Relationship of the cricothyroid space with vocal range in female singers

It is well documented that the cricothyroid (CT) space opens and closes with changes in pitch, narrowing with rising pitch and widening with falling pitch. Indeed, cricothyroid approximation surgery, a procedure where the CT space is deliberately made smaller, is used in male to female transgender subjects to successfully elevate vocal pitch. The present study focuses on investigating the relationship between the anterior CT space at rest and vocal range in female singers. Laryngeal dimensions (anterior CT space and heights of the thyroid and cricoid cartilages) were measured using ultrasound in 43 healthy, classically trained, female singers. Potential associations with and between age, ethnicity, anthropometric indices (height, weight, body mass index), neck dimensions (circumference and length), vocal data (practice and performance vocal range, lowest and highest practice and performance notes) along with usual speaking fundamental frequency were also explored. The main finding was that mezzo-sopranos have a significantly wider resting CT space than sopranos (11.6 mm versus 10.4 mm; P=0.007). Mezzo-sopranos also had significantly lower ‘lowest and highest’ performance notes and speaking fundamental frequencies than sopranos. Furthermore, there was a weak but significant negative correlation between the magnitude of the anterior CT space and the lowest performance note (r=-0.448; P=0.003) but there was no significant correlation with either the highest performance note or vocal range. These results suggest there is a relationship between the CT space and the lowest note a female can sing. This was evident in the correlation of a small CT space with a higher ‘lowest performance note’. It appears that the CT space influences how low female singers can sing, but not how high they can sing

Breast cancer and breast screening: perceptions of Chinese migrant women living in New Zealand

INTRODUCTION: Migrant Chinese constitute a significant and increasing proportion of New Zealand women. They have lower rates of participation in breast cancer screening than other New Zealanders, but reasons for this are unknown. The aim of this study was to investigate factors affecting Chinese women’s understanding of, and access to, breast health services, to better understand reasons for low participation in screening and their experiences of breast cancer clinic care. METHODS: The participants were 26 Chinese migrant women—19 recruited in the community and seven recruited from 17 eligible women attending a breast clinic between 2008 and 2010 in Wellington, New Zealand. The design was that of a qualitative study, using semi-structured interviews and thematic content analysis. FINDINGS: There were low levels of awareness about the national breast screening programme and limited engagement with preventive primary care services. Concerns about privacy and a range of communication difficulties were identified that related to oral language, lack of written information in Chinese, and limited understanding about Chinese perceptions of ill health and traditional Chinese medicine by New Zealand health professionals. CONCLUSION: Addressing communication barriers for Chinese migrant women has the potential to raise awareness about breast cancer and breast health, and to increase successful participation in breast cancer screening. Greater efforts are needed to ensure this group has an understanding of, and is engaged with a primary care provider. Such efforts are key to improving health for this growing sector of the New Zealand population

Factors Influencing Health Career Choices During Clinicians’ First Three Years in Practice

Background: Health systems globally need more clinicians to work rurally and in community-based primary care. This study explores factors influencing health graduates’ choice of clinical setting and geographical location during early careers, across a range of disciplines that work together to support the health of people in community-based and rural locations.Methods: Students from eight disciplines (n = 611) were recruited prior to their final year of pre-registration training. Data were collected via three electronic surveys completed at the end of participants’ first, second, and third year of clinical practice. Data were managed and analyzed with Template Analysis.Findings: Similar factors influenced clinical setting and location choice but differed in relative importance for each. The nature of the job itself was the most important factor influencing clinical setting choices. A broader range of influences were important to geographical location choices including personal reasons, the nature of the job, the nature of the location, and job availability and opportunities. Regulatory or training requirements limited choices available to some clinicians, particularly those from medicine.Conclusion: A range of complex and interacting factors influenced health graduates’ career choices. Findings indicate that a broad system-wide approach is needed to address community and rural health workforce needs

Modulation of frontal EEG alpha oscillations during maintenance and emergence phases of general anaesthesia to improve early neurocognitive recovery in older patients: protocol for a randomised controlled trial

