Life and career.

Early years.

Carreras was born in Sants, a working-class district in Barcelona. He was the youngest of Antònia Coll i Saigi and Josep Carreras i Soler's three children. In 1951, his family emigrated to Argentina in search of a better life. However, this move abroad proved unsuccessful, and within a year; they had returned to Sants where Carreras was to spend the rest of his childhood and teenage years. He showed an early talent for music and particularly singing, which intensified at the age of six when he saw Mario Lanza in "The Great Caruso". The story recounted in his autobiography and numerous interviews is that after seeing the film, Carreras sang the arias incessantly to his family, especially "[[La donna è mobile," often locking himself in the family's bathroom when they became exasperated with his impromptu concerts. At that point, his parents, with the encouragement of his grandfather Salvador Coll, an amateur baritone, found the money for music lessons for him. At first he studied piano and voice with Magda Prunera, the mother of one of his childhood friends, and at the age of eight, he also started taking music lessons at Barcelona's Municipal Conservatory.  At just eight years old, he also gave his first public performance, singing "La donna è mobile," accompanied by Magda Prunera on the piano, on Spanish National Radio. A recording of this still exists and can be heard on the video biography, "José Carreras – A Life Story". On 3 January 1958, at the age of eleven, he made his debut in Barcelona's great opera house, the [[Gran Teatre del Liceu]], singing the boy soprano role of Trujamán in [[Manuel de Falla]]'s "[[El retablo de Maese Pedro]]". A few months later, he sang for the last time as a [[boy soprano]] at the Liceu in the second act of "[[La Bohème]]".  Throughout his teenage years, he continued to study music, moving on to the [[Conservatori Superior de Música del Liceu]] and taking private voice lessons, first with Francisco Puig and later with Juan Ruax, whom Carreras has described as his "artistic father." Following the advice of his father and brother, who felt that he needed a 'backup' career, he also entered the [[University of Barcelona]] to study chemistry, but after two years he left the university to concentrate on singing.

1970s and 1980s.

Juan Ruax encouraged Carreras to audition for what was to become his first tenor role at the Liceu, Flavio in "[[Norma (opera)|Norma]]", which opened on 8 January 1970. Although only a minor role, the few phrases he sang caught the attention of the production's leading lady, the eminent soprano and fellow [[Catalan people|Catalan]], [[Montserrat Caballé]]. She asked him to sing Gennaro with her in [[Donizetti]]'s "[[Lucrezia Borgia (opera)|Lucrezia Borgia]]", which opened on 19 December 1970. It was his first principal adult role, and the one which he considers to be his true debut as a tenor. In 1971, he made his international debut in a concert performance of "[[Maria Stuarda]]" in London's [[Royal Festival Hall]], again with Caballé singing the title role. Caballé was instrumental in promoting and encouraging his career for many years, appearing in over fifteen different operas with him, while her brother and manager, Carlos Caballé, was also Carreras's manager until the mid-1990s.  During the 1970s Carreras's career progressed rapidly. In late-1971, he won first prize in [[Parma]]'s prestigious Voci Verdiane competition which led to his Italian debut as Rodolfo in "[[La bohème]]" at the [[Teatro Regio di Parma]] on 12 January 1972. Later that year he made his American debut as Pinkerton in "[[Madama Butterfly]]" with the [[New York City Opera]]. Other major house debuts followed – the [[San Francisco Opera]] in 1973, as Rodolfo; the [[Philadelphia Lyric Opera Company]] in 1973, as Alfredo in "[[La traviata]]"; the [[Vienna Staatsoper]] in 1974, as the Duke of Mantua in "[[Rigoletto]]"; London's [[Royal Opera House]] in 1974, as Alfredo; the New York [[Metropolitan Opera]] in 1974, as Cavaradossi in "[[Tosca]]"; and [[La Scala]], Milan in 1975, as Riccardo in "[[Un ballo in maschera]]". By the age of 28, he had already sung the tenor lead in 24 different operas in both Europe and North America, and had an exclusive recording contract with [[Philips Records|Philips]], which resulted in valuable recordings of several less often performed Verdi operas, notably "[[Il Corsaro]]", "[[I due Foscari]]", "[[La battaglia di Legnano]]", "[[Un giorno di regno]]" and "[[Stiffelio]]". [[File:RomanzaFinalScreenShot.jpg|thumb|190px|right|Carreras portraying [[Julián Gayarre]] in the film "Romanza Final" (1986)]] Carreras's leading ladies during the 1970s and 1980s included some of the most famous [[soprano]]s and [[mezzo soprano|mezzo-sopranos]] of the day: [[Montserrat Caballé]], [[Birgit Nilsson]], [[Viorica Cortez]], [[Renata Scotto]], [[Ileana Cotrubaş]], [[Sylvia Sass]], [[Teresa Stratas]], Dame [[Kiri Te Kanawa]], [[Frederica von Stade]], [[Agnes Baltsa]], [[Teresa Berganza]], and [[Katia Ricciarelli]]. His artistic partnership with Ricciarelli began when they both sang in the 1972 "La bohème" at Parma and lasted for thirteen years, both in the recording studio and on stage. They later made a studio recording of "La bohème" for [[Philips Records|Philips Classics]] and can be heard together on over 12 other commercial recordings of both operas and recitals, predominantly on the Philips and [[Deutsche Grammophon]] labels.  Of the many conductors he worked with during this period, the one with whom Carreras had the closest artistic relationship and who had the most profound influence on his career was [[Herbert von Karajan]]. He first sang under Karajan in the [[Verdi Requiem]] at [[Salzburg Festival|Salzburg]] on 10 April 1976, with their final collaboration in a 1986 production of "[[Carmen]]", again at Salzburg. With Karajan's encouragement, he increasingly moved towards singing heavier [[spinto|lirico-spinto]] roles, including "[[Aida]]", "[[Don Carlos]]", and "Carmen", which some critics have said were too heavy for his natural voice and may have shortened his vocal prime. (See the section on Carreras's [[José Carreras#Voice|voice]].)  The 1980s saw Carreras occasionally moving outside the strictly operatic repertoire, at least in the recording studio, with recitals of songs from [[zarzuela]], [[musical theatre|musicals]] and [[operetta]]s. He also made full-length recordings of two musicals – "[[West Side Story (musical)|West Side Story]]" (1985) and "[[South Pacific (musical)|South Pacific]]" (1986) – both with [[Kiri Te Kanawa]] as his co-star. The recording of "West Side Story" was unusual in two respects: Carreras was chosen and conducted by [[Leonard Bernstein]]. Bernstein was conducting for the first time nearly 30 years after he composed the music, and [[The Making of West Side Story|a full-length documentary]] was made about the recording sessions. His 1987 Philips recording of the Argentine folk mass, "Misa Criolla", conducted by its composer, [[Ariel Ramírez]], brought the work to a worldwide audience. Although many of Carreras's stage performances are available on video, he also ventured into film. In 1986, he portrayed the 19th century Spanish tenor [[Julián Gayarre]] in "Romanza Final" (The Final Romance) and in 1987, he started working on a film version of "La bohème" directed by [[Luigi Comencini]].  It was during the filming of "[[La bohème]]" in [[Paris]] that he was found to be suffering from [[acute lymphoblastic leukemia]] and given a 1 in 10 chance of survival. However, he recovered from the disease after undergoing a gruelling treatment involving [[chemotherapy]], [[Radiotherapy|radiation therapy]] and an [[Bone marrow transplant|autologous bone marrow transplant]] at the [[Fred Hutchinson Cancer Research Center]] in [[Seattle]]. Following his recovery, he gradually returned to both the operatic and the concert stage, embarking on a tour of come-back recitals in 1988 and 1989 and singing with Montserrat Caballé in "[[Médée (Cherubini)|Medea]]" (Mérida, Spain 1989) and in the world premiere of [[Leonardo Balada|Balada]]'s "Cristóbal Colón" (Barcelona, 1989)

1990–present.

