Performance anxiety in actors: symptoms, explanations and an Indian approach to treatment

There are numerous examples of renowned performers across the arts (actors and musicians) and in sports, which become news items in the media due to their performance anxiety (also called stage fright in English, or Lampenfieber in German). Given the number of celebrity actors suffering from stage fright, the number of those actors who do not make the news headlines in relation to their stage fright but nevertheless suffer from it must be even higher. In t his essay we provide an up to date account of the symptoms of stage fright, possible explanations for it and a range of known approaches to treatment. This is followed by an original approach to treating stage fright, based on Indian performance techniques, using details of a study undertaken in 2005.This multi-author journal article provides an in-depth analysis into the nature and treatment available for performance anxiety. The article offers examples of numerous artists and singers, including Sir Laurence Olivier, who had experienced stage fright for the duration of his performances of the title role in Ibsen’s The Master Builder (1965). The article run a clear analysis of the symptoms of stage fright and explain the nature of this psychophysical anxiety using clinical evidences and therapeutic methods. The key focus of the article is to compare and contrast two therapeutic methods for deducing stage anxiety: NLP, a well-established method, and SIT, which is an emerging method developed by Sreenath Nair using South Indian Bodily traditions. The article is based on a project carried out by Emerita Elizabeth Valentine and Daniel Meyer-Dinkgräfe in 2005, funded by the British Academy and the University of Wales Aberystwyth. The project compared two distinct methods of reducing stage fright in stage actors (Valentine et.al. 2006), one of them based on Indian approaches (South Indian Techniques, SIT) and the other Neuro Linguistic Programming (NLP). The SIT approach makes use of a range of psychophysical approaches deriving from the martial and performance traditions of Kerala. The study concludes that although many of the results were not statistically significant, ten of the eleven main effects were in the predicted direction, i.e. a greater effect for SIT than NLP. This multi-author journal article provides an in-depth analysis into the nature and treatment available for performance anxiety. The article offers examples of numerous artists and singers, including Sir Laurence Olivier, who had experienced stage fright for the duration of his performances of the title role in Ibsen’s The Master Builder (1965). The article run a clear analysis of the symptoms of stage fright and explain the nature of this psychophysical anxiety using clinical evidences and therapeutic methods. The key focus of the article is to compare and contrast two therapeutic methods for deducing stage anxiety: NLP, a well-established method, and SIT, which is an emerging method developed by Sreenath Nair using South Indian Bodily traditions. The article is based on a project carried out by Emerita Elizabeth Valentine and Daniel Meyer-Dinkgräfe in 2005, funded by the British Academy and the University of Wales Aberystwyth. The project compared two distinct methods of reducing stage fright in stage actors (Valentine et.al. 2006), one of them based on Indian approaches (South Indian Techniques, SIT) and the other Neuro Linguistic Programming (NLP). The SIT approach makes use of a range of psychophysical approaches deriving from the martial and performance traditions of Kerala. The study concludes that although many of the results were not statistically significant, ten of the eleven main effects were in the predicted direction, i.e. a greater effect for SIT than NLP. The study is a practice-based research demonstrating a highly relevant contribution to a therapeutic practice reducing stage fright. The research combines science and humanities indicating direct and wider impact

Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis

Importance: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. Objective: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. Design, Setting, and Participants: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. Interventions: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. Results: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). Conclusions and Relevance: Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. Trial Registration: isrctn.com Identifier: ISRCTN57819173

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially