Improving the lens design and performance of a contemporary electromagnetic shock wave lithotripter.

The efficiency of shock wave lithotripsy (SWL), a noninvasive first-line therapy for millions of nephrolithiasis patients, has not improved substantially in the past two decades, especially in regard to stone clearance. Here, we report a new acoustic lens design for a contemporary electromagnetic (EM) shock wave lithotripter, based on recently acquired knowledge of the key lithotripter field characteristics that correlate with efficient and safe SWL. The new lens design addresses concomitantly three fundamental drawbacks in EM lithotripters, namely, narrow focal width, nonidealized pulse profile, and significant misalignment in acoustic focus and cavitation activities with the target stone at high output settings. Key design features and performance of the new lens were evaluated using model calculations and experimental measurements against the original lens under comparable acoustic pulse energy (E+) of 40 mJ. The -6-dB focal width of the new lens was enhanced from 7.4 to 11 mm at this energy level, and peak pressure (41 MPa) and maximum cavitation activity were both realigned to be within 5 mm of the lithotripter focus. Stone comminution produced by the new lens was either statistically improved or similar to that of the original lens under various in vitro test conditions and was significantly improved in vivo in a swine model (89% vs. 54%, P = 0.01), and tissue injury was minimal using a clinical treatment protocol. The general principle and associated techniques described in this work can be applied to design improvement of all EM lithotripters.

The `Ulama' and the State: Negotiating Tradition, Authority and Sovereignty in Contemporary Pakistan

This dissertation is an account of how contemporary Pakistani ulama grapple with their political realities and the Islamic state of Pakistan. The central conceptual question that scaffolds my dissertation is: How do Pakistani ulama negotiate tradition, authority and sovereignty with the Islamic Republic of Pakistan? In engaging with this issue, this dissertation employs a methodology that weds ethnography with rigorous textual analysis. The ulama that feature in this study belong to a variety of sectarian persuasions. The Sunni ulama are Deobandi and Barelvi; the Shia ulama in this study are Ithna Ashari.

In assessing the relationship between Pakistani ulama and their nation-state, I assert that the ulama's dialectical engagements with the state are best understood as a dexterous navigation between affirmation, critique, contestation and cultivation. In proposing this manner of thinking about Pakistani ulama's engagements with their state, I provide a more detailed and nuanced view of the ulama-state relationship compared to earlier works. While emphasizing Pakistani ulama's vitality and their impact on their state, this dissertation also draws attention to the manners in which the state impacts the ulama. It theorizes the subject formation of the ulama and asserts the importance of understanding the ulama as formed not just by the ethico-legal tradition in which they are trained but also by the state apparatus.

The Performance Practice of Buddhist Baiqi in Contemporary Taiwan

The baiqi (Buddhist percussive instruments), also known as faqi (dharma instruments), are mentioned in the Chinese Buddhist scriptures under many different terms: jianzhi, jiandi, jianzhui, or jianchi. The original function of baiqi in earlier monastic life was to gather people or to call an assembly. With the completion of monasticism and monastic institutions, baiqi have become multifunctional in monasteries, and many baiqi instruments have been developed for different monastic applications. In contemporary Buddhist monasteries in Taiwan, baiqi are used, on the one hand, to mark the time throughout the day, signal the beginning and end of monastic daily activities, and regulate the monastic order; and on the other hand, baiqi are indispensable to the musical practices of all Buddhist rituals, where they are used to accompany fanbai (Buddhist liturgical chants) and to articulate the whole ritual process. This study investigates multiple facets of Buddhist baiqi in their performance practice, function, application, notation, and transmission, exploring the interaction between baiqi and fanbai, baiqi and the practitioner, baiqi and the monastic space, and baiqi and various Buddhist contexts. I draw upon ideas from performance theory as it concerns different disciplines, but I maintain a sharper focus on the musicological dimension of performance practice when analyzing, interpreting, and explaining the performance and music of baiqi in terms of the monastic lifestyle and its rituals. The study not only uncovers the musical system of baiqi, but also encapsulates various issues of performed identity, social interaction, performer/audience, associated behaviors, the musical construction of space, and transmission.

Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

Witnessing Crisis in Contemporary and Golden Age Spain

In this volume, experts on the Spanish Golden Age from the United Kingdom, Ireland, and the United States offer analyses of contemporary works that have been influenced by the classics from the sixteenth and seventeenth centuries.

Tracing Neoclassical Influences in selected solo and chamber music for the clarinet

The musical period of Neoclassicism began in the 1920's, between the first and second world wars. It was initiated by French composers and eventually spread to other countries. One of the most important themes to emerge from the movement was to escape from the formless, rather emotional music of the Romantic era and instead, emphasize balance, order, objectivity and clarity in musical form. Many popular clarinet repertoires are enjoyed by performers and listeners because the music is enjoyable to play and easy to listen to. In particular, classically influenced clarinet music is quite interesting because it features musical elements from both the past and contemporary musical styles. For instance, some composers have integrated preexisting, more traditional styles of composition with lighter styles of modern culture such as popular music and Jazz. It is difficult to discover purely neoclassical clarinet repertoires even though many composers created their pieces during the neoclassical era. What we most commonly find are both neoclassical and non-neoclassical influences in compositions from that time period. Thus, I aim to trace the influence of neoclassicism in selected clarinet repertoires that exist today. It is my hope that increased awareness and knowledge about accessible clarinet music may encourage the general public to develop a deeper interest in a wider sphere of clarinet music, beyond what is considered popular today. The works performed and discussed in this dissertation are the following: (Recital I) Duo Concertante by Darius Milhaud; Sonata by Leonard Bernstein; Sonata for Two Clarinets by Francis Poulenc; Duos for Flute and Clarinet, Op. 34 by Robert Muczynski; Dance Preludes by Witold Lutoslawski, (Recital II) Sonatine by Arthur Honegger; Time pieces by Robert Muczynski; Suite for Clarinet, Violin and Piano by Darius Milhaud; Sonate for Clarinet, Flute and Piano by Maurice Emmanuel; Tarantelle for Flute, Clarinet and Piano, Op. 6 by Camille Saint-Saëns, (Recital III) Sonatina by Joseph Horovitz; Suite from L'histoire du Soldat for Clarinet, Violin and Piano by Igor Stravinsky; Contrasts for Clarinet, Violin and Piano by Béla Bartók The recitals that took place on December 1, 2012 and on April 25, 2013 were performed in the Ulrich Recital Hall of the Clarice Performing Arts Center in College Park, Maryland. The recital that took place on November 2, 2013 was performed at the Gildenhorn Recital Hall of the same performing arts center.

Polish Violin Music in the 20th and 21st Century

The purpose of this dissertation is to promote Polish violin music written in the 20th and 21st Century. My recitals included many lesser-known compositions and composers which I strongly believe deserve to be better known and more often performed. The search and preparation of those pieces, for which recordings and music scores are not easily found, was a very exciting and stimulating process. Much Polish music written in the 20th and 21st Century is interesting, expressive, beautiful, and deserves to be more often performed. Performing 20th and 21st Century music opens new perspectives in two directions: musically and technically. Performer and listener are, in many cases, unbound from tonality. Composers are looking for new sonorities and exploring such performing techniques as varieties of harmonics, quarter tones, extreme dynamics, complex rhythms, and usage of a wide range of registers. An important part of Polish music is Polish folklore. The little town of Zakopane is known for Polish traditional clothing, food, architecture, dance and music. Also, most prominent Polish luthiers including Wojciech Topa, whose instrument I am playing, have been making their instruments in Zakopane. This little town in the Tatras Mountain has been an inspiration for many Polish artists including Iwaszkiewicz, Witkacy, Karłowicz, and Szymanowski. Those composers used such folklore elements as folk scales, popular tunes, and imitations of the sound of the folk band with characteristic folk dance rhythms. Other musical genres where folk elements are strongly present are the compositions dedicated to young musicians, with a specifically educational purpose. Among composers who wrote educational music were Grażyna Bacewicz, Witold Lutosławski, and Henryk Mikołaj Górecki. This approach makes the works more easily understood by young performers and, at the same time, broadens their understanding of Polish culture and prepares them for the challenges of contemporary music. This has been an exciting project for me because, on the one hand, it allowed me the challenge of performing compositions that are lesser-known and often consist of musical language new to me while, on the other, it brought me back to my roots and the country of my mother tongue.

