the music to invoke Americaness. I will support my hypothesis through a comparison of indigenous idioms, an examination of contract issues between Thurber and Dvorak, and contradictions between letters written by the composer to family and friends and the newspaper editorials attributed to Dvorak

Reply to the letter to the editor 'Small repeated boluses are unreliable to provide rapid analgesia with intravenous morphine titration and mislead conversion ratio to oral morphine' by Mercadante S.

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Designing, implementing, and evaluating a staff development project to improve student performance using a whole language cooperative learning approach.

This dissertation describes the design, implementation and assessment of a staff development project to develop a cooperative whole language approach. The foundation for this staff development project for elementary school was the recognition that language development is crucial to a child\u27s ability to succeed in the school environment. The educational objectives of this project were to motivate and encourage students of low income, African American families to write imaginatively and productively, and to teach writing to those same students to help them develop their own stylistic competence. These objectives necessitated the organization of three components. First, a staff development program focused on a whole language approach so teachers could share cooperative learning strategies for improving selected aspects of writing instruction. Second, a language experience approach in which the language, experience, and feelings of minority students could be used to advance motivation, accuracy, and pride. Third, the creation of a positive school climate to help students overcome difficulties in communicating in standard English by developing a school way of communicating without forcing the student to conclude that the way the family converses at home is wrong. Cooperative learning staff development sessions, predicated on a whole language approach, combined five underlying principles: (a) Distributed Leadership; (b) Heterogeneous Grouping; (c) Positive Interdependence; (d) Social Skills Acquisition; and (e) Group Autonomy. These prompted the preparation of writing activities for the African American students in all aspects of the curriculum. Ongoing monitoring of students\u27 progress and completed tasks were compiled in both a group and individual portfolios. Basic to the success of this project was overcoming six beliefs: (a) a single set of subcultural customs shape the behavior of African American members of our society; (b) language programs should involve only instruction in using standard English; (c) all African American children are apathetic and their classes are seldom exciting; (d) discipline is a unique problem in the African American classroom; (e) African American learners cannot become involved in inductive, inquiry centered learning; and, (f) staff development sessions are not required for teaching English to the African American child. The proposed goal of this effective staff development project was not to change, but, to add a new dialect to an existing one by using a child centered, whole language, cooperative learning approach. By mixing the students\u27 own experiences and the presentation of new experiences, a new dimension was introduced. The students were meeting established norms of success and were eager to accept additional challenges. Class improvement was clearly visible in a low income, urban elementary school

Opioids: Psychological dependence, physical dependence and tolerance in cancer patients

Abstract Not Provided

Pain Management in Cancer Center Inpatients:A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach—The Edinburgh Pain Assessment and Management Tool

Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects

Pain in malignant pleural mesothelioma: a prospective characterisation study.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is associated with severe pain. The underlying neurobiology of this is complex. The primary aim of this study was to characterize pain in MPM. METHODS: This study was undertaken as part of a trial examining radiotherapy for the treatment of pain in MPM (ISRCTN 10644347). Patients had MPM with associated pain for which radiotherapy was planned and a worst pain score ≥ 4/10. The following assessments were undertaken: clinical neuropathic pain assessment, Brief Pain Inventory (BPI), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Short form of the McGill Pain Questionnaire (SF-MPQ), and Quantitative Sensory Testing (QST). The relationship of these characteristics and response to radiotherapy was assessed. Unless stated, medians and interquartile range (IQR) are used. RESULTS: Thirty-seven patients were recruited. Average pain and worst pain was 4 (4-6) and 8 (6-8), respectively. Higher average pain and higher worst pain scores were associated with higher interference scores on the BPI, P < 0.001 and P < 0.0005. Twenty patients (54%) had a clinical diagnosis of neuropathic pain, and of these, only six patients (40%) screened positively for neuropathic pain using the LANSS. Patients with a high LANSS also had higher BPI and SF-MPQs. The presence of neuropathic pain (clinically or by LANSS) did not predict response to radiotherapy, P < 0.05. The SF-MPQ scores were higher in those with abnormal cool sensation on QST (P = 0.016). CONCLUSION: Pain in mesothelioma varies among patients and may have neuropathic components. An adequate pain assessment is necessary to guide the clinician in the appropriate choice of analgesics

Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines.

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