viernes, 21 de enero de 2011

The Greatest




The Greatest

HERE goes. This article completes my two-week project to select the top 10 classical music composers in history, not including those still with us. The argument, laid out in a series of articles, online videos and blog posts, was enlivened by the more than 1,500 informed, challenging, passionate and inspiring comments from readers of The New York Times. As often as I could, I answered direct questions online and jumped into the discussion.
Thomas Fuchs
The Greatest

The Top 10 Composers

Anthony Tommasini explores the qualities that make a classical composer great, maybe even the best of all time.

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Left, 1. Johann Sebastian Bach (1685-1750). From top left, 2. Ludwig van Beethoven (1770-1827), 3. Wolfgang Amadeus Mozart (1756 — 91). 4. Franz Peter Schubert (1797-1828). From middle left, 5. Claude Achille Debussy (1862 — 1918), 6. Igor Stravinsky (1882 — 1971), 7. Johannes Brahms (1833 — 97). From bottom left, 8. Giuseppe Verdi (1813 — 1901), 9. Richard Wagner (1813 — 83), 10. Bela Bartok (1881 — 1945).

Readers' Comments

I am about to reveal my list, though as those who have been with me on this quest already know, I’ve dropped hints along the way. And the winner, the all-time great, is ... Bach!
To step back for a moment, I began this project with bravado, partly as an intellectual game but also as a real attempt to clarify — for myself, as much as for anyone else — what exactly about the master composers makes them so astonishing. However preposterous the exercise may seem, when I found myself debating whether to push Brahms or Haydn off the list to make a place for Bartok or Monteverdi, it made me think hard about their achievements and greatness.
Ah, greatness. Early on I received a friendly challenge from a reader (“Scott”) who questioned the whole notion of greatness in music. He cited the title essay in “Listen to This,” a collection of astute, lively writings by Alex Ross, the music critic for The New Yorker and my good friend, which was published last year (Farrar, Straus & Giroux). In this essay he argues that the very term “classical music” makes this vibrant art form seem dead. Indeed, as he writes, “greatness” and “seriousness” are not classical music’s defining characteristics; it can also “be stupid, vulgar and insane.”
All true. Yet what came through in the comments from readers and, I hope, my articles and videos is that for most of us these composers are not monumental idols but living, compelling presences. Just as we organize our lives by keeping those we love in a network of support, we do something similar with the composers we rely on.
I was moved by how many readers could not wait to share their lists of favorite composers, whom, naturally, they also considered the greats. Even many of those who dismissed the exercise jumped right in: “This is absurd, of course. But here’s my list. And don’t you dare leave out Mahler.” OrBerg. Or Ligeti. Or, from one Baroque music enthusiast, Albinoni!
As a longtime champion of contemporary music, I was gratified to receive so many objections to my decision to eliminate living composers from consideration. Still, for me there was no other way. We are too close to living composers to have perspective. Besides, assessing greatness is the last thing on your mind when you are listening to an involving, exciting or baffling new piece.
So humbled by the discerning music lovers who wrote in, I now offer my own list. And remember: my editors gave the go-ahead for this project on condition that I go all the way and rank my 10 in order.
My top spot goes to Bach, for his matchless combination of masterly musical engineering (as one reader put it) and profound expressivity. Since writing about Bach in the first article of this series I have been thinking more about the perception that he was considered old-fashioned in his day. Haydn was 18 when Bach died, in 1750, and Classicism was stirring. Bach was surely aware of the new trends. Yet he reacted by digging deeper into his way of doing things. In his austerely beautiful “Art of Fugue,” left incomplete at his death, Bach reduced complex counterpoint to its bare essentials, not even indicating the instrument (or instruments) for which these works were composed.
On his own terms he could be plenty modern. Though Bach never wrote an opera, he demonstrated visceral flair for drama in his sacred choral works, as in the crowd scenes in the Passions where people cry out with chilling vehemence for Jesus to be crucified. In keyboard works like the Chromatic Fantasy and Fugue, Bach anticipated the rhapsodic Romantic fervor of Liszt, even Rachmaninoff. And as I tried to show in the first video for this project, through his chorales alone Bach explored the far reaches of tonal harmony.
The obvious candidates for the second and third slots are Mozart and Beethoven. If you were to compare just Mozart’s orchestral and instrumental music to Beethoven’s, that would be a pretty even match. But Mozart had a whole second career as a path-breaking opera composer. Such incredible range should give him the edge.
Still, I’m going with Beethoven for the second slot. Beethoven’s technique was not as facile as Mozart’s. He struggled to compose, and you can sometimes hear that struggle in the music. But however hard wrought, Beethoven’s works are so audacious and indestructible that they survive even poor performances.
I had an epiphany about Beethoven during the early 1980s when I heard the composer Leon Kirchner conduct the Harvard Chamber Orchestra. He began with a Piston symphony, a fresh, inventive Neo-Classical piece from the 1950s. “La Mer” by Debussy came next, and Kirchner, who had studied with Schoenberg and had a Germanic orientation, brought weighty, Wagnerian intensity to this landmark score, completed in 1905. The Debussy came across as more modern than the Piston.
After intermission Peter Serkin joined Kirchner for a performance of Beethoven’s Fourth Piano Concerto that brought out the mysticism, poetic reverie and wildness of the music. The Beethoven sounded like the most radical work in the program by far: unfathomable and amazing. I’m giving Beethoven the second slot, and Mozart No. 3.
Four? Schubert. You have to love the guy, who died at 31, ill, impoverished and neglected except by a circle of friends who were in awe of his genius. For his hundreds of songs alone — including the haunting cycle “Winterreise,” which will never release its tenacious hold on singers and audiences — Schubert is central to our concert life. The baritone Sanford Sylvan once told me that hearing the superb pianist Stephen Drury give searching accounts of the three late Schubert sonatas on a single program was one of the most transcendent musical experiences of his life. Schubert’s first few symphonies may be works in progress. But the “Unfinished” and especially the Ninth Symphony are astonishing. The Ninth paves the way for Bruckner and prefigures Mahler.




