"Qui la voce sua soave": "Maria Callas' dermatomyositis"-art beyond disease and its stigma.

Not available for a historical note.

Pelvic floor status in opera singers. a pilot study using transperineal ultrasound.

BACKGROUND: Control of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction. METHODS: Cross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images. RESULTS: The AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction). CONCLUSIONS: Transperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing.

Are Richard Wagner's operas a potential tool to teach medical students and young doctors humanities?

There is an increasing interest in using poems and novels as a powerful resource to teach medical students ethical and professional behavior, virtues, and to illustrate the complexity of the doctor-patient relationship. This approach as part of a narrative medicine provides a framework for approaching a patient's problems more holistically and also offers a method for addressing existential inner qualities such as grief, hope, and despair that are part of illnesses. Occasionally, operas (mainly Italian) have also been used for this purpose. I however, propose that medical students may learn a lot from a deeper confrontation with the operas from the German composer Richard Wagner (1813-1883). Certainly, Wagner had a rather self-centered personality, also known for his notorious nationalistic and anti-Semitic essays, but his complete Gesamtkunstwerk (total work of art) encompasses almost every human feeling, conflict, and psychological problem including suffering, compassion, redemption, etc. Wagner's opera somewhat reflected his unsteady life. Wagner was convinced that his art could fill the void left by the retreat of traditional religion, suggesting that humanity may achieve freedom through the perception of beauty uniting communities through shared aesthetic experience. Not a very modest approach and not a very likable character, but a great composer. After a short biography, I will provide some (because of the complexity of the subject, naturally limited) arguments on what medical students can learn from Wagner operas, even though I am convinced that Wagner and his music are not easy to digest, even for experienced opera lovers.

Mobile Devices and Sensors for an Educational Multimedia Opera Project.

Interactive computer-based music systems form a rich area for the exploration of collaborative systems where sensors play an active role and are important to the design process. The Soundcool system is a collaborative and educational system for sound and music creation as well as multimedia scenographic projects, allowing students to produce and modify sounds and images with sensors, smartphones and tablets in real time. As a real-time collaborative performance system, each performance is a unique creation. In a comprehensive educational project, Soundcool is used to extend the sounds of traditional orchestral instruments and opera singers with electronics. A multidisciplinary international team participates, resulting in different performances of the collaborative multimedia opera The Mother of Fishes in countries such as Spain, Romania, Mexico and the USA.

Integration of Arts and Health Sciences in Developing an Opera on Veteran Resilience and Recovery.

There is an emerging literature on research interviews to inform arts projects, but little on opera. This case study illustrates how research data informed an opera on Veteran recovery. Deidentified interviews were selected from 280 adults with a history of depression at 10-year follow-up to a randomized trial. Interviews were used to inform characters, storyline, and libretto. Ethical strategies included: changing details and merging stories and characters to create two Veterans and one spouse as leads, a storyline, and choral passages, with a focus on recovery from post-traumatic stress and homelessness. To engage a broad audience and address stigma, accessible composition techniques (melody, harmony) were used. We found that qualitative/mixed data can inform libretto and composition for an opera on Veteran recovery, through integrating art and health science.

Impact of Opera on Mental Health Stigma: Pilot of Provider/Community Workshop.

BACKGROUND: Arts can influence mental health stigma, but little is known about impact of operas. We examined effects of a two-opera workshop on complicated grief and schizophrenia. METHODS: Pre-post audience surveys with post-workshop discussion. The primary outcome was a 4-item measure of willingness to engage with persons with grief or schizophrenia. Secondary outcomes were perceptions of art affecting stigma and stigma mediators. Of 47 participants, 33 had pre-post surveys for both operas. RESULTS: There was a significant pre-post opera increase in audience willingness to engage with persons with grief or schizophrenia (p < .001). Perceptions of impact on mediators such as empathy, were significantly greater for the opera on schizophrenia relative to grief (p < .001).. CONCLUSION: The pre- to post increase in audience willingness to engage with affected persons (primary) with greater impact on secondary mediators for the schizophrenia opera and post-discussion suggest that operas may be a forum for addressing mental health stigma and promoting empathy.

[Fabulus of the concert for the 100th anniversary of Yevdokimov Moscow State University of Medicine and Dentistry].

