Preliminary Feasibility and Acceptability Examination of Using a Novel Ergonomic Chinrest with a Low Shoulder Rest by a Viola Player: A Case Report.

BACKGROUND: High-string players, such as violinists and violists, are prone to neck problems. One factor can be their body posture, with often a rotated and flexed neck position with the jaw placed on a flat chinrest. The Kréddle chinrest (EC) was specifically designed to promote a more neutral neck position and prevent musculoskeletal problems among high-string players. This case report aims to evaluate the preliminary feasibility and acceptability of using the EC, with a low shoulder rest, in a pain-free professional high-string player. A secondary aim was to register newly developed pain and fatigue. METHODS: A 32-year-old professional viola player was instructed to use the EC for most of her playing time during a 6-week trial period. Outcome measures such as compliance (% of use out of total playing time over the last 7 days), performance, comfort and acceptability were assessed at baseline and at the end of each trial week. The Rapid Upper Limb Assessment (RULA) tool was used to evaluate the body posture at baseline when using the EC versus her own chinrest and shoulder rest. RESULTS: The initial trial period was interrupted after 2 days due to pain. A second 6-week period was completed. While compliance was high and there was positive feedback on how the EC affected her performance and comfort while holding the instrument, the case report identified a challenge with the complex instruction material, which made it difficult to install and adjust the product. The viola player was positive towards using EC in the end despite pain and fatigue during the trial period. CONCLUSION: This case report examined a professional viola player's 6-week experience with an EC. While positive outcomes were observed in posture, performance, and product acceptance, issues with complex instructions were noted. This study marks the first exploration of individual challenges with EC use.

Does the Spraino low-friction shoe patch prevent lateral ankle sprain injury in indoor sports? A pilot randomised controlled trial with 510 participants with previous ankle injuries.

BACKGROUND: Lateral ankle sprains are common in indoor sports. High shoe-surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes. METHODS: In this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or 'do-as-usual'. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented. RESULTS: 480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino. CONCLUSION: Compared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms. TRIAL REGISTRATION NUMBER: NCT03311490.

Comparing the Impact of Specific Strength Training vs General Fitness Training on Professional Symphony Orchestra Musicians: A Feasibility Study.

Musculoskeletal symptoms, especially in the upper body, are frequent among professional symphony orchestra musicians. Physical exercise may relieve pain but might also interfere with playing performance. OBJECTIVE: To evaluate the feasibility and effect of "specific strength training" (SST) versus "general fitness training" (GFT). METHODS: A feasibility study using randomized controlled methods. Primarily, evaluations involved self-reported impact on instrument playing and satisfaction with the interventions. Secondary evaluations included pain intensity, hand-grip strength, aerobic capacity, body mass index, and self-assessed physical fitness. A total of 23 professional symphony orchestra musicians were randomly allocated to either the SST (n=12) or GFT (n=11) groups. Participants conducted three 20-minutes exercise periods/wk at the workplace for 9 weeks. RESULTS: Evaluations of both interventions showed that approximately 50% of musicians were satisfied with the interventions and experienced a positive impact on playing, while 18% reported a slightly negative impact. From baseline to follow-up, SST showed a significant reduction in pain (26.3±22.5 to 11.4±15.2 mm), with no significant reduction for GFT (19.7±24.0 to 13.5±26.0 mm). GFT significantly improved aerobic capacity (34.1±7.9 mL/min/kg to 40.0±13.6 mL/min/kg) compared to no significant gain for SST. For GFT, a significant improvement was seen in self-reported muscle strength (5.7±1.3 to 6.5±1.8) with a tendency toward significant improvement in self-reported aerobic fitness (5.6±2.3 to 6.2±2.5). CONCLUSION: Exercise interventions have the potential to improve musicians' working situation. For future research, muscle-strengthening exercises and aerobic fitness exercises might be combined in an intelligently designed program, which may include other relevant educational activities.

The user experience of violinists playing with a novel ergonomic chinrest: An evaluation on motivation, usage behaviour, usability and acceptance.

BACKGROUND: This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important. OBJECTIVE: To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product. METHODS: Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions. RESULTS: Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study. CONCLUSION: Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.

Measuring the usability of a novel ergonomic chinrest during violin playing: A feasibility study.