[[File:Jose Carreras Royal Albert Hall 2001.jpg|thumb|180px|left|Carreras backstage at the [[Royal Albert Hall]], December 2001]] The 1990s continued to see Carreras performing on the operatic stage in "[[Carmen]]" and "[[Fedora (Giordano)|Fedora]]" and making role debuts in "[[Samson et Dalila]]" ([[Peralada]], 1990), [[Verdi]]'s "[[Stiffelio]]" (London, 1993), and [[Wolf-Ferrari]]'s "[[Sly (opera)|Sly]]" (Zurich, 1998). However, his opera performances became less frequent as he increasingly devoted himself to concerts and recitals. His final operatic performances at the [[Gran Teatre del Liceu]], the opera house where his career began, were in "Samson et Dalila" (March 2001). He reprised the title role in "Sly" in Tokyo in 2002 and in 2004 performed at the Vienna State Opera in fully staged versions of the final act of "Carmen" and Act 3 of "Sly". In April 2014, Carreras returned to the opera stage after a ten-year absence singing the title role of Christian Kolonovits's opera, "El Juez" (The Judge) in its premiere at the Arriaga Theatre in [[Bilbao]]. He reprised the role in August 2014 at the Festival Erl in Austria and in January 2015 at the [[Mariinsky Theatre]] in St. Petersburg.  In 1990 the first [[The Three Tenors|Three Tenors]] concert took place in the [[Baths of Caracalla]] in Rome on the eve of the 1990 [[FIFA World Cup]] finals. It was originally conceived to raise money for Carreras's leukemia foundation and as a way for his colleagues, [[Plácido Domingo]] and [[Luciano Pavarotti]], to welcome their "little brother" back to the world of opera. However, it and the subsequent Three Tenors concerts brought Carreras a fame that went far beyond the opera house. It is estimated that over a billion people around the world watched the television broadcast of the 1994 Three Tenors concert in Los Angeles. By 1999, the CD from the first Three Tenors concert in Rome had sold an estimated 13 million copies, making it the best-selling classical recording of all time. Carreras is the center of a subplot in the 1996 episode "[[The Doll (Seinfeld)|The Doll]]" in the "[[Seinfeld]]" television series, in which he is never referred to by name but as "the other guy" in the Three Tenors. The early 1990s also saw Carreras serving as the Musical Director for the opening and closing ceremonies of 1992 Barcelona [[Olympic Games]], and performing in a worldwide concert tour in tribute to his first singing hero, [[Mario Lanza]].  By the 2000s Carreras's recording and live concert repertoire had moved largely to [[art song]], [[Neapolitan song]]s, the light classical genre, and 'easy-listening'. He has also increasingly performed and recorded with artists from outside the classical music world, such as [[Diana Ross]], [[Edyta Górniak]], [[Lluis Llach]], [[Peter Maffay]], [[Udo Jürgens]], [[Klaus Meine]], [[Charles Aznavour]], [[Kim Sozzi|Kim Styles]], [[Sarah Brightman]], [[Vicky Leandros]], [[Jackie Evancho]], [[Sissel Kyrkjebø]], [[Debbie Harry]], [[Majida El Roumi]], and [[Giorgia Fumanti]]. Beginning in 2002, Carreras scaled back his live performances to recitals and orchestral concerts.  In an interview published in "[[The Times]]" on 8 May 2009, Carreras announced that he would no longer perform principal opera roles but was still open to recitals.

Humanitarian work.

[[File:JoseCarrerasFoundationBulletin.jpg|thumb|200px|right|Carreras visiting a leukaemia patient on the cover of "Amigos de la Fundación", July 2005]]Following his own recovery from [[leukaemia]], Carreras sought both to repay the debt he owed to medical science and to improve the lives and care of other leukaemia sufferers. On 14 July 1988, he established the Fundació Internacional Josep Carreras per a la Lluita contra la Leucèmia (known in English as the José Carreras International Leukaemia Foundation) in [[Barcelona]]. The foundation, which publishes a tri-monthly magazine on its activities, "Amigos de la Fundación", concentrates its efforts in four main areas:  The José Carreras International Leukaemia Foundation also has affiliates in the U.S., Switzerland, and Germany, with the German affiliate the most active of the three. Since 1995, Carreras has presented an annual live television benefit gala in [[Leipzig]] to raise funds for the foundation's work in Germany. Since its inception, the gala alone has raised well over [[Euro|€]]71 million. Carreras also performs at least 20 charity concerts a year in aid of his foundation and other medical related charities. He is an Honorary Member of the European Society for Medicine and the European Haematology Association, an Honorary Patron of the European Society for Medical Oncology, and a Goodwill Ambassador for [[UNESCO]].

Awards and distinctions.

Carreras has received numerous awards and distinctions for both his artistic and humanitarian work. These include: Knight Grand Cross (First Class) of the Most Exalted [[Order of the White Elephant]] of Thailand (2019); Commander of the [[Ordre des Arts et des Lettres]] and Chevalier of the [[Légion d'honneur]] (France); Knight Grand Cross and [[Order of Merit of the Italian Republic|Grand Officer of the Order of Merit of the Italian Republic]] (20 May 1996 and 3 April 1991, respectively); [[Decoration for Services to the Republic of Austria|Grand Decoration of Honour for Services to the Republic of Austria]] (1999); the Cruz de Oro del Orden Civil de la Solidaridad Social from [[Queen Sofia of Spain]], the [[Prince of Asturias Prize]] for Art (joint winner, 1991), the [[Order of Merit of the Federal Republic of Germany|Grand Cross of Merit]] from the Federal Republic of Germany and the [[Gold Medal of the Generalitat of Catalonia]] (June 1984)  Carreras has received the [[Bavarian Order of Merit]], the [[Steiger Award]] (2006) and the St. George Order of the [[Semperoper]] ([[Dresden]], 2010)  Honorary Medal of the city of [[Leipzig]] on the occasion of his Leukemia Fundraiser for 2009 on 17 December 2009; awarded by the Mayor of Leipzig (unanimous decision of the town council of Leipzig).  On 23 February 2004, the Austrian Post Office issued a 1[[Euro|€]] stamp to commemorate the 30th anniversary of his debut at the Vienna Staatsoper.  In 2009, he received the [[Brit Award for Outstanding Contribution to Music]].  He has Honorary Doctorates from the [[University of Barcelona]] and [[Miguel Hernández University of Elche|Miguel Hernández University]] (Spain); [[Napier University|Napier]], [[Loughborough University|Loughborough]] and [[University of Sheffield|Sheffield]] universities (United Kingdom); the [[Mendeleev University|Mendeleev Russian University of Chemistry and Technology]] ([[Russia]]); the [[University of Camerino]] (Italy); [[Rutgers University]] (United States); the [[University of Coimbra]] (Portugal); the [[National University of Music Bucharest]] (Romania); [[University of Marburg|Philipps-Universität Marburg]] (Germany, 3 May 2006); [[University of Saarland]] (2012); the [[University of Pécs]] (Hungary) and most recently, [[Kyunghee University]] (Korea) and the [[University of Porto]] (Portugal).  In Spain the central plaza in [[Sant Joan d'Alacant]] bears his name, as do two theatres – the Auditori Josep Carreras in Vila-seca (near [[Tarragona]]) and The Teatro Josep Carreras in [[Fuenlabrada]].

Family.

Throughout his childhood in Barcelona, Carreras's father, Josep Carreras i Soler, worked as a traffic policeman. He had originally been a French teacher. However, he had fought on the Republican side during the [[Spanish Civil War]], and when the [[Francisco Franco|Franco]] government came into power in 1939, he was no longer allowed to teach. His mother, Antonia Coll i Saigi, ran a small hair-dressing salon, where, as a child, Carreras often sang to the customers in return for pocket money. He was very close to his mother, who was convinced that he would one day be a great singer, and her death from cancer when he was 18 affected him greatly. In "José Carreras: A Life Story", he said that "even now, every time I go on stage, I always, always, have a quick thought for her." In 1971 Carreras married Mercedes Pérez. They had two children: a son, Albert (born in 1972), and a daughter, Julia (born in 1978). The marriage ended in divorce in 1992. In 2006, Carreras married Jutta Jäger, but separated from her in 2011. Carreras's nephew, [[David Giménez Carreras]], is a conductor and Director of the [[Vallès Symphony Orchestra|Orquestra Simfònica del Vallès]]. He has conducted many of Carreras's concerts since the late 1990s as well as his opera performances in "Sly" at the Gran Teatre del Liceu in June 2000.

Voice.