Dance Based Music on Piano

According to the Merriam-Webster dictionary, the definition of dance is “to move your body in a way that goes with the rhythm and style of music that is being played.” As you can see in that definition, these two important ways of expressing human feelings, music and dance, are very closely related. Countless pieces of music have been composed for dance, and are still being composed. It is impossible and useless to count how many kinds of dances exist in the world. Different kinds of dances have been developed according to their purposes, cultures, rhythm and tempo. For this reason, the field of dance-related music necessarily expanded significantly. A great deal of dance music has been written for orchestras, small ensembles, or vocals. Along with them, keyboard music also has a huge repertoire of dance pieces. For example, one of the most famous form in Baroque period was suites. Suites usually include 5 or more dance movements in the same key, such as Minuet, Allemende, Courant, Sarabande, Gigue, Bourree, Gavotte, Passepied, and so on. Nationalistic dances like waltz, polonaise, mazurka, and tarantella, were wonderful sources for composers like Chopin, Brahms, and Tchaikovsky. Dance-based movements were used for Mozart and Beethoven’s piano sonatas, chamber works and concertos. Composers have routinely traveled around the world to collect folk and dance tunes from places they visit. For example, Bartok and Balakirev's pieces that are based on folk dances from where they had traveled became famous and are still thought to be valuable for studying and performing today. For these reasons, it is clear that dance-related music is a very important part of keyboard music. In three dissertation recitals, to expand my performing repertoire and to understand dance-related music deeper, I tried to explore many different styles of dances, and compare interpretations between composers. This program note contains information about each pieces’ composers, related dances, and backgrounds. I hope this will be helpful for a future performer who’s seeking an effective dance based keyboard piece.

The Great War on the small screen: Representing the First World War in contemporary Britain

In Britain since the 1960s television has been the most influential medium of popular culture. Television is also the site where the Western Front of popular culture clashes with the Western Front of history. This book examines the ways in which those involved in the production of historical documentaries for this most influential media have struggled to communicate the stories of the First World War to British audiences. Documents in the BBC Written Archives Centre at Caversham, Berkshire, the Imperial War Museum, and the Liddell Hart Centre for Military Archives all inform the analysis. Interviews and correspondence with television producers, scriptwriters and production crew, as well as two First World War veterans who appeared in several recent documentaries provide new insights for the reader. Emma Hanna takes the reader behind the scenes of the making of the most influential documentaries from the landmark epic series The Great War (BBC, 1964) up to more recent controversial productions such as The Trench (BBC, 2002) and Not Forgotten: The Men Who Wouldn't Fight (BBC, 2008). By examining the production, broadcast and reception of a number of British television documentaries this book examines the difficult relationship between the war's history and its popular memory.

Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

Hide and seek with rebels: tracing contemporary queer art in cracks and rips

This Article does not have an abstract.

Typical reggaeton in Morocco: forms of female political affirmation throught dance

Through an ethnographic account, this text analyses how social dance may become a discourse involving the cultural affirmation of a subordinate group. It describes how a group of girls faced with a complex of outlooks that construed them as Moroccan, Muslim or unattractive —or as objects of education and intervention— responded by affirming their own culture with an unanticipated corporal discourse. The way in which looking construes bodies is explored through metaphors: a hand that touches, a chisel that sculpts, a whip that lashes and a cobweb that controls and traps bodies. Owing to this political dimension of dance, workshops can also be an oppressive and silencing tool; to prevent this, the article concludes with a series of recommendations to implement dance in social intervention processes.