Debussy, who after hundreds of years of pulsating Germanic music proved that there could be tension in timelessness, is my No. 5. With his pioneering harmonic language, the sensual beauty of his sound and his uncanny, Freudian instincts for tapping the unconscious, Debussy was the bridge over which music passed into the tumultuous 20th century.

Readers' Comments

One who later walked that bridge was Stravinsky, my No. 6. During the years when “The Firebird” and “The Rite of Spring” were shaking up Paris, Stravinsky was swapping ideas with his friend Debussy, who was 20 years older. Yet Stravinsky was still around in the 1960s, writing serial works that set the field of contemporary music abuzz. One morning in 1971 I arrived at the door of the music building at Yale, on which someone had posted an index card with this simple news: “Igor Stravinsky died today.” It felt as if the floor had dropped out from under the musical world I inhabited. Stravinsky had been like a Beethoven among us.
I’m running out of slots. In some ways, as I wrote to one reader, either a list of 5 or a list of 20 would have been much easier. By keeping it to 10, you are forced to look for reasons to push out, say, Handel or Shostakovich to make a place for someone else.
Some musicians I respect have no trouble finding shortcomings in Brahms. He did sometimes become entangled in an attempt to extend the Classical heritage while simultaneously taking progressive strides into new territory. But at his best (the symphonies, the piano concertos, the violin concerto, the chamber works with piano, the solo piano pieces, especially the late intermezzos and capriccios that point the way to Schoenberg) Brahms has the thrilling grandeur and strangeness of Beethoven. Brahms is my No. 7.
In an earlier installment of this series I tried to weasel out of picking Romantic composers other than Brahms by arguing that the era fostered originality and personal expression above all. To a genius like Chopin, having a distinctive voice and giving vent to his inspirations were more important than achieving some level of quantifiable greatness.
But the dynamic duo of 19th-century opera, Verdi and Wagner, aimed high. As I already let slip, they both make my list. That a new production of a Verdi opera, like Willy Decker’s spare, boldlyreimagined staging of “La Traviata” at the Metropolitan Opera, can provoke such heated passions among audiences is testimony to the enduring richness of Verdi’s works. A production of Wagner’s “Ring” cycle has become the entry card for any opera company that wants to be considered big time. The last 20 minutes of “Die Walküre” may be the most sadly beautiful music ever written.
But who ranks higher? They may be tied as composers but not as people. Though Verdi had an ornery side, he was a decent man, an Italian patriot and the founder of a retirement home for musicians still in operation in Milan. Wagner was an anti-Semitic, egomaniacal jerk who transcended himself in his art. So Verdi is No. 8 and Wagner No. 9.
One slot left. May Haydn forgive me, but one of the Vienna Four just had to go, and Haydn’s great legacy was carried out by his friend Mozart, his student Beethoven and the entire Classical movement. My apologies to Mahler devotees, so impressively committed to this visionary composer. Would that I could include my beloved Puccini.
I was heartened by the hundreds of readers who championed 20th-century composers like Ligeti, Messiaen, Shostakovich, Ives, Schoenberg, Prokofiev and Copland, all of whom are central to my musical life. Then there is Berg, who wrote arguably the two greatest operas of the 20th century. His Violin Concerto, as I explained in my first video, would make my list of top 10 pieces. I was disappointed that an insignificant number of readers made a case for Britten. I have some advocacy work to do.
I received the most forceful challenges from readers who thought that pre-Bach composers simply had to be included, especially Monteverdi. Though Monteverdi did not invent opera, he took one look at what was going in Florence around 1600 and figured out how this opera thing should really be done. In 1607 he wrote “Orfeo,” the first great opera. His books of madrigals brought the art of combining words and music to new heights. The Monteverdi contingent is probably right.
But forced to pick only one more composer, I’m going with Bartok. In an earlier piece I made my case for Bartok, as an ethnomusicologist whose work has empowered generations of subsequent composers to incorporate folk music and classical traditions from whatever culture into their works, and as a formidable modernist who in the face of Schoenberg’s breathtaking formulations showed another way, forging a language that was an amalgam of tonality, unorthodox scales and atonal wanderings.
So that’s my list.
And now, in an act of contrition, I am beginning a personal project to listen nonstop to recordings of Britten, Haydn, Chopin, Monteverdi, Ligeti and those composers whom I could not squeeze in but whose music carries me through my days.

Efectos circadianos sobre el bloqueo subaracnoideo con bupivacaína hiperbárica


Efectos circadianos sobre el bloqueo subaracnoideo con bupivacaína hiperbárica
Circadian Effects on Neural Blockade of Intrathecal Hyperbaric Bupivacaine
Cheol Lee, Deok Hwa Choi, and Soo Uk Chae.
Departments of Anesthesiology and Pain Medicine, Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea
Korean J Pain 2010; 23: 186-189. 
Background: Circadian variations in the absorption, distribution, protein binding, elimination and metabolism of drugs account for many of the administration-time-dependent differences in their pharmacokinetics. The aim of this study is to determine whether the time of intrathecal injection influences spinal anesthesia. Methods: Ninety patients scheduled for orthopedic surgery were randomly assigned to three groups. Each group received spinal anesthesia with 0.5% bupivacaine 10 mg at different times; group AM (8 am to 12:00), group Noon (12:00 to 4:00 pm) and group PM (4:00 pm to 8:00 pm). Sensory and motor blockade were assessed by pinprick and a four-point modified Bromage scale. Time to first postoperative analgesic requirement and side effects such as hypotension, bradycardia, nausea, and shivering were recorded. Results: No significant differences were found among the three groups in peak sensory blockade, duration of motor block to Bromage 1 or side effects, but time to first postoperative analgesic requirement (P = 0.008), and recovery time of S1 sensation to pinprick were significantly prolonged in group Noon compared with the other groups (P = 0.03). Conclusions: The time of administration of spinal local anesthetics influences the duration of local anesthesia.

