David Maslanka’s Liberation: A Conductor’s Analysis

Abstract For more than forty years, David Maslanka (1943–2017) was a prolific composer for every musical medium. With significant contributions to chamber music, solo literature, vocal settings, and symphony orchestras, his works for wind band have garnered the most success. In addition to composing eight symphonies for band between 1985 and 2017, Maslanka's other significant works for band include, A Child’s Garden of Dreams (1981), Concerto for Alto Saxophone and Wind Ensemble (1999), Give Us This Day (2006), and Liberation (2010). His distinctive musical voice emerges in each of these works as he explores a wide gamut of emotions. Within his works for band, performers and audiences experience a composer with full control of the wind band’s range of forces and palette of colors. Through some of the most technically challenging literature written for wind band, Maslanka creates incredibly powerful moments comprised of surprisingly simple gestures. This document is an examination of David Maslanka’s piece for symphonic wind ensemble and chorus, Liberation. Included within this paper are sections covering: biographical information of the composer; Maslanka’s compositional approach; and information about the origin, inspiration, and source material, addressing formal structure, and performance considerations; in addition to appendices of errata, recommended program notes, and communication with the Maslanka Foundation

Advance care planning documentation strategies; goals-of-care as an alternative to not-for-resuscitation in medical and oncology patients. A pre-post controlled study on quantifiable outcomes

Background: Health services in Tasmania, Victoria and now Western Australia are changing to goals-of-care (GOC) advance care planning (ACP) documentation strategies. Aim: To compare the clinical impact of two different health department-sanctioned ACP documentation strategies. Methods: A non-blinded, pre–post, controlled study over two corresponding 6-month periods in 2016 and 2017 comparing the current discretional not-for-resuscitation (NFR) with a new, inclusive GOC strategy in two medical/oncology wards at a large private hospital. Main outcomes were the uptake of ACP forms per hospitalisation and the timing between hospital admission, ACP form completion and in-patient death. Secondary outcomes included utilisation of the rapid response team (RRT), palliative and critical care services. Results: In total, 650 NFR and 653 GOC patients underwent 1885 admissions (mean Charlson Comorbidity Index = 3.7). GOC patients had a higher uptake of ACP documentation (346 vs 150 ACP forms per 1000 admissions, P \u3c 0.0001) and a higher proportion of ACP forms completed within the first 48 h of admission (58 vs 39%, P = 0.0002) but a higher incidence of altering the initial ACP level of care (P = 0.003). All other measures, including ACP documentation within 48 h of death (P = 0.50), activation of RRT (P = 0.73) and admission to critical (P = 0.62) or palliative (P = 0.81) care services, remained similar. GOC documentation was often incomplete, with most sub-sections left blank between 74 and 87% of occasions. Conclusion: Despite an increased uptake of the GOC form, overall use remained low, written completion was poor, and most quantitative outcomes remained statistically unchanged. Further research is required before a wider GOC implementation can be supported in Australia’s healthcare systems

A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls

<p>Abstract</p> <p>Background</p> <p>Guidelines recommend that older people should receive multi-factorial interventions following an injurious fall however there is limited evidence that this is routine practice. We aimed to improve the delivery of evidence based care to patients presenting to the Emergency Department (ED) following a fall.</p> <p>Methods</p> <p>A prospective before and after study was undertaken in the ED of a medium-sized hospital in Perth, Western Australia. Participants comprised 313 community-dwelling patients, aged 65 years and older, presenting to ED as a result of a fall. A multi-faceted strategy to change practice was implemented and included a referral pathway, audit and feedback and additional falls specialist staff. Key measures to show improvements comprised the proportion of patients reviewed by allied health, proportion of patients referred for guideline care, quality of care index, all determined by record extraction.</p> <p>Results</p> <p>Allied health staff increased the proportion of patients being reviewed from 62.7% in the before period to 89% after the intervention (P < 0.001). Before the intervention a referral for comprehensive guideline care occurred for only 6/177 (3.4%) of patients, afterwards for 28/136 (20.6%) (difference = 17.2%, 95% CI 11-23%). Average quality of care index (max score 100) increased from 18.6 (95% CI: 16.7-20.4) to 32.6 (28.6-36.6).</p> <p>Conclusions</p> <p>A multi-faceted change strategy was associated with an improvement in allied health in ED prioritizing the review of ED fallers as well as subsequent referral for comprehensive geriatric care. The processes of multi-disciplinary care also improved, indicating improved care received by the patient.</p

Biotic and abiotic factors interact to regulate Northern peatland carbon cycling

Understanding the spatio-temporal variability of controls on peatland carbon (C) cycling is essential to project the effects of future environmental change. While there is understanding of individual drivers of C cycling, the effect of multiple drivers, including interactions, remains poorly understood. Using a spatially and temporally explicit sampling framework, we examined the effects of biotic and abiotic controls on key indicators of peatland functioning: ecosystem respiration (R (eco)), photosynthesis (P (cal)), net ecosystem exchange (NEE), methane (CH4) fluxes, and pore water dissolved organic carbon concentration ([DOC]). Measurements were made over 12 months in a blanket peatland hosting a wind farm in Scotland, UK. Overall, we found that (i) season and plant functional type (PFT) explained most variation in R (eco) and P (cal), (ii) PFT and spatial location within the wind farm, which integrates several peat properties, were dominant predictors of CH4 fluxes, and (iii) season and location within the wind farm correlated with pore water [DOC]. Examination of predictors indicated that interactions, between and within biotic and abiotic factors, explained a significant amount of variation in greenhouse gas fluxes and [DOC]. These findings indicate that combinations of biotic and abiotic factors could mediate or exacerbate the effects of future environmental change on peatland C cycling. Given this, studies of C cycling need to capture the spatial and temporal variance of biotic and abiotic factors and their interactions to project the likely impacts of environmental change

Ground-level climate at a peatland wind farm in Scotland is affected by wind turbine operation

The global drive to produce low-carbon energy has resulted in an unprecedented deployment of onshore wind turbines, representing a significant land use change for wind energy generation with uncertain consequences for local climatic conditions and the regulation of ecosystem processes. Here, we present high-resolution data from a wind farm collected during operational and idle periods that shows the wind farm affected several measures of ground-level climate. Specifically, we discovered that operational wind turbines raised air temperature by 0.18 °C and absolute humidity (AH) by 0.03 g m−3 during the night, and increased the variability in air, surface and soil temperature throughout the diurnal cycle. Further, the microclimatic influence of turbines on air temperature and AH decreased logarithmically with distance from the nearest turbine. These effects on ground-level microclimate, including soil temperature, have uncertain implications for biogeochemical processes and ecosystem carbon cycling, including soil carbon stocks. Consequently, understanding needs to be improved to determine the overall carbon balance of wind energy

Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear

Objectives Otitis media with effusion (OME) is a common cause of hearing loss and possible developmental delay in children, and there are a range of ‘preference sensitive’ treatment options. We aimed to evaluate the attitudes and beliefs of parents of affected children to treatment options including watchful-waiting, hearing aids, grommets, and, oral steroids with the intention of developing our understanding of decision-making and the factors influencing it, sources of parental information, and satisfaction with information provision. Design We recruited a convenience sample of twelve parents of eleven children with OME at a single ENT department of a teaching hospital into a qualitative research study. The children of the parents interviewed had already been recruited into the Oral Steroids for the Resolution of Otitis Media with effusion In Children (OSTRICH) study. Semi structured interviews were audio recorded, transcribed and then coded using an inductive, thematic approach. Results Parents were satisfied with the verbal provision of information during the treatment consultation, although many were keen to receive supplementary printed information. Discussion with family and friends helped the decision-making process, whereas insufficient information and a paternalistic approach were viewed as obstacles. Parents were particularly influenced by the following: the immediacy of the treatment option effect, perceived efficacy, perceived risks and adverse effects, social implications (especially with hearing aids) and past personal and informant experience. Conclusions Parents appreciate clinicians tailoring information provision to parents' information needs and preferred format. Clinicians should also elicit parental attitudes towards the different management options for OME and the factors influencing their decisions, in order to optimise shared-decision making and ultimately provide a better standard of clinical care

Composition of the Adult Digestive Tract Bacterial Microbiome Based on Seven Mouth Surfaces, Tonsils, Throat and Stool Samples

Background: To understand the relationship between our bacterial microbiome and health, it is essential to define the microbiome in the absence of disease. The digestive tract includes diverse habitats and hosts the human body's greatest bacterial density. We describe the bacterial community composition of ten digestive tract sites from more than 200 normal adults enrolled in the Human Microbiome Project, and metagenomically determined metabolic potentials of four representative sites. Results: The microbiota of these diverse habitats formed four groups based on similar community compositions: buccal mucosa, keratinized gingiva, hard palate; saliva, tongue, tonsils, throat; sub- and supra-gingival plaques; and stool. Phyla initially identified from environmental samples were detected throughout this population, primarily TM7, SR1, and Synergistetes. Genera with pathogenic members were well-represented among this disease-free cohort. Tooth-associated communities were distinct, but not entirely dissimilar, from other oral surfaces. The Porphyromonadaceae, Veillonellaceae and Lachnospiraceae families were common to all sites, but the distributions of their genera varied significantly. Most metabolic processes were distributed widely throughout the digestive tract microbiota, with variations in metagenomic abundance between body habitats. These included shifts in sugar transporter types between the supragingival plaque, other oral surfaces, and stool; hydrogen and hydrogen sulfide production were also differentially distributed. Conclusions: The microbiomes of ten digestive tract sites separated into four types based on composition. A core set of metabolic pathways was present across these diverse digestive tract habitats. These data provide a critical baseline for future studies investigating local and systemic diseases affecting human health