Salivary Cortisol and Alpha-Amylase are Modulated by the Time and Context of Musical Performance

Auditioning can cause considerable apprehension for musicians, typically giving rise to a wide range of physical and mental stress responses irrespective of age, amount of practice and level of experience. However, studies giving clear and replicable information on these experiences, in particular the physiological reactions to such psychosocial stress and the precise timing of that response have been limited. This study sets out to understand musicians’ endocrinological reactivity and recovery to performing in low- and high-stress auditions by focusing on the 2 endocrinological pathways: the hypothalamic-pituitaryadrenal (HPA) axis and the sympathetic adrenal medullar (SAM). Salivary cortisol (CORT) and salivary alpha-amylase (sAA) samples were collected in 11 musicians (6 men, 5 women) 2 times prior to and 4 times after low- and high-stress conditions, and benchmarked against musicians’ subjective experience of anxiety. The results reveal peak CORT levels 15 min after the performance, in the high-stress condition. By contrast, the activity in sAA increased from 1 min before to after the performance, before dropping to levels below with musicians’ low-stress conditions. This study demonstrates that (a) musical performing affects both the HPA axis and the SAM system and that these responses are modulated by the time and condition of performance, and (b) sAA is an important biomarker in understanding musical performance stress

Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

Introduction: Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM. Method: Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation's degree of realism, content, relevance, as well as areas for improvement. Results: Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes. Conclusions: Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions

Understanding health management and safety decisions using signal processing and machine learning

Background: Small group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of team working in healthcare. Methods: Clinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using Recurrence Quantification Analysis (Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data. Results: Groups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture. Conclusions: This study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research on how the nature of group interaction and communication processes contribute to the quality of team and task decision making

Financial Stress Through Complexity Science

Financial markets typically undergo periods of prosperity followed by periods of stagnation, and this undulation makes it challenging to maintain market efficiency. The efficient market hypothesis (EMH) states that there exist differences in structural complexity in security prices between regular and abnormal situations. Yet, despite a clear link between market acceleration (cf. recession in security prices) and stress in physical systems, indices of financial stress still have significant scope for further development. The overarching aim of this work is therefore to determine the characteristics of financial indices related to financial stress, and to establish a robust metric for the extent of such 'stress'. This is achieved based on intrinsic multiscale analysis which quantifies the so called complexity-loss hypothesis in the context of financial stress. The multiscale sample entropy and our proposed Assessment of Latent Index of Stress methods have successfully assessed financial stress, and have served as a measure to establish an analogy between transitions from 'normal' (relaxed) to 'abnormal' (stressed) financial periods with the sympatho-vagal balance in humans. Four major stock indices of the US economy over the past 25 years are considered: (i) Dow Jones Industrial Average, (ii) NASDAQ Composite, (iii) Standard & Poor's 500, and (iv) Russell 2000, together with FTSE 100, CAC 40 and exchange rates. Our findings support the EMH theory and reveal high stress for both the periods of Internet bubble burst and sub-prime mortgage crisis.This work was supported by the Financial Signal Processing Laboratory (http://www.fsplab.com/) at Imperial College London. The guest editor coordinating the review of this manuscript and approving it for publication was Prof. Ali N. Akansu.Hemakom, A.; Chanwimalueang, T.; Carrión García, A.; Aufegger, L.; Constantinides, AG.; Mandic, DP. (2016). Financial Stress Through Complexity Science. IEEE Journal of Selected Topics in Signal Processing. 10(6):1112-1126. doi:10.1109/JSTSP.2016.2581299S1112112610

Musicians’ perceptions and experiences of using simulation training to develop performance skills

Simulation has been applied as a tool for learning and training in sports, psychology and medicine for some time, but its current use and potential for training musicians is less well understood. The aim of this study was to explore musicians’ perceptions and experiences of using simulated performance environments. Nine conservatory students performed in two simulations, each with interactive virtual elements and vivid environmental cues: a recital with a virtual audience and an audition with virtual judges. Qualitative data were collected through a focus group interview and written reflective commentaries. Thematic analysis highlighted the musicians’ experiences in terms of (1) their anticipation of using the simulations, (2) the process of performing in the simulations, (3) the usefulness of simulation as a tool for developing performance skills and (4) ways of improving simulation training. The results show that while simulation was new to the musicians and individual levels of immersion differed, the musicians saw benefits in the approach for developing, experimenting with and enhancing their performance skills. Specifically, the musicians emphasised the importance of framing the simulation experience with plausible procedures leading to and following on from the performance, and they recognised the potential for combining simulation with complementary training techniques