[[File:CarrerasAndreaChenier.jpg|thumb|right|Carreras in "Andrea Chénier", La Scala, 1985|341x341px]]In its prime, Carreras's voice was considered one of the most beautiful [[tenor]] voices of the day. The Spanish critic, Fernando Fraga has described it as a [[Voice type|lyric tenor]] with the generosity of a [[spinto]], having "a noble [[timbre]], richly coloured and sumptuously resonant". This is particularly true of the middle [[Voice type#Tenor|range]] of his voice. Fraga also noted, as has Carreras himself, that even in his youth the high notes of the tenor range were always somewhat problematic for him, and became more so as his career progressed. Like his idol, [[Giuseppe di Stefano]], Carreras was also known for the beauty and expressiveness of his phrasing and for his passionate delivery. These qualities are perhaps best exemplified in his 1976 recording of "[[Tosca]]" with [[Montserrat Caballé]] in the title role and conducted by [[Sir Colin Davis]].  According to several critics his assumption of the heavier spinto roles such as "[[Andrea Chénier]]", Don José in "[[Carmen]]", "[[Don Carlo]]", and Alvaro in "[[La forza del destino]]" put a strain on his naturally lyric instrument which may have caused the voice to prematurely darken and lose some of its bloom. Nevertheless, he produced some of his finest performances in those roles.  The "[[Daily Telegraph]]" wrote of his 1984 "Andrea Chénier" at London's [[Royal Opera House]]: "Switching effortlessly from the lyric poet Rodolfo in "La Bohème" a few weeks ago to the heroic poet Chenier, the Spanish tenor's vocal artistry held us spellbound throughout." Of his 1985 performance in "Andrea Chénier" at [[La Scala]] (preserved on DVD), Carl Battaglia wrote in "[[Opera News]]" that Carreras dominated the opera "with formidable concentration and a cleverly refined vocal accent that imparts to this spinto role an overlay of intensity lacking in his essentially lyric tenor." However, Carl H. Hiller's review of the La Scala performance in "[[Opera (magazine)|Opera]]" also noted that while in the quiet phrases of the score "he could display all the tonal mellowness of which this perhaps most beautiful tenor voice of our time is capable", he had difficulty with the high loud notes, which sounded strained and uneasily produced.

Recordings.

Complete operas.

This list is a representative selection of notable commercial recordings from the peak years of José Carreras's career. He has an extremely large discography and videography, which also includes many performances preserved on private recordings.

External links.

[[Category:José Carreras| ]] [[Category:1946 births]] [[Category:Living people]] [[Category:Catalan opera singers]] [[Category:Spanish male singers]] [[Category:Spanish operatic tenors]] [[Category:20th-century opera singers]] [[Category:Spanish Roman Catholics]] [[Category:Grammy Award winners]] [[Category:Commanders Crosses of the Order of Merit of the Federal Republic of Germany]] [[Category:Commandeurs of the Ordre des Arts et des Lettres]] [[Category:Chevaliers of the Légion d'honneur]]  [[Category:Knights Grand Cross of the Order of Merit of the Italian Republic]] [[Category:Recipients of the Grand Decoration for Services to the Republic of Austria]] [[Category:Recipients of the Bavarian Order of Merit]]  [[Category:Cancer survivors]] [[Category:Conservatori Superior de Música del Liceu alumni]] [[Category:Honorary Members of the Royal Academy of Music]] [[Category:Singers from Barcelona]] [[Category:Sony Classical Records artists]] [[Category:The Three Tenors]]

Josep Maria Carreras i Coll (; born 5 December 1946), better known as José Carreras (, ), is a Spanish tenor who is particularly known for his performances in the operas of Verdi and Puccini.

Josep Carreras (* 5. prosince 1946 v Barceloně, Katalánsko, Španělsko), známější jako José Carreras, je známý španělský operní pěvec-tenorista, proslavený svými interpretacemi děl Giuseppe Verdiho a Giacoma Pucciniho. Slávu získal díky své účasti mezi "Los Tres Tenores" ("Tři tenoři") společně s Plácidem Domingem a Lucianem Pavarottim.


Natural shade.

The perception of tooth colour is multi-factorial. Reflection and absorption of light by the tooth can be influenced by a number of factors including specular transmission of light through the tooth; specular reflection at the surface; diffuse light reflection at the surface; absorption and scattering of light within the dental tissues; enamel mineral content; enamel thickness; dentine colour, the human observer, the fatigue of the eye, the type of incident light, and the presence of extrinsic and intrinsic stains. Additionally, the perceived brightness of the tooth can change depending on the brightness and colour of the background.  The combination of intrinsic colour and the presence of extrinsic stains on the tooth surface influence the colour and thus the overall appearance of teeth. The scattering of light and absorption within enamel and dentine determine the intrinsic colour of teeth and because the enamel is relatively translucent, the dentinal properties can play a major role in determining the overall tooth colour. On the other hand, extrinsic stain and colour is the result of coloured regions that have formed within the acquired pellicle on the enamel surface and can be influenced by lifestyle behaviours or habits. For example, dietary intake of tannin-rich foods, poor tooth brushing technique, tobacco products, and exposure to iron salts and chlorhexidine can affect the colour of a tooth.  With increasing age, teeth tend to be darker in shade. This can be attributed to secondary dentin formation and thinning of enamel due to tooth wear which contributes to a significant decrease in lightness and increase in yellowness. Tooth shade is not influenced by gender or race.

Staining and discolouration.

Tooth discolouration and staining is primarily due to two sources of stain: intrinsic and extrinsic (see Figure 2). In essence, tooth whitening primarily targets those intrinsic stains in which cannot be removed through mechanics such as a debridement (clean) or prophylaxis, in the dental office. Below explains in-depth the differences between the two sources of which contribute to such discolouration of the tooth's surface.

Extrinsic staining.

Extrinsic staining, is largely due to environmental factors including smoking, pigments in beverages and foods, antibiotics, and metals such as iron or copper. Coloured compounds from these sources are adsorbed into acquired dental pellicle or directly onto the surface of the tooth causing a stain to appear.

Removal of extrinsic staining.

Extrinsic staining may be removed through various treatment methods:

Intrinsic staining.

Intrinsic staining primarily occurs during the tooth development either before birth or at early childhood. Intrinsic stains are those that cannot be removed through mechanical measures such as debridement or a prophylactic stain removal. As the age of the person increases, the teeth can also appear yellower over time. Below are examples of intrinsic sources of stains:

Methods.

Prior to proceeding to tooth whitening alternatives, it is advised that the patient comes into the dental office to have a comprehensive oral examination that consists of a full medical, dental, and social history. This will allow the clinician to see if there is any treatment that needs to be done such as restorations to remove caries, and to assess whether or not the patient will be a good candidate to have the whitening done. The clinician would then debride (clean) the tooth surface with an ultrasonic scaler, hand instruments, and potentially a prophy paste to remove extrinsic stains as mentioned above. This will allow a clean surface for maximum benefits of whichever tooth whitening method the patient chooses. Below will discuss the various types of tooth whitening methods including both internal application of bleaching and external application through the use of bleaching agents.

In-office.

Before the treatment, the clinician should examine the patient: taking a health and dental history (including allergies and sensitivities), observe hard and soft tissues, placement and conditions of restorations, and sometimes x-rays to determine the nature and depth of possible irregularities. If this is not completed prior to the whitening agents being applied to the tooth surface, excessive sensitivity and other complications may occur.  The whitening shade guides are used to measure tooth colour. These shades determine the effectiveness of the whitening procedure, which may vary from two to seven shades. These shades may be reached after a single in office appointment, or may take longer, depending on the individual. The effects of bleaching can last for several months, but may vary depending on the lifestyle of the patient. Consuming tooth staining foods or drinks that have a strong colour may compromise effectiveness of the treatment. These include food and drinks containing tannins such as; coffee, tea, red wines, and curry.  In-office bleaching procedures generally use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10% and 44% carbamide peroxide, which is roughly equivalent to a 3% to 16% hydrogen peroxide concentration. The legal percentage of hydrogen peroxide allowed to be given is 0.1–6%. Bleaching agents are only allowed to be given by dental practitioners, dental therapists, and dental hygienists.  Bleaching is least effective when the original tooth color is grayish and may require custom bleaching trays. Bleaching is most effective with yellow discolored teeth. If heavy staining or tetracycline damage is present on a patient's teeth, and whitening is ineffective (tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer), there are other methods of masking the stain. Bonding, which also masks tooth stains, is when a thin coating of composite material is applied to the front of a person's teeth and then cured with a blue light. A veneer can also mask tooth discoloration.  In-chair whitening is faster and more effective in comparison to the take-home bleaching options. Some clinicians also make custom bleaching trays for you, which can take up to a week to create, so that after the whitening treatment is completed, you are able to use these trays in the future for maintenance of your bleaching with at home kits or for the use of desensitising products.

Light-accelerated bleaching.

Power or light-accelerated bleaching uses light energy which is intended to accelerate the process of bleaching in a dental office. Different types of energy can be used in this procedure, with the most common being halogen, LED, or plasma arc. Use of light during bleaching increases the risk of tooth sensitivity and may not be any more effective than bleaching without light when high concentrations of hydrogen peroxide are used. A 2015 study showed that the use of a light activator does not improve bleaching, has no measurable effect, and rather is likely to increase the temperature of the associated tissues, resulting in damage.  The ideal source of energy should be high energy to excite the peroxide molecules without overheating the pulp of the tooth. Lights are typically within the blue light spectrum as this has been found to contain the most effective wavelengths for initiating the hydrogen peroxide reaction. A power bleaching treatment typically involves isolation of soft tissue with a resin-based, light-curable barrier, application of a professional dental-grade hydrogen peroxide whitening gel (25–38% hydrogen peroxide), and exposure to the light source for 6–15 minutes. Recent technical advances have minimized heat and UV emissions, allowing for a shorter patient preparation procedure.  For any whitening treatments, it is recommended that a comprehensive examination of the patient is done including the use of radiographs to aid in the diagnosis of the current condition of the mouth, including any allergies that may be present. The patient will need to have a healthy mouth and free of periodontal disease or caries and to have had a debridement/clean done to remove any tartar or plaque build up.  It is recommended to avoid smoking, drinking red wine, eating or drinking any deeply coloured foods after this as the teeth may stain considerably straight after treatment.