On the basis of critical analysis of sources the author reveals the role of doctors in opera productions, ballet and art in general. Looking through opera librettos and director's productions the author makes conclusions about characteristic human health problems, treatment methods used and the social status of doctors. About 10 percent of the four hundred opera and ballet productions performed today include doctor characters. These characters differ significantly from each other, depending on the time of creation of the work or the era reflected in the plot.

Asymmetric faces: Symbolic, spiritual, and representative.

In humans, physically attractive faces are measurably, though subtly, asymmetric. As asymmetry increases, it has a negative impact. Medically, asymmetry can be congenital or acquired. Symbolically, it has varied connotations from playfulness and complexity to despair and corruption. In Chinese opera, stylized make-up exaggerates the features, and aspects of the "mask" indicate qualities of the character. The asymmetric faces belong to characters who are corrupt, devious, or evil. In the Dan culture of western Africa, performance masks channel spirits in the community. A spirit with asymmetric facial mask exemplifies ugliness and moral failing. The Nasca culture of South America made generic figures of farmers, deities, and so on, but not of individuals. However, there is evidence of mutual influence between the Nasca and the Wari, with whom they traded. A clay figure apparently representing an individual, or at least a very specific recognized persona, is a ball player with facial asymmetry presumably due to injury. Here the message is one of fierceness and strength. The relative rarity of asymmetric facial depictions compared to symmetric ones is cross-cultural. This implies that asymmetry is special somehow, in all connotations of that term.

A Night at the OPERA: A Conceptual Framework for an Integrated Distributed Sensor Network-Based System to Figure out Safety Protocols for Animals under Risk of Fire.

Large scale wildfire events that occurred around the world involved a massive loss of animal lives, with a consequent economic impact on agricultural holdings and damages to ecosystems. Preparing animals for a wildfire evacuation requires an extra level of planning, preparedness and coordination, which is missing in the current practice. This paper describes a conceptual framework of an ICT system implemented to support the activities of the Regional Veterinary referral Center for non-epidemic emergencies (CeRVEnE) in the Campania Region for the twofold objectives. On the one hand, it realizes the monitoring of the wooded areas under risk of fire in the so-called "Mount Vesuvius' red zone". On the other hand, it determines the OPtimal Evacuation Route for Animals (OPERA) in case of fire, for each of the reported animal species living in the mentioned red zone. The main innovation of the proposed system lies in its software architecture that aims at integrating a Distributed Sensor Network (DSN), an ad-hoc software to generate timely simulations for fire risk modeling, and a GIS (Geographic Information System) for both the activities of web mapping and OPERA definition. This paper shows some effective preliminary results of the system implementation. The importance of the system mainly lies in its accordance with the so-called "Foresight approach" perspective, that provides models and tools to guarantee the prevention of systematic failure in disaster risk management, and becomes moreover critical in the case of Mount Vesuvius, which hosts a unique combination of both animal and anthropic elements within a delicate natural ecosystem.

Effect of traditional opera on older adults with dementia.

This study evaluates the effectiveness of traditional Chinese opera on older adults with dementia; those who met the inclusion criteria were categorized into intervention (n = 21) and control (n = 22) groups. Traditional Chinese opera was organized for the intervention group for 12 weeks. The Mini-Mental State Examination (MMSE), the Chinese version of the neuropsychiatric inventory (CNPI), and Quality of Life in Alzheimer's disease (QOL-AD) assessed the effectiveness at the pre-test stage and after 6 and 12 weeks of the intervention, and generalized estimated equation was used for statistical analysis. Statistically significant (P < 0.05) differences were observed between the intervention and control groups in terms of MMSE, CNPI, and QOL-AD. Traditional Chinese opera can potentially be an effective therapy for improving the cognitive function of older adults with dementia, reducing their behavioral and psychiatric symptoms and enhancing their quality of life.

Adjusting for BMI in analyses of volumetric mammographic density and breast cancer risk.