Global hepatitis C elimination: an investment framework

WHO has set global targets for the elimination of hepatitis B and hepatitis C as a public health threat by 2030. However, investment in elimination programmes remains low. To help drive political commitment and catalyse domestic and international financing, we have developed a global investment framework for the elimination of hepatitis B and hepatitis C. The global investment framework presented in this Health Policy paper outlines national and international activities that will enable reductions in hepatitis C incidence and mortality, and identifies potential sources of funding and tools to help countries build the economic case for investing in national elimination activities. The goal of this framework is to provide a way for countries, particularly those with minimal resources, to gain the substantial economic benefit and cost savings that come from investing in hepatitis C elimination

Innovative strategies for the elimination of viral hepatitis at a national level: a country case series

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints

Stage Call: Cardiovascular Reactivity to Audition Stress in Musicians

Auditioning is at the very center of educational and professional life in music and is associated with significant psychophysical demands. Knowledge of how these demands affect cardiovascular responses to psychosocial pressure is essential for developing strategies to both manage stress and understand optimal performance states. To this end, we recorded the electrocardiograms (ECGs) of 16 musicians (11 violinists and 5 flutists) before and during performances in both low- and high-stress conditions: with no audience and in front of an audition panel, respectively. The analysis consisted of the detection of R-peaks in the ECGs to extract heart rate variability (HRV) from the notoriously noisy real-world ECGs. Our data analysis approach spanned both standard (temporal and spectral) and advanced (structural complexity) techniques. The complexity science approaches—namely, multiscale sample entropy and multiscale fuzzy entropy—indicated a statistically significant decrease in structural complexity in HRV from the low- to the high-stress condition and an increase in structural complexity from the pre-performance to performance period, thus confirming the complexity loss theory and a loss in degrees of freedom due to stress. Results from the spectral analyses also suggest that the stress responses in the female participants were more parasympathetically driven than those of the male participants. In conclusion, our findings suggest that interventions to manage stress are best targeted at the sensitive pre-performance period, before an audition begins

Virtual reality feedback influences musicians’ physical responses and mental attitude towards performing

Simulation has been applied as a successful training, however, an investigation of its effect with implications for musical performance training is still lacking. The aim of this study was to explore the impact of positive and negative simulated feedback on musicians’ performance confidence (PC), perceived performance quality (PQ), state anxiety (SA) and heart rate variability (HRV). Twelve musicians performed the same piece three times: twice in front of three interactive virtual ‘judges’ with positive and negative facial and behavioural feedback and a ‘no judges but identical environment’ control. PC and SA were reported before and after each performance, while musicians’ perceived PQ was addressed after. The HRV was monitored throughout. Using Generalised Estimating Equations to examine relationships between physiological and psychological responses and condition, the results showed a significant influence of condition, with the positive feedback resulting in the highest physiological arousal and PQ ratings. Musicians who experienced an increase in SA before the performance showed a lower HRV during the performance. The SA and PC significantly predicted the PQ, with lower levels of SA and greater degrees of PC leading to a higher perceived PQ. Results are discussed in the light of simulation training

Workspace and Productivity: Guidelines for Virtual Reality Workplace Design and Optimization

Employee satisfaction and productivity are highly dependent on the alignment between the design of a workplace, the culture, the work activities, and the technology used, and while the understanding of such interactions has received increased interest in fields including architecture, health, and psychology, very little is known in relation to virtual work and reality (VR). VR workplaces have the potential to become an integral part of new work arrangements, enabling employees to execute teamwork and task work through (mature) simulated environments designed to meet individual, team, and organizational productivity needs. Thus, the aim of this study was three-fold: In study 1, we gained, through expert interviews, insights into contemporary thinking in workplace design, and gathered a greater understanding of the dimensions of design, behaviors, environments, and tools that affect collaborative work and productivity. In study 2, we observed knowledge workers in home environments and open, closed, and balanced office layouts, in order to understand the potential for successful integration in VR. In study 3, we evaluated environmental needs and opportunities through VR. Based on our findings, we developed an Ecology of Work model, combining work systems and pillars of performance success. These are followed by discussions on design needs and implications for VR