Learning from COVID-19 to improve access to physiotherapy

Published online 16 July 2020. Letter to the EditorFunding for telehealth should continue post-COVID-19 and should include provision for tele-physiotherapy. There are several instances where tele-physiotherapy may be an appropriate form of primary care, including the early management of acute pain, which may otherwise become chronic. By extending the availability of tele-physiotherapy beyond 30 September 2020, we can improve the health of the population generally and, in particular, better serve remote or otherwise isolated people.Jessica Stanhope and Philip Weinstei

Organisational injustice from the COVID-19 pandemic: a hidden burden of disease

During the current climate, the workers’ experience is constantly changing, with increased workload and a reduction in promotion and bonus opportunities. This leads to an increase in effort-reward imbalance (ERI) experienced by workers. In this article, Stanhope and Weinstein, outline the health effects of this and how businesses can strategise to reduce it.J Stanhope, P Weinstei

Should musicians play in pain?

Musculoskeletal symptoms, including pain, are often experienced by musicians at all levels. These symptoms may have a detrimental impact on musicians’ personal and work lives, and may also impact upon the ensembles they work within. Providing musicians with appropriate, evidence-based advice regarding pain management is therefore paramount. In this review, we aim to improve the advice given to musicians regarding playing when in pain, by answering the question ‘should musicians play in pain?’. This multidisciplinary narrative review draws upon contemporary pain science, including factors associated with poorer prognoses for those in pain, as well as the reported experiences of musicians with pain (including those who have taken time off from playing). Our current understanding of pain science provides further support for the potential for consequences related to avoiding activities due to pain. Pain is modulated by a number of neuro-immunological processes and is influenced by a range of psychosocial factors. Taking time off from playing might therefore not have any benefit. Importantly, one of the leading causes of a transition from acute to chronic pain is fear-avoidance behaviour (e.g. not playing when in pain); hence, encouraging such behaviour cannot be supported. Musicians who have taken time off from playing due to pain have experienced a range of consequences, including emotional and financial consequences. These experiences indicate that there are potential negative consequences related to taking time off from playing which need to be weighed against any benefits. We conclude that musicians should not necessarily be advised to take time off from playing to manage their pain, in keeping with current best practice for pain management. Instead, we recommend that musicians be educated on contemporary pain science and when to seek treatment from a health professional for individualised advice to reduce the burden of musicians’ pain.Jessica Stanhope and Philip Weinstei

Travel restrictions and evidence-based decision making for novel epidemics

Letter to the Editor.Jessica Stanhope, Philip Weinstei

Note to chew on: insect damage to musical instruments

Published online in Wiley Online Library: 25 June 2020Insects have a diverse range of ecologies that leaves many pre-adapted to exploiting manufactured products as food sources, including musical instruments. To review what is known and to make recommendations for preventing and managing insect damage to musical instruments, we conducted a systematic search and a narrative review of the area. Of 339 papers, only eight peer-reviewed publications met the inclusion criteria, and all were on xylophagous insects causing damage to wooden instruments. To supplement this material, we report a case of damage to the key pads (composed of felt enclosed in fish buoyancy bladder skin) of a clarinet by carpet beetles (Anthrenus verbasci (Dermestidae)), the first reported case of non-woody damage and the first instance of insect damage rendering an instrument unplayable. To avoid such damage, regular inspection of instruments is recommended, and rapid treatment of any insect infestations in the immediate environment that could extend to affecting stored instruments. Instruments themselves can be extremely expensive, and if insects are still present these should only be treated by an expert; instrument cases can be more easily dealt with by heat treatment (black plastic bag in the sun) or application of a residual insecticide.Jessica Stanhope and Philip Weinstei