Nanoparticle catalysts for reduced hydrogen peroxide concentration.

A recent addition to the field is new light-accelerated bleaching agents containing lower concentrations of hydrogen peroxide with a titanium oxide nanoparticle-based catalyst. Reduced concentrations of hydrogen peroxide cause lower incidences of tooth hypersensitivity. The nanoparticles act as photocatalysts, and their size prevents them from diffusing deeply into the tooth. When exposed to light, the catalysts produce a rapid, localized breakdown of hydrogen peroxide into highly reactive radicals. Due to the extremely short lifetimes of the free radicals, they are able to produce bleaching effects similar to much higher concentration bleaching agents within the outer layers of the teeth where the nanoparticle catalysts are located. This provides effective tooth whitening while reducing the required concentration of hydrogen peroxide and other reactive byproducts at the tooth pulp.

Internal bleaching.

Internal bleaching is a process which occurs after a tooth has been endodontically treated. This means that the tooth will have had the nerve of the tooth extirpated or removed through a root canal treatment at the dentist or by a specialist endodontist. Internal bleaching is often sought after in teeth which have been endodontically treated as tooth discolouration becomes a problem due to the lack of nerve supply to that tooth. It is common to have this internal bleaching done on an anterior tooth (a front tooth that you can see when smiling and talking). A way around this is by sealing off the bleaching agent inside the tooth itself and replacing it every few weeks until the desired shade has been achieved. The amount of time between appointments varies from patient to patient and with operator preference until the desired shade has been achieved. Even though this is a great option, the disadvantage of this treatment is a risk of internal root resorption of the tooth that is being internally bleached. This may not occur in every patient or every tooth, and its occurrence is difficult to determine prior to completing the treatment.

At home.

At home tooth whitening products are available from dentists or 'over the counter' (OTC). At home whitening methods include over-the-counter strips and gels, whitening rinses, whitening toothpastes, and tray-based tooth whiteners. OTC products can be used for milder cases of tooth staining. Home-based bleaching (following manufacturer's instructions) results in less tooth sensitivity than in-office bleaching.

Strips and gels.

The plastic whitening strips contain a thin layer of peroxide gel and are shaped to fit the buccal/labial surfaces of teeth. Many different types of whitening strips are available on the market, after being introduced in the late 1980s. Specific whitening strip products have their own set of instructions however the strips are typically applied twice daily for 30 minutes for 14 days. In several days, tooth colour can lighten by 1 or 2 shades. The tooth whitening endpoint does depend on the frequency of use and ingredients of the product.  Whitening gels are applied onto the tooth surface with a small brush. The gels contain peroxide and are recommended to be applied twice a day for 14 days. The tooth whitening endpoint like that of the whitening strips.

Rinses.

Whitening rinses work by reaction of the oxygen sources such as hydrogen peroxide within the rinse and the chromogens on or within the tooth. It is recommended to use twice a day, rinsing for one minute. To see an improvement in shade colour, it can take up to three months.

Toothpastes.

Whitening toothpastes differ from regular toothpastes in that they contain higher amounts of abrasives and detergents to be more effective at removing tougher stains. Some whitening toothpastes contain low concentrations of carbamide peroxide or hydrogen peroxide which help lighten tooth colour however they do not contain bleach (sodium hypochlorite). With continuity of use over time, tooth colour can lighten by one or two shades.

Tray-based.

Tray-based tooth whitening is achieved by wearing a fitted tray containing carbamide peroxide bleaching gel overnight or for two to four hours a day. If manufacturer's instructions are followed, tooth whitening can occur within three days and lighten teeth by one or two shades. This type of tooth whitening is available over-the-counter and professionally from an oral health professional.

Baking soda.

Baking soda is a safe, low abrasive, and effective stain removal and tooth whitening toothpaste. Tooth whitening toothpaste that have excessive abrasivity are harmful to dental tissue, therefore baking soda is a desirable alternative. To date, clinical studies on baking soda report that there have been no reported adverse effects. It also contains acid-buffering components that makes baking soda biologically antibacterial at high concentrations and capable of preventing growth of "Streptococcus mutans." Baking soda might be useful for caries-prone patients as well as those who wish to have whiter teeth.

Indications.

Tooth whitening may be undertaken for a variety of reasons, but whitening may also be recommended to some individuals by dental professionals.

Contraindications.

Some groups are advised to carry out tooth whitening with caution as they may be at higher risk of adverse effects.

Risks.

Some of the common side effects involved in teeth whitening are increased sensitivity of the teeth, gum irritation, and extrinsic teeth discolouration.

Hypersensitivity.

The use of bleach with extremely low pH levels in the tooth whitening procedure may lead to hypersensitive teeth, as it causes the dentinal tubules to open. Exposure to cold, hot, or sweet stimuli may further exacerbate the intensity of the hypersensitive response. Amongst those who receive in-office whitening treatment, between 67–78% of the individuals experience sensitivity after the procedure where hydrogen peroxide and heat is utilised. Although it varies from person to person, sensitivity after whitening treatment can last up to 4–39 days.  Potassium nitrate and sodium fluoride in toothpastes are used to ease discomfort following bleaching, however, there is no evidence to suggest that this is a permanent method to eradicate the issue of hypersensitivity.

Irritation of mucous membranes.

Hydrogen peroxide is an irritant and cytotoxic. Hydrogen peroxide with concentrations of 10% or higher can cause tissue damage, be corrosive to mucous membranes and cause burning sensation to the skin. Chemical burns can commonly occur whilst bleaching, irritation and discolouration of the mucous membranes may occur if a high concentration of oxidising agent comes in to contact with unprotected tissue. Poorly fitting bleaching trays are amongst the most common reasons for chemical burns. The temporary burning induced by whitening treatments can be reduced by using custom-made plastic trays or nightguards provided by the dental professional. This prevents the leakage of solution onto the surrounding mucosa.

Uneven results.

Uneven results are quite common after bleaching. Consuming less foods and drinks that cause surface staining of teeth can contribute to attaining a good result from tooth whitening.

Return to original pre-treatment shade.

Nearly half the initial change in colour provided by an intensive in-office treatment (i.e., one hour treatment in a dentist's chair) may be lost in seven days. Rebound is experienced when a large proportion of the tooth whitening has come from tooth dehydration (also a significant factor in causing sensitivity). As the tooth rehydrates, tooth colour "rebounds", back toward where it started.

Over-bleaching.

Over-bleaching, more often known as the "bleached effect", occurs among treatments that promise a large change over a short period of time e.g., hours. Over-bleaching can emit a translucent and brittle appearance.

Damage to enamel.

Teeth enamel can have an adverse negative effect by whitening treatment. Evidence from studies show that carbamide peroxide present in whitening gels can damage the enamel surface. Although this effect is not as damaging as phosphoric acid etch, the increased irregularity of the teeth surface makes the teeth more susceptible to extrinsic staining, thus having an increased detrimental effect on the aesthetics. The increased porosity and changes in surface roughness may have an impact on the formation of supra- and subgingival plaque, thus increasing the adhesion of bacterial species such as "Streptococcus mutans and Streptococcus sobrinus," significant contributors to dental caries. Dental restorations are susceptible to unacceptable colour change even when using the home-based systems.

Weakened dentine.

Intracoronal bleaching is a tooth whitening method that uses 30% more hydrogen peroxide. Such tooth whitening methods can weaken the mechanical properties of dentine and could potentially lead to severe tooth sensitivity.

Effects on existing restorations.

Dental restorations are susceptible to unacceptable colour change even when using the home-based systems.  Ceramic Crowns – aggressive bleaching can chemically react with ceramic crowns and reduce their stability.  Dental amalgam – exposure to carbamide peroxide solutions increase mercury release for one to two days. The release of amalgam components is said to be due to active oxidation. This increase in amalgam mercury release is proportional to the concentration of carbamide peroxide.  Resin composite – bond strength between enamel and resin based fillings become weakened. Many studies have found that 10-16% carbamide peroxide tooth bleaching gels (containing approximately 3.6-5.76% hydrogen peroxide) leads to an increase in the surface roughness and porosity of composite resins. However, the saliva may exert a protective effect. In addition, changes in the reflectance of the composite have been analysed following whitening with high concentration (30-35%) hydrogen peroxide. This suggests that tooth whitening negatively impacts composite resin restorations.  Glass ionomer and other cements – studies suggest that solubility of these materials may increase.

