Study No. 26


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Health plans reported a recent trend of making urgent care copayments lower than ED visit copayments, higher than primary care visits and similar to specialist physician visit copayments. Across the study sites, UCCs tend not to participate in Medicaid, reportedly because of low payment rates. Of the six communities studied, only Phoenix appeared to have significant contracting between Medicaid health plans and UCCs.

UCCs do serve some uninsured patients but typically require upfront payment, which can be a barrier for low-income patients. To ensure that they receive payment and to promote their centers, many UCC respondents reported offering discounted or flat fees to patients who pay in full at the time of treatment rather than in installments. Other UCCs offer membership programs where subsequent visits are discounted. Any time you come back within a year, you would get a reduced rate [for the visit].

Most respondents perceived that urgent care centers do not significantly disrupt existing relationships with primary care providers or coordination of patient care.

One reason is that many patients treated at UCCs have acute needs that can be handled in isolation from other health care needs or conditions. Indeed, only an estimated 2. But if [patients are] diabetic or hypertensive, we have to refer them to primary care because we do not follow that.

Although UCCs were not seen as a major disruption to care coordination, they do not appear to emphasize care coordination. In general, UCC respondents reported little to no role in connecting patients with follow-up care. Some exceptions were hospital-owned or hospital-affiliated UCCs, which are more likely to have shared electronic health records that can facilitate referrals to other providers.

Studies after Frederic Chopin (Godowsky, Leopold)

In fact, some hospital-owned UCCs reported sometimes being able to schedule follow-up appointments for patients within their system faster than if the patients had gone through their primary care provider or scheduled an appointment directly. The impact of urgent care centers on health care costs remains unclear. Respondents across the board reported a lack of data to show whether the growth of UCCs has generally saved money by diverting patients away from EDs or increased costs by drawing patients from primary care practices.

The more we started looking at that and reviewing the data, it was kind of a wash. Were we keeping them out of the ER? Still, many respondents speculated the presence of urgent care centers, with after-hours and weekend availability, diverts patients from EDs to lower-cost settings.

Also, in response to the growth of UCCs, more primary care practices are offering after-hours and weekend appointments as a competitive strategy to retain patients. Other respondents believed UCCs did little to keep patients from using EDs and instead disrupted care by diverting patients from their primary care clinicians.

For example, some noted that UCCs tend to locate in more-affluent, suburban areas and attract a relatively well-insured population rather than locating in inner-city areas where people may lack alternatives to the ED for urgent needs. Several respondents also speculated that UCCs add costs by diverting patients from primary care practices. If I need to see a doctor, I just go to an urgent care center. It probably adds to the cost of primary care.

As mentioned previously, some health plans have partnered with or purchased urgent care centers. One recent study predicted the United States would need 52, more primary care physicians by However, if primary care practices become more congested, stop accepting new patients or have longer appointment-wait times, UCCs could grow as an attractive alternative for patients. In addition, as more uninsured people gain subsidized private coverage under health reform, UCCs might become a viable option for those with problems finding or establishing a relationship with a PCP.

The potential for urgent care centers to generate cost savings could be expanded by making UCCs more accessible to low-income patients, many of whom currently have no viable alternative to EDs. While independent UCCs may see little financial incentive to enter underserved areas and to treat Medicaid and uninsured patients, hospitals, which could gain financially, may be more likely to add UCCs as a way to decrease ED use. Alternatively, if Medicaid managed care plans can justify higher payment rates for UCCs as way to control ED use, independent UCCs may be more willing to participate in Medicaid and serve areas with many Medicaid patients.

Growth in hospital ownership of or affiliation with UCCs may increase the degree to which UCCs become integrated with other care settings and provide coordinated care. The communities were selected for their high penetration of urgent care centers and represent varying levels of provider integration. Two-person research teams conducted 30 telephone interviews with urgent care center executives and directors, hospital-based emergency department directors, and health plan network managers between May and November Interview notes were transcribed and jointly reviewed for quality and validation purposes.

It is suspected that the Study No. This study was later compiled from the three initial parts into a five movement suite entitled Boogie-Woogie Suite in Its fourth movement included fragments of the second movement of Nancarrow's Suite for Orchestra , composed in It was arranged for piano, piano four-hands, chamber orchestra and small orchestra. Of the two available versions of the third study, the Boogie-Woogie Suite remains the better known and more recorded one.

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A photocopy of the first version of the study is available at the Lincoln Center Library. The suite consists of five movements featuring different music styles. The first movement features a hasty boogie-woogie in which up to seven layers of melodic and rhythmic structures are superimposed. The second movement features a blues , with a twelve-bar ostinato in the bass line which is repeated ten times. The third movement also has a blues character with canonic passages. The fourth movement features a jazz style, whereas the fifth movement comes back to an even more rushed boogie-woogie.

The first study came right after, entitled Rhythm Study No.

The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience?

The study has more than two hundred tempo changes. It was premiered together with Studies Nos. It is a slow blues with two melodic bass parts in tempo ratio of 3: However, Nancarrow also composed three additional version of the same study, entitled by himself Didactical Study No. These versions are also known as 2b, 2c and 2d, respectively, 2a being the main study.