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Atentamente
Anestesiología y Medicina del Dolor

Remifentanil en pacientes cardiacos graves y Comparación de la efectividad de lidocaína y salbutamol sobre la tos provocada por remifentanil intravenoso durante la inducción de la anestesia


Remifentanil en pacientes cardiacos graves
Remifentanil in critically ill cardiac patients
Laura Ruggeri, Giovanni Landoni, Fabio Guarracino, Sabino Scolletta, Elena Bignami, Alberto Zangrillo
Department of Anesthesia and Intensive Care Medicine, Università Vita-Salute San Raffaele, Milan, Italy.  Department of Cardiothoracic, Cardiothoracic Anesthesia and Intensive Care Medicine, University Hospital of Pisa, Pisa, Italy.  Department of Surgery and Bioengineering, Unit of Cardiothoracic Anesthesia and Intensive Care, University of Siena, Siena, Italy
Ann of Cardiac Anaesth 2011;14: 6-12.     DOI: 10.4103/0971-9784.74393

Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal). In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients. 

Comparación de la efectividad de lidocaína y salbutamol sobre la tos provocada por remifentanil intravenoso durante la inducción de la anestesia
Comparison of the effectiveness of lidocaine and salbutamol on coughing provoked by intravenous remifentanil during anesthesia induction.
Bang SR, Ahn HJ, Kim HJ, Kim GH, Kim JA, Yang M, Kim JK, Cho HS.
Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea.
Korean J Anesthesiol. 2010 Nov;59(5):319-22. Epub 2010 Nov 25. 

Abstract
BACKGROUND: Coughing is a side effect of opioids that is rarely studied. Here, we evaluated the incidence of remifentanil induced coughing during anesthesia induction in an attempt to identify its risk factors and to examine the preventive effects of lidocaine and salbutamol.
METHODS: A total of 237 patients scheduled to undergo general anesthesia were allocated randomly into three groups. Group C received no medication, while Group L received 2% lidocaine at 0.5 mg/kg intravenously 1 minute prior to remifentanil infusion and Group S inhaled one metered aerosol puff of salbutamol 15 minutes prior to entering the operating room. Remifentanil was infused at 5 ng/ml by target controlled infusion and coughing was measured for five minutes and graded as none, mild, moderate, or severe based on the number of coughs. RESULTS: The incidences of coughing were 30.4%, 25.3%, and 35.4% in Groups C, L, and S, respectively. The incidences, onset times, and severity of coughing did not differ significantly among groups. In addition, multivariate analysis showed that non-smoking and a lower body weight were risk factors of remifentanil-induced coughing (odds ratio, 8.13; P = 0.024, 1.11, and 0.004, respectively). CONCLUSIONS: The incidence of remifentanil-induced coughing was 30%. A total of 0.5 mg/kg lidocaine and 1 metered aerosol puff of salbutamol did not prevent coughing. Non-smoking and low body weight were found to be risk factors of remifentanil-induced coughing

Atentamente
Anestesiología y Medicina del Dolor

Aqueous extract of Carica papaya leaves exhibits anti-tumor activity and immunomodulatory effects