Bleachorexia.

Bleachorexia is the term that is used to describe an individual that develops an unhealthy obsession with teeth whitening. This condition is similar to body dysmorphic disorder. The characteristics of bleachorexia are the continuous use of whitening products even though the teeth cannot possibly become whiter, despite the provision of repeated treatment. A person with bleachorexia will continually seek out for different whitening products, hence, it is recommended that a target shade is agreed upon before starting the treatment procedure to help with this problem.

Home teeth whitening risks.

The use of personalised home whitening trays is a patient administered therapy that is prescribed and dispensed by a dentist. Patients need to actively participate in their treatment and follow the guidelines given by the dentist accurately. Erratic or inaccurate use of the bleaching trays could cause harm to the patient such as blistering or sensitivity of the teeth and the surrounding soft tissue. Inconsistent use of the bleaching trays can lead to the slowing and irregularity of the whitening process. Some patients with a substantial gag reflex may not be able to tolerate the trays and would need to consider other methods of teeth whitening.

Other risks.

Evidence suggests that hydrogen peroxide might act as a tumour promoter. Although cervical root resorption is more evidently observed in thermocatalytic bleaching methods, intracoronal internal bleaching may also lead to tooth root resorption. Moreover, severe damage to intracoronal dentine and tooth crown fracture can occur due to this bleaching method.  However, the International Agency of Research on Cancer (IARC) has concluded that there is insufficient evidence to prove that hydrogen peroxide is a carcinogen to humans. Recently, the genotoxic potential of hydrogen peroxide was evaluated. The results indicated that the oral health products that contain or release hydrogen peroxide up to 3.6% will not increase the cancerous risk of an individual, hence, it is safe to use in moderation.

Maintenance.

Despite achieving the results of treatment, stains can return within an initial couple of months of treatment. Various methods may be employed to prolong the treatment results, such as:

History.

Teeth whitening remedies have been present since ancient times. Despite seeming absurd, some methods were somewhat effective in their results.  The Ancient Romans believed in using urine with goat milk to make their teeth look whiter. Pearly white teeth symbolized beauty and marked wealth. In the Auyrveda medicine system, oil pulling was used as an oral therapy. For this process today, swish coconut or olive oil in your mouth for up to 20 minutes each day. In the late 17th century, many people reached out to barbers, who used a file to file down the teeth before applying an acid that would, in fact, whiten the teeth. Although the procedure was successful, the teeth would become completely eroded and more prone to becoming decayed. Guy de Chauliac suggested the following to whiten the teeth: "Clean the teeth gently with a mixture of honey and burnt salt to which some vinegar has been added." In 1877, oxalic acid was proposed for whitening, followed by calcium hypochlorite.  In the late 1920s, mouthwash containing pyrozone (ether peroxide) was found to reduce caries while providing a whiter appearance to the teeth. By 1940s and 1950s, ether and hydrogen peroxide gels were used to whiten vital teeth, whereas non-vital teeth were whitened using pyrozone and sodium perborate.  In the late 1960s, Dr William Klusmeier, an Orthodontist from Fort Smith, Arkansas, introduced the custom tray bleaching. However, it was not until 1989 when Haywood and Heymann published an article that supported this method. Carbamide peroxide with a shelf life of one to two years, as opposed to hydrogen peroxide with a shelf life one to two months, was seen as a more stable agent for whitening teeth.

Society and culture.

Teeth whitening has become the most promoted and mentioned methodology in cosmetic dentistry. In excess of 100 million Americans brighten their teeth using different methods; spending $15 billion in 2010. The US Food and Drug Administration only endorses gels that are under 6% hydrogen peroxide or 16% or less of carbamide peroxide. The Scientific Committee on Consumer Safety of the EU consider gels containing higher fixations can be dangerous.  As per European Council guidelines, only a certified dental professional can lawfully give tooth whitening products utilizing 0.1–6% hydrogen peroxide, provided the patient is 18 years of age or older. In 2010, the UK General Dental Council became concerned of the "risk to patient safety from poor quality tooth whitening being carried out by untrained or poorly trained staff." A public attitudes survey, conducted by the GDC, showed that 83% of people support "policies of regulating tooth whitening to protect patient safety and prosecuting illegal practice." A group of dental professionals and associations called The Tooth Whitening Information Group (TWIG) was founded to advance protected and beneficial tooth whitening information and assistance to the general population. Reports can be made to the TWIG through their website with respect to any individual giving unlawful tooth whitening services, or if an individual has personally undergone treatment done by a non-dental professional.  In Brazil, all whitening items are classed as cosmetics (Degree II). There are worries that this will bring about increasing abuse of whitening products and thus there have been calls for reanalysis.  According to research, tooth whitening can produce positive changes in young participants’ Oral Health Related Quality of Life (OHRQoL) in aesthetic areas such as smiling, laughing, and showing teeth without embarrassment. However, its main side-effect, tooth sensitivity, does negatively affect quality of life.

The process of tooth whitening lightens the colour of a tooth. Tooth whitening can be achieved by either changing the intrinsic colour or by removing and controlling the formation of extrinsic stains. The chemical degradation of the chromogens within or on the tooth is termed as bleaching. Hydrogen peroxide () is the active ingredient most commonly used in whitening products and is delivered as either hydrogen peroxide or carbamide peroxide. Hydrogen peroxide is analogous to carbamide peroxide as it is released when the stable complex is in contact with water. When it diffuses into the tooth, hydrogen peroxide acts as an oxidising agent that breaks down to produce unstable free radicals. In the spaces between the inorganic salts in tooth enamel, these unstable free radicals attach to organic pigment molecules resulting in small, less heavily pigmented components. Reflecting less light, these smaller molecules create a "whitening effect". There are different products available on the market to remove stains. For whitening treatment to be successful, dental professionals should correctly diagnose the type, intensity and location of the tooth discolouration. Time exposure and the concentration of the bleaching compound, determines the tooth whitening endpoint.

Bělení zubů označuje metody, kterými se z estetických důvodů upravují zuby tak, aby jejich barva byla bělejší. Již staří Římané dbali na zabarvení svých zubů. Zuby se dříve snažili brousit například popelem. V dnešní době se používá najemno rozemletý perlit nebo vápenec, který se přidává do bělících zubních past. Tato metoda ovšem zuby nebělí, protože neodbarvuje pigmenty v zubu usazené, ale pouze mechanicky obrušuje zubní usazeniny na povrchu zubu. Dokáže navrátit přirozenou barvu zubu, avšak řada lidí tento efekt nepovažuje za dostatečný.


Geography.

The town of Zwiesel is situated in an extensive valley basin at the foot of the mountain range formed by the peaks of the Großer Arber (1,456 m), Großer Falkenstein (1,315 m) and Kiesruck (1,265 m), exactly at the spot where the two rivers, the Großer Regen and the Kleiner Regen join and form the Black Regen. It is located 10 km to the north-east of the district town of Regen, 35 km from the town of Deggendorf, 30 km from the town of Grafenau and 15 km from the border crossing point at Bayerisch Eisenstein, entry point to the Czech Republic. In addition to be accessed by the federal road B11, the town of Zwiesel has a main railway station run by the Bavarian Forest Railway, where trains depart for Plattling, Bayerisch Eisenstein or Bodenmais at hourly intervals, and for Grafenau at two-hour intervals.

Division of the town.

Zwiesel consists of 11 districts:

Mineralogy.

In the area of Zwiesel a great diversity of mineralogical compositions can be found and especially the glass manufacturing companies benefited from the outstanding amount of quartz. The most famous mining site is probably the quartz quarry at the mountain "Hennenkobel" (the name translates as chicken coop) where many rare and popular minerals were found. The mineral Zwieselite, which can be found there, was named after the glass town of Zwiesel.

History.