STUDY NO. THE UNAUTHORIZED DUPLICATION OF. SOUND RECORDINGS. By BARBARA A. RINGER. February IX. The Studies for Player Piano is a series of 49 études for player piano by Mexican composer . 26 is actually the only study where all voices have no rhythmic differentiation. The canon is 1/1, which means that all the notes have the same tempo.

This way, 2x 2b has a tempo ratio of 5: Some publishers and record companies use the title Study No. This extended version arranged for player piano was also composed in and was later included in the set decades later as an afterthought. Between and , Nancarrow wrote the studies nos. Some of these compositions have been dated according to evidence, but Nancarrow never left a date in any of his originals.

In these studies, Nancarrow explored the possibilities of polyrhythm , prolation canons and the usage of irrational numbers , such as the square root of two. However, he still used different musical styles, including jazz or blues. However, it is not a strict canon, as the rhythmic patterns are not followed. It was arranged for the ballet Crises , by Merce Cunningham and John Cage , and again for piano four-hands.

It is a study of repeated and rapid runs and chordal motifs, superimposed over two ostinato rhythmic and melodic lines in the bass at tempos 5: It starts with only two voices but ends up with thirteen. It was also arranged for Crises and, later on, for chamber orchestra. It was first performed in Kassel , in Summer , and has since been arranged for a Marantz computer-piano, chamber orchestra, piano four-hands, two pianos and small orchestra. Of all of Nancarrow's early compositions for player piano, Study No.

It takes 6 minutes to perform. According to American music scholar Kyle Gann , it is one of the few studies approaching the sonata form. One of the most complex early compositions, the study features striking rhythmic pattern together with melodic lines. The eight-part composition ends with racing arpeggios.

After this study, Nancarrow decided to go back to the unprepared piano. Of the two available versions of the third study, the Boogie-Woogie Suite remains the better known and more recorded one. To ensure that they receive payment and to promote their centers, many UCC respondents reported offering discounted or flat fees to patients who pay in full at the time of treatment rather than in installments. Use parentheses to group different search terms together. The more we started looking at that and reviewing the data, it was kind of a wash. Several respondents also speculated that UCCs add costs by diverting patients from primary care practices. The fourth movement features a jazz style, whereas the fifth movement comes back to an even more rushed boogie-woogie.

It was originally presented with a longer beginning and a shorter ending. It was first performed together with the first three studies in Mexico City , on 30 July and has been arranged for a Marantz computer-piano, chamber orchestra, piano four-hands, two pianos and two disc-pianos. These techniques were further developed along his musical career.

The study is in three parts and is considered the first acceleration study. It was also the first time Nancarrow used bar lines and conventional notation. The first performance of the work was the one in in Mexico City. The following studies would continue to explore varied meters and tempos. Among them, the Study No. As his previous studies, the bass line is in ostinato and the ratios used in the study are 3: It was also premiered in the performance of the studies 7 and 8, in Mexico City and was arranged for chamber orchestra, piano four-hands and two pianos.

The last study to feature jazz characteristics is Study No. It has a blues melody and complex rhythmic patterns, given the continually changing time signature. The first version of this study was in ABA form. However, in Nancarrow's circa revision of the study, the first section was dropped. This later revision is now considered authoritative.

It uses conventional notation and features a sequence of repeating chords. There are up to thirty tempo changes in the first page alone.

Conlon Nancarrow, Study for Player Piano No. 26

The study imitates the guitar arpeggios used in flamenco music. This study was arranged for chamber orchestra in These three studies were first performed at the Mexico City event in which most of his other studies to date were performed. All of these canons have at least one characteristic in common: Nancarrow became displeased with the result and decided to withdraw it and to never publish it.

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However, he made it available as a recording. The rest of the canons were published, starting with Study No. It is largely seen as a precursor of Study No. Finally, the Study No.

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Chronologically, the next composition to be finished was the Study No. It is an acceleration study where one voice progressively slows down while the other speeds up. The study starts with a bass line playing a tone row at about 4 notes per second, immediately followed by the other voice, playing thirty-nine notes per second. Then the bass line starts to speed up and the treble line slows down progressively, reaching the same tempo halfway through the piece. The piece ends up with one of the lines playing notes per second.

It was presumably written in and was first performed in the Mexico City performance in The X alludes to the tempo acceleration and deceleration of both parts in the canon. It was also arranged for synthesizer, Marantz computer-piano, two disc-pianos and two voices. The three voices accelerate until the middle of the piece, where they decelerate at the same rate and get to the end of the piece at the same initial speeds.

This canon was first performed in Kassel, Germany , in Summer As in Study No. The treble accelerated part is considered to be "unplayable". The study was also first performed in Kassel in It features rapid repetitions, chains of trills and glissandi. It has been called a "masterpiece" by American scholar Kyle Gann. It was first performed on 30 May , in Ojai, California. It features many "idiomatic" traits of the player piano: Its ending is a second section in which notes are player with the sustain pedal held down, sometimes even getting to two hundred notes per second.

However, even though it has canonic elements, it is mostly a rhapsodic piece. It starts with one voice and ends up with seven. The study has been arranged for 7 hands on two to four pianos, piano four-hands, small orchestra and chamber ensemble.