BACKGROUND: Fully automated assessment of mammographic density (MD), a biomarker of breast cancer risk, is being increasingly performed in screening settings. However, data on body mass index (BMI), a confounder of the MD-risk association, are not routinely collected at screening. We investigated whether the amount of fat in the breast, as captured by the amount of mammographic non-dense tissue seen on the mammographic image, can be used as a proxy for BMI when data on the latter are unavailable. METHODS: Data from a UK case control study (numbers of cases/controls: 414/685) and a Norwegian cohort study (numbers of cases/non-cases: 657/61059), both with volumetric MD measurements (dense volume (DV), non-dense volume (NDV) and percent density (%MD)) from screening-age women, were analysed. BMI (self-reported) and NDV were taken as measures of adiposity. Correlations between BMI and NDV, %MD and DV were examined after log-transformation and adjustment for age, menopausal status and parity. Logistic regression models were fitted to the UK study, and Cox regression models to the Norwegian study, to assess associations between MD and breast cancer risk, expressed as odds/hazard ratios per adjusted standard deviation (OPERA). Adjustments were first made for standard risk factors except BMI (minimally adjusted models) and then also for BMI or NDV. OPERA pooled relative risks (RRs) were estimated by fixed-effect models, and between-study heterogeneity was assessed by the I2 statistics. RESULTS: BMI was positively correlated with NDV (adjusted r = 0.74 in the UK study and r = 0.72 in the Norwegian study) and with DV (r = 0.33 and r = 0.25, respectively). Both %MD and DV were positively associated with breast cancer risk in minimally adjusted models (pooled OPERA RR (95% confidence interval): 1.34 (1.25, 1.43) and 1.46 (1.36, 1.56), respectively; I2 = 0%, P >0.48 for both). Further adjustment for BMI or NDV strengthened the %MD-risk association (1.51 (1.41, 1.61); I2 = 0%, P = 0.33 and 1.51 (1.41, 1.61); I2 = 0%, P = 0.32, respectively). Adjusting for BMI or NDV marginally affected the magnitude of the DV-risk association (1.44 (1.34, 1.54); I2 = 0%, P = 0.87 and 1.49 (1.40, 1.60); I2 = 0%, P = 0.36, respectively). CONCLUSIONS: When volumetric MD-breast cancer risk associations are investigated, NDV can be used as a measure of adiposity when BMI data are unavailable.

Reduction in a high-risk sex script among young urban women in the Love, Sex, & Choices web video HIV prevention intervention study.

For women, the high-risk sex script of condomless sex to maintain relationships with men is concerning, particularly in regard to heterosexual HIV acquisition. This secondary analysis of data from a clinical trial evaluated the effect of a 12-episode, web-based video series intervention, entitled Love, Sex, and Choices, versus a text message control on lowering the high-risk sex script. The sample comprised 238 predominately urban Black women, ages 18-29, having HIV sex risk behavior. Data were collected at baseline and 6 months post-intervention. The Sex Script Video Response score was used to measure a high-risk sex script. HIV sex risk behavior was measured by Vaginal Equivalent Episodes with high-risk partners. At baseline, lower education, younger age at first sexual intercourse, and alcohol/non-injection drug use before sex were positively associated with a high-risk sex script. At baseline, as the high-risk sex script increased by one log unit, sex risk behavior increased by 0.47 log units (p < 0.001), equivalent to a 60% increase in the geometric mean of sex risk behavior. ANCOVA analysis indicated that from baseline to 6-months post intervention, lowering the high-risk sex script by one unit was associated with an additional reduction of 0.26 units in sex risk behavior. Compared to the text messages, the LSC video series was associated with a 27% greater reduction in the geometric mean of the sex script (p = 0.03). Further investigation into the effect of lowering sex scripts to reduce sex risk behavior is recommended.

[Psychological and psychoanalytical issues in Schreker's opera "Die Gezeichneten"]. / Psychologische und psychoanalytische Grundlagen in Schrekers Musikdrama "Die Gezeichneten".

Franz Schrekers opera "Die Gezeichneten" is the artistically answer to Sigmund Freud's psychoanalysis. The proceedings in this drama discuss some principles of psychoanalyses. The figures show typical psychological mechanisms like repression, sublimation or regression and also the typical symptoms of neurosis. During the date of origin of the opera, Freud's method of psychoanalysis becomes well known and a lot of physicians and psychologists begin with their education in it. Themes like the theory of sexuality by Freud were discussed in the Vienna society. The story contains all mechanisms of psychoanalysis and discloses the psychopathology of the society of "fín de siègle" on the end of the 19th century. Franz Schreker's opera is like a forecasting of the nemesis, which in Europe occurs two decades later. The figures of the opera show the central facts of psychoanalysis and their artificial expression in music and performance.

Respiratory function in vocal soloists, opera singers and wind instrument musicians.