The town hall built in 1838 According to the legend, the first settlers were gold diggers. It was in 1255 that Zwiesel was first mentioned as a village with a wooden chapel. In 1280 the area was an important trading centre for goods to and from Bohemia. From the year 1313 on, Zwiesel was already designated to as a market municipality. On 11 September 1560, the municipality of Zwiesel was granted the coat of arms by the Duke of Bavaria, Albrecht V., which is valid still today. Philipp Apian indicated the place on his map of 1568 calling it "Zwisel".  The development of Zwiesel was frequently hampered by wars and epidemic plagues. I.e. the area was destroyed in 1431 by the Hussites, in 1468 during the "Böckler" war and in 1633 by the Swedish army during the Thirty Years' War. In 1741 it was invaded by the Pandurs and in 1809 there was a great battle at the "Landwehrbergl" against a horde of Bohemian plunderers.  It was as early as in the 16th century that mining started in Zwiesel at the Rotkot mine. In 1767 another church was built, known as "Bergkirche", and in 1838 the present town hall was constructed. Serious fires were raging in the municipality in the years 1825, 1832, 1846, 1849 and 1870. With the latter fire, on 19 August 1876, the parish church burst into flames too. Water pipes were laid in 1888, electricity was available from 1896. In the years between 1891 and 1896 the main parish church Staint Nicholas was built. In 1904 Zwiesel was raised to the status of a town and quickly became the economic and cultural centre of the middle part of the Bavarian Forest.  From the very beginning development was driven by glass and timber.The regional glass industry around Zwiesel dates back to the 15th century (the glass hut of Rabenstein was founded in 1421). In 1836 the glass factory of Theresienthal was founded and in 1872 the master glass maker, Anton Müller, started to build the glass works Annathal, which later became the Schott-Werke. Today this factory operates under the name of Zwiesel Kristallglas plc. and is an important producer of goblets in Germany. In 1904 the technical school for glass manufacturing and decorating professions was founded, which continuously developed into a national training centre for glass related professions.  At the end of World War II, at noon on 20 April 1945, the bombing of the railway bridges destroyed several houses, 15 civilians lost their lives. On 22 April 1945 Zwiesel was handed over to the American army without any further bloodshed. An outstanding event in recent town history was the Bavarian State Exhibition Bavaria - Bohemia: 1500 years of neighbourhood. Many visitors of the exhibition also came from the neighbouring Czech Republic.

Etymology.

The name of the town was mentioned in 1254 as "Zwisel", soon after in 1301 as "Zwiseln", in 1738 as "Zwisl" and in 1832 as "Zwiesel" or "Zwisel". The Middle High German word "zwisel" means "fork" and refers to the merging of the rivers Großer Regen and Kleiner Regen as well as to a junction of streets.

Incorporations.

In the course of regional reforms the community of Klautzenbach was incorporated on 1 October 1971. On 1 January 1978 the larger part of the community of Rabenstein was added, too. The community of Bärnzell spanning over 1250 hectares with 652 inhabitants living there, was incorporated on 1 May 1978.  As early as in the year 1356, the place had an own pastoral worker who was subordinated as vicar to the priest of the town of Regen. In 1558 the branch was raised to the status of a parish. From 1962 there is also the Augustinian monastery Maria Trost (OSA) which was founded by monks of the Sudetenland and which belongs to the Vicariate of Vienna. As a consequence of the Bavarian Edict of Religion of the year 1803 issued by Elector Maximilian, Protestant Christians started settling in Zwiesel. In 1885 the Evangelic Association Zwiesel was founded and achieved that in 1889 a location for a traveling priest was established in Zwiesel. On 29 May 1895 the neo-Gothic church in the Bahnhofstraße (today renamed in Dr.-Schott-Straße) was inaugurated. In 1922 the Protestant church in Zwiesel was raised to the status of parish. A New Apostolic Community with its own church house was also established in Zwiesel.

Demographic development.

In the year of 1800 Zwiesel had 803 inhabitants living in 140 houses. As early as in 1810 the one thousandth inhabitant could be counted. In 1867 the market municipality of Zwiesel had 2,303 inhabitants living in 243 houses. By 1900 the number of inhabitants had increased to 3,760 with 333 houses. After World War II the number increased to 5885 inhabitants. The highest level was reached in the year 1984 with 10,670 people registered. Currently 9,257 people live in the town of Zwiesel and its surrounding neighbourhoods.

Politics.

Town Council.

Since the latest local election on 16 March 2014 the Town Council of Zwiesel is formed as follows:

Mayor.

Since the 13 February 2011 Franz Xaver Steininger has been the First Mayor (independent). He was elected the new mayor in the second ballot with 60,57 % of the votes. He was reelected in December 2016 with 55,4 % of the votes.

Twin towns.

Since May 2006 the Glass town of Zwiesel has maintained an official town twinning with the port town of Brake (Lower Saxony) at the river Weser. Brake is approximately 800 km from Zwiesel.

Economy.

Glass making, brewing, and tourism are the most important industries in the town.

Zwiesel is a town located in the lower-Bavarian district of Regen, and since 1972 is a state-approved health resort with particularly good air. The name of the town was derived from the Bavarian word stem "zwisl" which refers to the form of a fork. The fork of the rivers Großer Regen and Kleiner Regen and the land that lies between these two rivers were called Zwiesel.

Zwiesel (česky "Svízel") je město v dolnobavorském okrese Regen. Od roku 1972 se řadí mezi státem uznané klimatické lázně. Pojmenování města bylo odvozeno od kořene bajuvarského slova „zwisl“, který označuje rozvětvení. Území nacházející se mezi dvěma řekami Großer Regen (Velká Řezná) a Kleiner Regen (Malá Řezná) bylo pojmenováno Zwiesel.


First generation (NA1, NA2; 1990–2005).

The NSX was designed by a team led by Chief Designer Masahito Nakano and Executive Chief Engineer Shigeru Uehara. It benefited from advanced aerodynamics and styling inspired by a F-16 fighter jet cockpit and input from the late Formula One World Champion, Ayrton Senna, during the final development stages.  This NSX became the world's first mass-produced car to feature an all-aluminium body. It was powered by an all-aluminium 3.0 L V6 engine, which featured Honda's VTEC (Variable Valve Timing and Lift Electronic Control) system developed in the 1980s, a 5-speed manual transmission, or starting in 1994 the SportShift 4-speed automatic transmission, also known as F-Matic, which allows the option of conventional automatic shifting or manually shifting with a fingertip shift lever on the steering column. It was presented at the 1989 Chicago Auto Show and was built in a purpose-made factory in Japan, for sale from 1990. It was originally available as a coupé and, from 1995, a targa top. It underwent a performance upgrade in 1997, which saw the arrival of a larger 3.2 L V6 engine, and a facelift in 2002 before being discontinued in 2005. North American models were sold as the Acura NSX.  Cars with the 3.0 L C30A engine are referred to as NA1 models, while the 3.2 L C32B engined cars are known as NA2 models.

Second generation (NC1; 2016–present).

In December 2007, Acura announced plans to launch a NSX successor by 2010, based on the styling of the front V10-engined Acura ASCC (Advanced Sports Car Concept). Despite prototypes being tested for production, just a year later, Honda announced that plans had been canceled due to poor economic conditions. Instead, in March 2010, Honda unveiled the HSV-010 GT for participation in the Japanese SuperGT Championship. This car never reached production as a street-legal car.  Reports that Honda was again developing a successor to the NSX reemerged in April 2011. By December 2011, Honda officially announced a second generation NSX concept, which was unveiled the following month at the 2012 North American International Auto Show as the Acura NSX Concept.  The production model was displayed three years later at the 2015 North American International Auto Show, for sale in 2016. Although the original name was retained, this time it was defined as "New Sports eXperience". Unlike the first generation NSX which was manufactured in Japan, the new NSX was designed and engineered in Marysville, Ohio, at Honda's plant, led by chief engineer Ted Klaus.  The new NSX is a hybrid sports car powered by 3.5 L twin-turbocharged V6 engine and three electric motors, two of which form part of the "SH-AWD" all wheel drive drivetrain, altogether capable of close to 600 hp. The transmission is a 9-speed dual-clutch automatic. Its body utilizes a space frame design—which is made from aluminum, ultra-high-strength steel, and other rigid and lightweight materials, some of which are the world's first applications.  The first production vehicle with VIN #001 was auctioned off by Barrett Jackson on 29 January 2016. NASCAR team owner Rick Hendrick won the auction with a bid for. The entire bid was donated to the charities Pediatric Brain Tumor Foundation and Camp Southern Ground. The first NSX rolled off the line in Ohio on 27 May 2016. Hendrick was there to drive it off. The first sales of the new NSX in the US were registered in June 2016.

The Honda NSX, marketed in North America as the Acura NSX, is a two-seat, mid-engine sports car manufactured by Honda.

Honda NSX je sportovní automobil (v Severní Americe prodávaný pod názvem Acura NSX), který byl určen především pro americký trh, kde byla tato Honda dost úspěšná a oblíbená. Díky výkonnému motoru a zadnímu pohonu kol poskytovala skutečné sportovní zážitky. V Česku je tento model málokdy k vidění. K dispozici byla také verze s označením NSX-T s odnímatelným střešním panelem. Na finálním nastavení vozu se podílel sám Ayrton Senna.


Signs and symptoms.