The human health effects of singing bowls: a systematic review

Objective: The objective of this study was to determine the human health effects (beneficial or adverse) of any singing bowl therapies. Design: A systematic review was conducted. Setting: The setting was not specified, so it could include clinical and non-clinical settings. Journal Pre-proof 2 Intervention: Studies of any intervention predominantly involving singing bowls (e.g. playing singing bowls, listening to singing bowls) were eligible for inclusion. The comparison interventions were not specified, and studies without comparisons (e.g. pre-post studies) were also considered potentially relevant. Main outcome measures: Any human health outcome was investigated. Results: The effects of singing bowls on human health were investigated in four peer-reviewed studies, one of which investigated patients with metastatic cancer, and another those with chronic spinal pain. Low-level designs were used in two studies. Improvements in distress, positive and negative affect, anxiety, depression, fatigue, tension, anger, confusion and vigour were reported, as were improvements in blood pressure, heart rate, respiratory rate, peripheral capillary oxygen saturation, cutaneous conductance, and anterior-frontal alpha values. Conclusions: Given there were few studies and the potential risk of methodological bias, we cannot recommend singing bowl therapies at this stage. As the evidence suggests positive health effects we recommend that future studies consider the effect of singing bowl therapist using more robust study methods, allowing for evidence-based recommendations to be made to reduce the disease burden.Jessica Stanhope, Philip Weinstei

Convexity of reduced energy and mass angular momentum inequalities

In this paper, we extend the work in \cite{D}\cite{ChrusLiWe}\cite{ChrusCo}\cite{Co}. We weaken the asymptotic conditions on the second fundamental form, and we also give an $L^{6}-$norm bound for the difference between general data and Extreme Kerr data or Extreme Kerr-Newman data by proving convexity of the renormalized Dirichlet energy when the target has non-positive curvature. In particular, we give the first proof of the strict mass/angular momentum/charge inequality for axisymmetric Einstein/Maxwell data which is not identical with the extreme Kerr-Newman solution.Comment: 27 page

Global well-posedness of the KP-I initial-value problem in the energy space

We prove that the KP-I initial value problem is globally well-posed in the natural energy space of the equation

Exposure to greenspaces could reduce the high global burden of pain

Available online 08 May 2020Painful conditions are among the leading causes of years lived with disability. To reduce this burden, novel, cost-effective and accessible interventions are required. We propose that greenspace exposure may be one such intervention. Drawing on evidence from neuroscience, physiology, microbiology, and psychology, we articulate how and why exposure to greenspaces could improve pain outcomes and reduce the high global burden of pain. Greenspace exposure potentially provides opportunities to benefit from known or proposed health-enhancing components of nature, such as environmental microbiomes, phytoncides, negative air ions, sunlight, and the sights and sounds of nature itself. We review the established and potential links between these specific exposures and pain outcomes. While further research is required to determine possible causal links between greenspace exposure and pain outcomes, we suggest that there is already sufficient evidence to help reduce the global burden of pain by improving access and exposure to quality greenspaces.Jessica Stanhope, Martin F. Breed, Philip Weinstei

Are adult amateur musicians at ‘high risk’ of experiencing musculoskeletal symptoms?

Musculoskeletal symptoms (MSSs) are a common problem for musicians, but the MSS burden of amateur musicians specifically is under-investigated. For the first time we sought to compare the MSS prevalence and profile (e.g. MSS location, impact) of adult amateur musicians with those of non-musicians. Amateur and non-musicians were asked to complete a questionnaire that collected data on their demographics, musical activities and MSS outcomes. A total of 456 participants were included, 30.9% of whom were amateur musicians. MSSs were common for both amateurs and non-musicians (96.4% and 96.1%, respectively, for the last twelve months). The only significant difference between the two groups was for the twelve-month prevalence of head MSSs with amateur musicians having a higher prevalence than non-musicians (49.6% and 39.8%, respectively, p<0.05). We conclude that amateur musicians do not have a substantially different MSS prevalence and profile compared with non-musicians for this university-based population.Stanhope, Jessica, Cook, Angus, Weinstein, Phili