INTRODUCTION: Current studies have not yet reached a definitive conclusion on the effects of singing and playing wind instruments professionally on an individual's respiratory function. OBJECTIVE: The purpose of this study was to investigate the respiratory function of wind instrument players and opera singers in comparison with a group of healthy individuals. METHODS: The experimental group comprised 45 men and 35 women, 58 opera singers and vocal soloists in total and 22 wind instruments players. Eighty controls were all non-smokers, healthy individuals, matched for age and sex. Spirometry was performed with a dry spirometer, according to the American Thoracic Society recommendations. RESULTS: The mean age of the experimental group was 47.9 (15.5) years for men and 46.6 (16.8) for women. Experimental group and controls differed (p<0.01) in FVC [%predicted values: 98.69±13.07 vs 89.62±14.01 (men), 104.2±17.7 vs 93.8±13.9 (women)], FEV1[% predicted values: 98.69±13.07 vs 89.62±14.01 (men), 104.2±17.7 vs 93.8±13.9 (women)] and in PEFR values (p=0.001). [100.4±18.8 vs 76.7±19.8 (men)]. FEV1/FVC ratio significant differences were detected only in women (p=0.001, for predicted values). CONCLUSION: The findings of the present study provide evidence that professional involvement with wind musical instrument or monody might have beneficial effects on respiratory function. Future therapeutic perspectives, and associations between a documented improved respiratory function and performance by the musician should be examined.

The Illness and Death of Enrico Caruso (1873-1921): A Medical Chorus Out of Tune?

The Italian opera singer Enrico Caruso is considered by many people the most famous opera singer of all time or "The Matchless Singer" for his unique and suggestive vocal timber. Although a man of humble origins, he managed to rise from poverty, thanks to his extraordinary intelligence and determination. From his debut in 1895 in Naples, until December 24, 1920, the tenor had a brilliant career with many performances and over 500 songs in his repertoire. This intense lifestyle went on until 1919, when the fortune that had always accompanied him began to fade and he entered a fast "descending parable." In this study, we analyze Caruso's medical history during his last year of life: Through the study of the newspapers from the period and the statements reported on the tenor's many biographies, we tried to offer a detailed evaluation of the complex pathogenic chain of events that led to his death, impeding him from keeping to alleviate the heart-breaking nostalgia of many emigrants that felt in his singing the warmth of a too distant land.

Images by the vineyard: images of addiction and substance users in the media and other culture sites/sights.

This article constitutes a discovery journey into the world of drinking images, the pleasures and harms related to consuming alcoholic beverages, as well as the relationships between drinking and spirituality. These aspects are described historically and globally, over time through a series of snapshots and mini-discussions about both visual and mental images from art, classical literature and operatic music.The images are interpreted according to how they represent the drinking culture within which they were created and sustained, and how they are able to involve the spectator and the user in terms of either empathizing, accepting and including or distancing, stigmatizing and marginalizing the user.

Phenotype of migraine headache and migraine aura of Richard Wagner.

BACKGROUND: The headache phenotype and neurological symptoms of the German composer Richard Wagner (1813-1883), whose music dramas count towards the most frequently performed operas across the world, are previously undocumented. METHODS: Richard Wagner's own descriptions of his headache symptoms in his original writings and letters are investigated, as well as the complete diary records of his second wife, Cosima Wagner. RESULTS: There are manifold indications that Richard Wagner suffered from a severe headache disorder, which fulfils most likely the diagnostic criteria of migraine without aura and migraine with aura of ICHD-3 beta. CONCLUSIONS: Richard Wagner's life and opus can help to better understand the burden and suffering caused by migraine with its severe effects on the individual, familial and social life, the culture and community.

Some reflections on madness and culture in the post-war world.

This article examines the treatment of madness as a theme in drama, opera and films, concentrating its attention for the most part on the period between World War II and the 1980s. These were the years in which psychoanalysis dominated psychiatry in the USA, and so Freud's influence in the broader culture forms the central though not the sole focus of the analysis.

The description of epileptic seizures in the classical opera.

Epilepsy or epileptic seizures have only rarely been described in the classical opera. Four operas were detected, in which epileptic seizures are described also by musical means. Three of them ("Der Golem" by Eugen d'Albert; "Idiot" by Mieczyslaw Weinberg; "Otello" by Giuseppe Verdi) describe a generalized tonic-clonic epileptic seizure by a descending chromatic scale. One opera ("The turn of the screw" by Benjamin Britten) describes temporal lobe seizures by overtone music played by the instrument celesta.