People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterwards. The severity of these symptoms depends on the person, the type of trauma involved, and the emotional support they receive from others. The range of reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.  After a traumatic experience, a person may re-experience the trauma mentally and physically, hence trauma reminders, also called triggers, can be uncomfortable and even painful. Re-experiencing can damage people's sense of safety, self, self-efficacy, as well as their ability to regulate emotions and navigate relationships. They may turn to psychoactive substances including alcohol to try to escape or dampen the feelings. These triggers cause flashbacks, which are dissociative experiences where the person feels as though the events are recurring. Flashbacks can range from distraction to complete dissociation or loss of awareness of the current context. Re-experiencing of symptoms is a sign that the body and mind are actively struggling to cope with the traumatic experience.  Triggers and cues act as reminders of the trauma and can cause anxiety and other associated emotions. Often the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive behaviors or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.  Consequently, intense feelings of anger may frequently surface, sometimes in inappropriate or unexpected situations, as danger may always seem to be present due to re-experiencing past events. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. Trauma doesn't only cause changes in one's daily functions, but could also lead to morphological changes. Such epigenetic changes can be passed on to the next generation, thus making genetics one of the components of psychological trauma. However, some people are born with or later develop protective factors such as genetics and sex that help lower their risk of psychological trauma.  The person may not remember what actually happened, while emotions experienced during the trauma may be re-experienced without the person understanding why (see Repressed Memory). This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the subject from gaining perspective on the experience. This can produce a pattern of prolonged periods of acute arousal punctuated by periods of physical and mental exhaustion. This can lead to mental health disorders like acute stress and anxiety disorder, traumatic grief, undifferentiated somatoform disorder, conversion disorders, brief psychotic disorder, borderline personality disorder, adjustment disorder, etc.  In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, as well as dissociation or "numbing out" can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. Dissociation includes depersonalisation disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, etc. Exposure to and re-experiencing trauma can cause neurophysiological changes like slowed myelination, abnormalities in synaptic pruning, shrinking of the hippocampus, cognitive and affective impairment. This is significant in brain scan studies done regarding higher order function assessment with children and youth who were in vulnerable environments.  Some traumatized people may feel permanently damaged when trauma symptoms do not go away and they do not believe their situation will improve. This can lead to feelings of despair, transient paranoid ideation, loss of self-esteem, profound emptiness, suicidality, and frequently, depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question. Often despite their best efforts, traumatized parents may have difficulty assisting their child with emotion regulation, attribution of meaning, and containment of post-traumatic fear in the wake of the child's traumatization, leading to adverse consequences for the child. In such instances, seeking counselling in appropriate mental health services is in the best interests of both the child and the parent(s).

Causes.

Situational trauma.

Trauma can be caused by man-made, technological and natural disasters, including war, abuse, violence, mechanized accidents (car, train, or plane crashes, etc.) or medical emergencies.  Responses to psychological trauma: Response to psychological trauma can be varied based on the type of trauma, as well as socio-demographic and background factors. There are several behavioral responses common towards stressors including the proactive, reactive, and passive responses. Proactive responses include attempts to address and correct a stressor before it has a noticeable effect on lifestyle. Reactive responses occur after the stress and possible trauma has occurred and are aimed more at correcting or minimizing the damage of a stressful event. A passive response is often characterized by an emotional numbness or ignorance of a stressor.  Those who are able to be proactive can often overcome stressors and are more likely to be able to cope well with unexpected situations. On the other hand, those who are more reactive will often experience more noticeable effects from an unexpected stressor. In the case of those who are passive, victims of a stressful event are more likely to suffer from long-term traumatic effects and often enact no intentional coping actions. These observations may suggest that the level of trauma associated with a victim is related to such independent coping abilities.  There is also a distinction between trauma induced by recent situations and long-term trauma which may have been buried in the unconscious from past situations such as childhood abuse. Trauma is sometimes overcome through healing; in some cases this can be achieved by recreating or revisiting the origin of the trauma under more psychologically safe circumstances, such as with a therapist.

In psychoanalysis.

French neurologist, Jean-Martin Charcot, argued in the 1890s that psychological trauma was the origin of all instances of the mental illness known as hysteria. Charcot's "traumatic hysteria" often manifested as a paralysis that followed a physical trauma, typically years later after what Charcot described as a period of "incubation". Sigmund Freud, Charcot's student and the father of psychoanalysis, examined the concept of psychological trauma throughout his career. Jean Laplanche has given a general description of Freud's understanding of trauma, which varied significantly over the course of Freud's career: "An event in the subject's life, defined by its intensity, by the subject's incapacity to respond adequately to it and by the upheaval and long-lasting effects that it brings about in the psychical organization".  The French psychoanalyst Jacques Lacan claimed that what he called "The Real" had a traumatic quality external to symbolization. As an object of anxiety, Lacan maintained that The Real is "the essential object which isn't an object any longer, but this something faced with which all words cease and all categories fail, the object of anxiety "par excellence"".

Stress disorders.

All psychological traumas originate from stress, a physiological response to an unpleasant stimulus. Long term stress increases the risk of poor mental health and mental disorders, which can be attributed to secretion of glucocorticoids for a long period of time. Such prolonged exposure causes many physiological dysfunctions such as the suppression of the immune system and increase in blood pressure. Not only does it affect the body physiologically, but a morphological change in the hippocampus also takes place. Studies showed that extreme stress early in life can disrupt normal development of hippocampus and impact its functions in adulthood. Studies surely show a correlation between the size of hippocampus and one's susceptibility to stress disorders. In times of war, psychological trauma has been known as shell shock or combat stress reaction. Psychological trauma may cause an acute stress reaction which may lead to post-traumatic stress disorder (PTSD). PTSD emerged as the label for this condition after the Vietnam War in which many veterans returned to their respective countries demoralized, and sometimes, addicted to psychoactive substances. The symptoms of PTSD must persist for at least a month for diagnosis. The main symptoms of PTSD consist of four main categories: trauma (i.e. intense fear), reliving (i.e. flashbacks), avoidance behavior (i.e. emotional numbing), and hypervigilance (i.e. continuous scanning of the environment for danger). Research shows that about 60% of the US population reported as having experienced at least one traumatic symptom in their lives, but only a small proportion actually develops PTSD. There is a correlation between the risk of PTSD and whether or not the act was inflicted deliberately by the offender. Psychological trauma is treated with therapy and, if indicated, psychotropic medications.  The term "continuous post traumatic stress disorder" (CTSD) was introduced into the trauma literature by Gill Straker (1987). It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression. The term is also applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services.  As one of the processes of treatment, confrontation with their sources of trauma plays a crucial role. While debriefing people immediately after a critical incident has not been shown to reduce incidence of PTSD, coming alongside people experiencing trauma in a supportive way has become standard practice.

Vicarious trauma.

Vicarious trauma affects workers who witness their clients' trauma. It is more likely to occur in situations where trauma related work is the norm rather than the exception. Listening with empathy to the clients generates feeling, and seeing oneself in clients' trauma may compound the risk for developing trauma symptoms. Trauma may also result if workers witness situations that happen in the course of their work (e.g. violence in the workplace, reviewing violent video tapes.) Risk increases with exposure and with the absence of help seeking protective factors and pre-preparation of preventive strategies.

Diagnosis.

