A Study of Ralph Vaughan Williams\u27s An Oxford Elegy and Epithalamion .

Choral music occupies a central place in the compositional output of Ralph Vaughan Williams. Some pieces, such as the Sea Symphony (1909), Five Mystical Songs (1911), Mass in G minor (1922), and Serenade to Music (1938), have become standards in the choral repertoire. Others, such as Sancta Civitas (1925), Dona Nobis Pacem (1936) and Hodie (1954), may be less familiar, but have still received considerable critical acclaim. A few pieces remain relatively unknown even to choral conductors. Two choral works, Epithalamion (1957) and An Oxford Elegy (1949), fall into this latter category. This monograph is the first detailed study of these compositions. An Oxford Elegy and Epithalamion are unique among Vaughan Williams\u27s compositions: An Oxford Elegy is the only work to combine speaker with textless choral singing and orchestra; Epithalamion is the only choral piece adapted from a masque (The Bridal Day, 1938). Both are settings of texts by important British poets: An Oxford Elegy combines lines from Matthew Arnold\u27s The Scholar Gipsy and Thyrsis; while Epithalamion features selected stanzas from Edmund Spenser\u27s famous poem by that name. The monograph is divided into two chapters, the first being an examination of An Oxford Elegy; the second a study of Epithalamion. Each chapter provides background information on the works, discussion of the original poems upon which the works are based, the identification and discussion of the most prominent stylistic elements in the scores, and consideration of how these works compare with other choral compositions by Vaughan Williams. The study is done in conjunction with the release of a commercial recording of these works (Centaur CRC 2299), conducted by the author

Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine

Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg)

Gabapentinoid use disorder. Update for clinicians

Gabapentinoids (gabapentin and pregabalin) are versatile drugs, indicated mainly for epilepsy and neuropathic pain, and have long been viewed as agents with little potential for abuse. Burgeoning prescribing patterns and studies indicate that these drugs are increasingly being abused, particularly by polydrug abusers who also abuse opioids. Gabapentinoid abuse is found in less 2% of the general population but may be as high as 15% to 22% among opioid abusers. Other risk factors for gabapentinoid abuse are less clear-cut but include mental health disorders. Gabapentinoids are relatively easy for drug abusers to obtain and many clinicians are not fully aware of their abuse potential. It is thought that gabapentinoids may offer psychoactive effects or enhance the effects of other drugs of abuse. Those who discontinue gabapentinoids abruptly may suffer withdrawal symptoms, but gabapentinoid overdose fatality is rare. Since gabapentinoids are often prescribed off-label to treat psychiatric disorders, these drugs may be dispensed to a particularly vulnerable population. Clinicians must be aware of the potential for Gabapentinoid Use Disorder: Update for Clinicians

The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment

This paper explores the relationship between religion and obsessive–compulsive dis- order (OCD), with particular interest in religion’s possible influence in the development of OCD and its impact on treatment outcome. The paper begins with a review of theoretical and research literatures concerning religious involvement, research evidence linking religious involvement and physical and mental health, and theoretical linkages supporting both positive and negative religious effects on health. Following this, we provide a general overview and description of OCD and information concerning the prevalence and incidence of religiously based OCD. Next, extant research linking religion and OCD is presented. Information relevant to the clinical treatment of OCD with religious content is discussed. Finally, practice implications for clinicians and clergy are provided.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107413/1/2011-11166-001.pdfDescription of 2011-11166-001.pdf : Main articl

Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences.

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men

America is not losing its religion – population trends mean thatit is simply becoming more religiously diverse.

A recent Pew study found that there has been an increase in the number of Americans who claim to have ‘no-religion’. Does this mean that religion in the U.S. is on the way out? In new research which examines data from three national surveys, R. Khari Brown, Robert Joseph Taylor, and Linda M. Chatters find that African Americans and African Caribbean Americans are less likely than Non-Hispanic Whites, Hispanic Americans, and Asian Americans to identify as non-religious, with the latter group the most likely to identify as non-religious. They write that the recent shifts in religious affiliation may have less to do with Americans abandoning religion to America shifting towards increasing religious diversity

The Use of a Learning Community and Online Evaluation of Utilization for SPECT Myocardial Perfusion Imaging

Resource-sensitive and quality-centered imaging begins with the selection of the appropriate patient and test. Appropriate use criteria have been developed to aid clinicians but are often not available in an easily accessible format. FOCUS (Formation of Optimal Cardiovascular Utilization Strategies), a Web-based community and quality improvement instrument, was developed to increase the feasibility of measuring and improving practice patterns based on the appropriate use criteria. The FOCUS instrument proposed to reduce inappropriate imaging by 15% in 1 year and by 50% within 3 years. Between April 2010 and December 2011, data were voluntarily collected through the FOCUS radionuclide imaging performance improvement module (PIM). Appropriateness rates were compared between phases of the PIM. For the 55 participating sites that had completed the PIM by December 2011, the proportion of inappropriate cases decreased from 10% to 5% (p < 0.0001). These preliminary data from initial participating sites suggest that through the use of a self-directed, quality improvement software and an interactive community, physicians may be able to significantly decrease the proportion of tests not meeting appropriate use criteria

Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel's View on Preventable Harm Associated with NSAID Therapy

Optimization of current pain management strategies is necessary in order to reduce medication risks. Promoting patient and healthcare provider education on pain and pain medications is an essential step in reducing inadequate prescribing behaviors and adverse events. In an effort to raise awareness on medication safety, the FDA has launched the Safe Use Initiative program. The program seeks to identify areas with the greatest amount of preventable harm and help promote new methods and practices to reduce medication risks. Since the establishment of the program, FDA's Safe Use initiative staff convened a panel of key opinion leaders throughout the medical community to address pain management in older adults (≥65 years of age). The aim of the expert panel was to focus on areas where significant risk occurs and where potential interventions will be feasible, implementable, and lead to substantial impact. The panel suggested one focus could be the use of NSAIDs for pain management in the elderly