Journal of Ethnopharmacology 127 (2010) 760–767
Contents lists available at ScienceDirect
Journal of Ethnopharmacology
journal homepage: www.elsevier.com/locate/jethpharm
Aqueous extract of Carica papaya leaves exhibits anti-tumor activity and
immunomodulatory effects
Noriko Otsukia,1, Nam H. Dangb,1, Emi Kumagaia, Akira Kondoc, Satoshi Iwataa, Chikao Morimotoa,d,
a Division of Clinical Immunology, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Japan
b Division of Hematology/Oncology, The University of Florida, Gainesville, FL, USA
c Kondo Hospital, 1-6-25, Nishishinhama, Tokushima, Tokushima 770-8008, Japan
d Department of Rheumatology and Allergy, Research Hospital, The Institute of Medical Science, The University of Tokyo, Japan
a b s t r a c t
Aim of the study: Various parts of Carica papaya Linn. (CP) have been traditionally used as ethnomedicine
for a number of disorders, including cancer. There have been anecdotes of patients with advanced cancers
achieving remission following consumption of tea extract made from CP leaves. However, the precise
cellular mechanism of action of CP tea extracts remains unclear. The aim of the present study is to
examine the effect of aqueous-extracted CP leaf fraction on the growth of various tumor cell lines and
on the anti-tumor effect of human lymphocytes. In addition, we attempted to identify the functional
molecular weight fraction in the CP leaf extract.
Materials and methods: The effect of CP extract on the proliferative responses of tumor cell lines and
human peripheral blood mononuclear cells (PBMC), and cytotoxic activities of PBMC were assessed by
[3H]-thymidine incorporation. Flow cytometric analysis and measurement of caspase-3/7 activities were
performed to confirm the induction of apoptosis on tumor cells. Cytokine productions by PBMC were
measured by ELISA. Gene profiling of the effect of CP extract treatment was performed by microarray
analysis and real-time RT-PCR.
Results: We observed significant growth inhibitory activity of the CP extract on tumor cell lines. In PBMC,
the production of IL-2 and IL-4 was reduced following the addition of CP extract, whereas that of IL-
12p40, IL-12p70, IFN-_ and TNF-_ was enhanced without growth inhibition. In addition, cytotoxicity of
activated PBMC against K562 was enhanced by the addition of CP extract. Moreover, microarray analyses
showed that the expression of 23 immunomodulatory genes, classified by gene ontology analysis, was
enhanced by the addition of CP extract. In this regard, CCL2, CCL7, CCL8 and SERPINB2 were representative
of these upregulated genes, and thus may serve as index markers of the immunomodulatory effects of
CP extract. Finally, we identified the active components of CP extract, which inhibits tumor cell growth
and stimulates anti-tumor effects, to be the fraction with M.W. less than 1000.
Conclusion: Since Carica papaya leaf extract can mediate a Th1 type shift in human immune system,
our results suggest that the CP leaf extract may potentially provide the means for the treatment and
prevention of selected human diseases such as cancer, various allergic disorders, and may also serve as
immunoadjuvant for vaccine therapy.
© 2009 Elsevier Ireland Ltd. All rights reserved.


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Obama Adds to Emphasis on Business With Adviser Choice


Obama Adds to Emphasis on Business With Adviser Choice

Drew Angerer/The New York Times
President Obama with Jeffrey R. Immelt, the chairman and chief executive of General Electric, on Friday at G.E. headquarters in Schenectady, N.Y.
SCHENECTADY, N.Y. — President Obama, sending another strong signal that he intends to make his White House more business-friendly, traveled to this industrial city on Friday to appoint a prominent corporate executive as his chief outside economic adviser, and to spotlight his efforts on job creation, in advance of next week’sState of the Union address.

Related in Opinion

Drew Angerer/The New York Times
Gov. Andrew M. Cuomo of New York greeted President Obama as he arrived in Albany on Friday.
Charles Dharapak/Associated Press
General Electric’s Jeffrey Immelt with President Obama at a roundtable discussion with business leaders in Mumbai, India in November.
Joshua Roberts/Bloomberg News
Paul Volcker stepped down as the chairman of President Obama’s Economic Recovery Advisory Board.