As "trauma" adopted a more widely defined scope, traumatology as a field developed a more interdisciplinary approach. This is in part due to the field's diverse professional representation including: psychologists, medical professionals, and lawyers. As a result, findings in this field are adapted for various applications, from individual psychiatric treatments to sociological large-scale trauma management. However, novel fields require novel methodologies. While the field has adopted a number of diverse methodological approaches, many pose their own limitations in practical application.  The experience and outcomes of psychological trauma can be assessed in a number of ways. Within the context of a clinical interview, the risk of imminent danger to the self or others is important to address but is not the focus of assessment. In most cases, it will not be necessary to involve contacting emergency services (e.g., medical, psychiatric, law enforcement) to ensure the individuals safety; members of the individual's social support network are much more critical.  Understanding and accepting the psychological state an individual is in is paramount. There are many misconceptions of what it means for a traumatized individual to be in psychological crisis. These are times when an individual is in inordinate amounts of pain and incapable of self-comfort. If treated humanely and respectfully the individual is less likely to resort to self harm. In these situations it is best to provide a supportive, caring environment and to communicate to the individual that no matter the circumstance, the individual will be taken seriously rather than being treated as delusional. It is vital for the assessor to understand that what is going on in the traumatized person's head is valid and real. If deemed appropriate, the assessing clinician may proceed by inquiring about both the traumatic event and the outcomes experienced (e.g., post-traumatic symptoms, dissociation, substance abuse, somatic symptoms, psychotic reactions). Such inquiry occurs within the context of established rapport and is completed in an empathic, sensitive, and supportive manner. The clinician may also inquire about possible relational disturbance, such as alertness to interpersonal danger, abandonment issues, and the need for self-protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individual's ability to enter and sustain a clinical relationship.  During assessment, individuals may exhibit activation responses in which reminders of the traumatic event trigger sudden feelings (e.g., distress, anxiety, anger), memories, or thoughts relating to the event. Because individuals may not yet be capable of managing this distress, it is necessary to determine how the event can be discussed in such a way that will not "retraumatize" the individual. It is also important to take note of such responses, as these responses may aid the clinician in determining the intensity and severity of possible post traumatic stress as well as the ease with which responses are triggered. Further, it is important to note the presence of possible avoidance responses. Avoidance responses may involve the absence of expected activation or emotional reactivity as well as the use of avoidance mechanisms (e.g., substance use, effortful avoidance of cues associated with the event, dissociation).  In addition to monitoring activation and avoidance responses, clinicians carefully observe the individual's strengths or difficulties with affect regulation (i.e., affect tolerance and affect modulation). Such difficulties may be evidenced by mood swings, brief yet intense depressive episodes, or self-mutilation. The information gathered through observation of affect regulation will guide the clinician's decisions regarding the individual's readiness to partake in various therapeutic activities.  Though assessment of psychological trauma may be conducted in an unstructured manner, assessment may also involve the use of a structured interview. Such interviews might include the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995), Acute Stress Disorder Interview (ASDI; Bryant, Harvey, Dang, & Sackville, 1998), Structured Interview for Disorders of Extreme Stress (SIDES; Pelcovitz et al., 1997), Structured Clinical Interview for DSM-IV Dissociative Disorders- Revised (SCID-D; Steinberg, 1994), and Brief Interview for post-traumatic Disorders (BIPD; Briere, 1998).  Lastly, assessment of psychological trauma might include the use of self-administered psychological tests. Individual scores on such tests are compared to normative data in order to determine how the individual's level of functioning compares to others in a sample representative of the general population. Psychological testing might include the use of generic tests (e.g., MMPI-2, MCMI-III, SCL-90-R) to assess non-trauma-specific symptoms as well as difficulties related to personality. In addition, psychological testing might include the use of trauma-specific tests to assess post-traumatic outcomes. Such tests might include the post-traumatic Stress Diagnostic Scale (PDS; Foa, 1995), Davidson Trauma Scale (DTS: Davidson et al., 1997), Detailed Assessment of post-traumatic Stress (DAPS; Briere, 2001), Trauma Symptom Inventory (TSI: Briere, 1995), Trauma Symptom Checklist for Children (TSCC; Briere, 1996), Traumatic Life Events Questionnaire (TLEQ: Kubany et al., 2000), and Trauma-related Guilt Inventory (TRGI: Kubany et al., 1996).  Children are assessed through activities and therapeutic relationship, some of the activities are play genogram, sand worlds, coloring feelings, self and kinetic family drawing, symbol work, dramatic-puppet play, story telling, Briere's TSCC, etc.

Definition.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines trauma as direct personal experience of an event that involves actual or threatened death or serious injury; threat to one's physical integrity, witnessing an event that involves the above experience, learning about unexpected or violent death, serious harm, or threat of death, or injury experienced by a family member or close associate. Memories associated with trauma are typically explicit, coherent, and difficult to forget. The person's response to aversive details of traumatic event involves intense fear, helplessness or horror. In children it is manifested as disorganized or agitative behaviors.  Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person's core assumptions about the world and their human rights, putting the person in a state of extreme confusion and insecurity. This is seen when institutions depended upon for survival violate, humiliate, betray, or cause major losses or separations instead of evoking aspects like positive self worth, safe boundaries and personal freedom.  Psychologically traumatic experiences often involve physical trauma that threatens one's survival and sense of security. Typical causes and dangers of psychological trauma include harassment, embarrassment, abandonment, abusive relationships, rejection, co-dependence, physical assault, sexual abuse, partner battery, employment discrimination, police brutality, judicial corruption and misconduct, bullying, paternalism, domestic violence, indoctrination, being the victim of an alcoholic parent, the threat or the witnessing of violence (particularly in childhood), life-threatening medical conditions, and medication-induced trauma. Catastrophic natural disasters such as earthquakes and volcanic eruptions, large scale transportation accidents, house or domestic fire, motor vehicle accident, mass interpersonal violence like war, terrorist attacks or other mass victimization like sex trafficking, being taken as a hostage or being kidnapped can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or other forms of abuse, such as verbal abuse, exist independently of physical trauma but still generate psychological trauma.  Some theories suggest childhood trauma can increase one's risk for mental disorders including post-traumatic stress disorder (PTSD), depression, and substance abuse. Childhood adversity is associated with neuroticism during adulthood. Parts of the brain in a growing child are developing in a sequential and hierarchical order, from least complex to most complex. The brain's neurons change in response to the constant external signals and stimulation, receiving and storing new information. This allows the brain to continually respond to its surroundings and promote survival. The five traditional signals (sight, hearing, taste, smell, and touch) contribute to the developing brain structure and its function. Infants and children begin to create internal representations of their external environment, and in particular, key attachment relationships, shortly after birth. Violent and victimizing attachment figures impact infants' and young children's internal representations. The more frequently a specific pattern of brain neurons is activated, the more permanent the internal representation associated with the pattern becomes. This causes sensitization in the brain towards the specific neural network. Because of this sensitization, the neural pattern can be activated by decreasingly less external stimuli. Childhood abuse tends to have the most complications with long-term effects out of all forms of trauma because it occurs during the most sensitive and critical stages of psychological development. It could also lead to violent behavior, possibly as extreme as serial murder. For example, Hickey's Trauma-Control Model suggests that "childhood trauma for serial murderers may serve as a triggering mechanism resulting in an individual's inability to cope with the stress of certain events."  Often psychodynamic aspects of trauma are overlooked even by health professionals: "If clinicians fail to look through a trauma lens and to conceptualize client problems as related possibly to current or past trauma, they may fail to see that trauma victims, young and old, organize much of their lives around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects."

Treatment.

A number of psychotherapy approaches have been designed with the treatment of trauma in mind—EMDR, progressive counting (PC), somatic experiencing, biofeedback, Internal Family Systems Therapy, and sensorimotor psychotherapy.  There is a large body of empirical support for the use of cognitive behavioral therapy for the treatment of trauma-related symptoms, including post-traumatic stress disorder. Institute of Medicine guidelines identify cognitive behavioral therapies as the most effective treatments for PTSD. Two of these cognitive behavioral therapies, prolonged exposure and cognitive processing therapy, are being disseminated nationally by the Department of Veterans Affairs for the treatment of PTSD. A 2010 Cochrane review found that trauma-focused cognitive behavioral therapy was effective for individuals with acute traumatic stress symptoms when compared to waiting list and supportive counseling. Seeking Safety is another type of cognitive behavioral therapy that focuses on learning safe coping skills for co-occurring PTSD and substance use problems. While some sources highlight Seeking Safety as effective with strong research support, others have suggested that it did not lead to improvements beyond usual treatment. Recent studies show that a combination of treatments involving dialectical behavior therapy (DBT), often used for borderline personality disorder, and exposure therapy is highly effective in treating psychological trauma. If, however, psychological trauma has caused dissociative disorders or complex PTSD, the trauma model approach (also known as phase-oriented treatment of structural dissociation) has been proven to work better than the simple cognitive approach. Studies funded by pharmaceuticals have also shown that medications such as the new anti-depressants are effective when used in combination with other psychological approaches.  Trauma therapy allows processing trauma-related memories and allows growth towards more adaptive psychological functioning. It helps to develop positive coping instead of negative coping and allows the individual to integrate upsetting-distressing material (thoughts, feelings and memories) and to resolve these internally. It also aids in the growth of personal skills like resilience, ego regulation, empathy, etc.  Processes involved in trauma therapy are:  A number of complementary approaches to trauma treatment have been implicated as well, including yoga and meditation. Trauma-sensitive yoga has been specifically developed for the purposes of use with traumatized individuals.

Psychological trauma is damage to the mind that occurs as a result of a distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope, or integrate the emotions involved with that experience. Trauma may result from a single distressing experience or recurring events of being overwhelmed that can be precipitated in weeks, years, or even decades as the person struggles to cope with the immediate circumstances, eventually leading to serious, long-term negative consequences.

Psychické (nebo též duševní) trauma je psychické zranění, duševní stav člověka, ke kterému dochází v důsledku traumatické (traumatizující) události, jakou může být těžký úraz, úmrtí v rodině, znásilnění, šikana apod.