Background Postoperative delirium may manifest in the immediate post-anaesthesia care period. Such episodes appear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Frontal electroencephalogram (EEG) findings of suppression patterns and low proprietary index values have been associated with postoperative delirium and poor outcomes. However, the efficacy of titrating anaesthesia to proprietary index targets for preventing delirium remains contentious. We aim to assess the efficacy of two strategies which we hypothesise could prevent post-anaesthesia care unit (PACU) delirium by maximising the alpha oscillation observed in frontal EEG channels during the maintenance and emergence phases of anaesthesia. Methods This is a 2 × 2 factorial, double-blind, stratified, randomised control trial of 600 patients. Eligible patients are those aged 60 years or over who are undergoing non-cardiac, non-intracranial, volatile-based anaesthesia of expected duration of more than 2 h. Patients will be stratified by pre-operative cognitive status, surgery type and site. For the maintenance phase of anaesthesia, patients will be randomised (1:1) to an alpha power-maximisation anaesthesia titration strategy versus standard care avoiding suppression patterns in the EEG. For the emergence phase of anaesthesia, patients will be randomised (1:1) to early cessation of volatile anaesthesia and emergence from an intravenous infusion of propofol versus standard emergence from volatile anaesthesia only. The primary study outcomes are the power of the frontal alpha oscillation during the maintenance and emergence phases of anaesthesia. Our main clinical outcome of interest is PACU delirium. Discussion This is a largely exploratory study; the extent to which EEG signatures can be modified by titration of pharmacological agents is not known. The underlying concept is maximisation of anaesthetic efficacy by individualised drug titration to a clearly defined EEG feature. The interventions are already clinically used strategies in anaesthetic practice, but have not been formally evaluated. The addition of propofol during the emergence phase of volatile-based general anaesthesia is known to reduce emergence delirium in children; however, the efficacy of this strategy in older patients is not known. Trial registration. Australian and New Zealand Clinical Trial Registry, ID: 12617001354370. Registered on 27/09/2017

Sixteen Months “From Square One”: The Process of Forming an Interprofessional Clinical Teaching Team

Background: Descriptions of interprofessional education (IPE) programs and teacher competencies exist, but limited research has been undertaken about the process of IPE teaching team formation. This research project examined how pedagogically naïve clinicians of different disciplines initially formed an IPE teaching team.Methods and Findings: A case study approach was undertaken with data collected over the first sixteen months of an IPE program. Data included: audio recordings, transcripts, and field notes from nine individual teacher interviews, two teaching team focus groups, five student focus groups, and eight summary reports. Data analysis using a grounded theory constant comparison approach revealed themes relating to the formation, development, and evolving sophistication of the teaching team from functioning, to co-ordinating, to co-operating, and finally to collaborating. These stages were influenced by four external factors: remote rural context, Hauora Māori principles, personal attributes, and teacher development.Conclusions: Formation of interprofessional clinical teaching teams requires educational preparation, time learning to work with each other, and trust development, with a number of local contextual factors influencing this process. Teaching team formation paralleled Wegner’s Community of Practice model where shared vision supported the adoption of an increasingly complex IPE pedagogy

Importance of effective collaboration between health professionals for the facilitation of optimal community diabetes care

Diabetes places a significant burden on the individuals concerned, their families and society as a whole. The debilitating sequelae of diabetes can be limited or prevented altogether through strict glycaemic control. Despite the seemingly uncomplicated nature of the disorder, effective management can be elusive, as the impact of having to deal with diabetes on a daily basis can be profound and appropriate professional support is not always readily available. As the roles of general practitioners (GPs) and allied health professionals have evolved, a major issue now facing all is that of developing and maintaining effective collaborative relationships for the facilitation of optimal community diabetes care. Using a simple survey methodology, the present exploratory study investigated the referral patterns of GPs to diabetic educators (DEs) working for a community health service in an Australian town, and reasons for referral and non-referral in order to identify factors that contribute to a sound and sustainable collaborative relationship.The results provide some evidence that GPs and DEs in this town do work collaboratively towards achieving client-centred goals and highlight the need to inform GPs who are new to communities, such as this one, of the available DE services. Most importantly, the study identified that there are many opportunities to strengthen collaboration so as to facilitate optimal community diabetes care. This information is valuable, because there is limited empirical evidence either nationally or internationally about the process of collaboration between health professionals in the management of chronic diseases, such as diabetes

Key Strategies for First-Time Interprofessional Teachers and those Developing New Interprofessional Education Programs

Background: Evidence that interprofessional education (IPE) leads to better teamwork and improved interprofessional collaboration has created a drive to establish pre-registration IPE health science and social care programs. Yet there is limited guidance available for teachers new to IPE.Objectives: To provide first-time teachers practical strategies to undertake IPE.Methods: Strategies developed from experience.Findings: First-time IPE teachers should: try to join an existing IPE team; observe and collaborate with experienced IPE teachers; contribute to the development of new IPE programs; seek institutional support; undertake IPE evaluation and research; and gain high-level institutional endorsement.Conclusions: Six strategies are designed to overcome commonly recognized problemsand enable first-time teachers to more confidently develop or engage in IPE,thus supporting students to attain skills in interprofessional collaboration