Here in the birthplace of General Electric, where the company’s historic brick edifice and iconic neon-script logo loom over downtown, Mr. Obama turned to Jeffrey R. Immelt, the company’s chairman and chief executive, to run his outside panel of economic advisers. Mr. Immelt succeeds Paul A. Volcker, the former Federal Reserve chairman, who is stepping down.
The selection of Mr. Immelt, who was by Mr. Obama’s side during his trip to India last year and again this week during the visit of President Hu Jintao of China, is the latest in a string of pro-business steps the president has taken. He has installed William Daley, a former JPMorgan Chaseexecutive, as his chief of staff; has scheduled a major speech to the U.S. Chamber of Commerce next month; and ordered federal agencies this week to review regulations with an eye toward eliminating some.
Taken together, the moves amount to a carefully choreographed shift in strategy for the White House, both substantively and on the public relations front, as Mr. Obama makes the case to the nation that the United States has moved past economic crisis mode and is entering ‘’a new phase of our recovery” that demands an emphasis on job creation.
As he moves into the second half of his term and lays the foundation for his 2012 re-election campaign, Mr. Obama will try to frame the national conversation on the economy around this crisis-to-job-creation narrative. Republicans, who have spent the first weeks of the new Congress talking about repealing Mr. Obama’s health care law, have given the president an opening to do so. Here in Schenectady, Mr. Obama seized the opportunity.
“The past two years were about pulling our economy back from the brink,” Mr. Obama said, standing before the backdrop of a huge generator in a well-lighted plant, with a giant American flag hanging from the ceiling. “The next two years, our job now, is putting our economy into overdrive.”
The president went on: “Our job is to do everything we can to ensure that business can take root and folks can find good jobs and America is leading out global competition that will define our success in the 21st century.”
The appointment of Mr. Immelt is not without complications for the president. G.E. has countless regulatory matters now before federal agencies, on subjects ranging from television mergers to environmental cleanup. Having the chief executive of such a company advising the White House on job creation at a time when Mr. Obama is assuming a more deregulatory posture could generate criticism for the president, who came to Washington vowing to reduce the influence of lobbyists and special interests.
Mr. Immelt will be chairman of the Council on Jobs and Competitiveness that Mr. Obama intends to create by executive order. In a statement issued shortly after midnight, Mr. Obama said he wanted the council to “focus its work on finding new ways to encourage the private sector to hire and invest in American competitiveness.”
The council will be a reconfigured version of the board Mr. Volcker led, the President’s Economic Recovery Advisory Board. That body, created by Mr. Obama when he took office in the thick of the worst economic crisis since the Great Depression, is set to expire on Feb. 6.
Asked about his new role during a conference call about G.E.’s latest earnings report on Friday morning, Mr. Immelt said that the advisory position would give him a chance to contribute to issues in the broader economy, with a focus on competitiveness and jobs. “I am honored to serve,” he said.
Mr. Immelt said that his commitment to G.E. would not change. “This is my passion,” he said of the company. “I am committed. I am a hard worker. I am focused on the company.”
Though G.E. moved its headquarters away from Schenectady long ago, the city remains home to G.E.’s largest energy division, and the company’s plants here will build the steam turbines ordered by Reliance Power of India in a $750 million deal announced when Mr. Obama and Mr. Immelt were in India last November. G.E. reported early on Friday that it had earned $4.5 billion in the fourth quarter of 2010 and $11.6 billion for the full year, exceeding Wall Street analysts’ expectations.
Mr. Immelt mentioned his impending appointment in an opinion article published in The Washington Post on Friday. “The president and I are committed to a candid and full dialogue among business, labor and government to help ensure that the United States has the most competitive and innovative economy in the world,” he said in the article. “My hope is that the council will be a sounding board for ideas and a catalyst for action on jobs and competitiveness. It will include small and large businesses, labor, economists and government.”
Christine Hauser contributed reporting from New York
.