BACKGROUND: Playing the violin often requires a rotated and lateral flexed neck, leading to potential neck and shoulder problems. An ergonomic chinrest (EC) with or without a shoulder rest (SR or WSR) may enhance neutral neck positioning, but the feasibility of the EC needs to be studied. OBJECTIVE: Our goal was to evaluate the usability of the EC for a two-week familiarisation period, including aspects such as playing performance, comfort level, and emotional response (e.g., feelings about using the product) among a group of violinists. METHODS: A one-arm feasibility study was conducted to assess the feasibility of violinists playing with EC every day for two weeks. Six violinists who usually played with SR were included and asked to divide their daily playing time equally between SR and WSR. Feasibility outcomes were measured as adherence (days), compliance (playing hours per day) and usability (5-point Likert scale and open-ended questions). Compliance was achieved with a minimum of 25% playing time. RESULTS: Daily violin playing with EC showed high adherence of 89.3%. Compliance with the 25% play time criterion was met for SR, but not for WSR. Low playing performance (median 45.8 points difference), long confidence time (two violinists failed to reach a confidence level) and mainly negative feedback (26 out of 33 comments) were found in WSR compared to SR. CONCLUSIONS: The feasibility of playing WSR was low and negatively impacted playing performance. As a result, a larger-scale study will only evaluate the EC with SR due to greater feasibility.

Effects of different violin playing techniques on workload in forearm and shoulder muscles.

Due to their working position, violinists are more prone to musculoskeletal pain than other instrumentalists. Playing the violin may cause increased activity in the shoulder and forearm muscles due to techniques such as vibrato (pitch variation), double-fingering (thirds), and changes in speed and volume (piano and forte). This study investigated how the different violin techniques affect muscle activity while playing scales and a music piece. Surface EMG was recorded bilaterally from the upper trapezius and forearm muscles in 18 violinists. Increased playing speed followed by playing with vibrato was the most demanding task affecting the left forearm muscles. Playing forte was the most demanding factor for the right forearm muscles. The music piece and the grand mean of all techniques showed similar workload demands. These results show that specific techniques require higher workload demands and should be considered when planning rehearsals with these techniques as a part of injury prevention.

The effects of an ergonomic chinrest among professional violin players. A biomechanical investigation in a randomised crossover design.

This study aimed to compare violinists' upper body kinematics and muscle activity while playing with different supportive equipment: their usual chinrest (UC) or an ergonomic chinrest (EC), each mounted on the violin. Three-dimensional motion capture and electromyographic data were acquired from the upper body while 38 pain-free professional violinists performed an excerpt of a music piece. There were only minor differences between the two set-ups tested. The EC resulted in less left rotation of the head (3.3°), slightly more neck extension (1.3°) and less muscle activity (0.5-1.0 %MVE). However, the overall high static muscle activity (4-10 %MVE across all muscles) was maintained using EC. For both setups, the head posture was left-rotated >15°, ≤6° flexed and left-bent 90% of the time. The EC did not produce a substantial difference in biomechanical load. Instead, future studies may focus on aspects other than chinrest design to lower the static workload demands.

The elixir of muscle activity and kinesiology in a health perspective: Evidence of worksite tailored exercise training alleviating muscle disorders.

Physical activity is known to benefit health while muscle activation and movements performed during occupational work in contrast may result in work-related musculoskeletal disorders. Therefore, we posed the research question: which mode of muscle activation may result in a reversal of work-related disorders? To address this, we performed electromyographic (EMG) and kinematic assessments of workers with diverse exposure categories: sedentary monotonous work, prolonged walking/standing, and physically heavy work. The various job-specific exposure variables could be categorized in terms of duration, intensity, repetition, static component, peak force etc. that were subsequently identified as risk factors. Based on sports science principles we developed tailored exercise programs to counteract job exposure. EMG activity during exercise training was monitored to identify principal differences between exercise training and job patterns. Evidence from more than 20 RCT studies including >4000 workers showed positive effects such as decreased muscle pain and increased workability. Finally, we identified plausible underlying mechanisms in muscle tissue - human and animal - that confirmed metabolic, morphological, and hormonal changes with e.g. repetitive work that were reversal to adaptations reported with exercise training. Progress has been made in developing intelligent physical exercise training, IPET, as the best complementary activity to job exposure and includes muscle activations and movements that limit work-related inactivity atrophy as well as overload injury.

Surface electromyography of forearm and shoulder muscles during violin playing.

The aims of this study were to explore muscle activity levels during different violin repertoires, quantify the general levels bilaterally in upper extremity muscles, and evaluate associations between muscle activity and anthropometrics characteristics. In 18 skilled violin players surface EMG was recorded bilaterally from trapezius (UT), flexor digitorum superficialis (FDS), extensor carpi ulnaris (ECU), extensor digitorum cummunis (EDC), and extensor carpi radialis (ECR) during A and E major scales played in three octaves and Mozart's Violin Concerto no. 5. To compare side differences the static, median and peak levels of muscle activity were calculated from an amplitude probability distribution function (APDF). This study demonstrated that scales played as standardized tasks can be used to estimate the average muscle activity during violin playing. Comparing results from scales and the music piece revealed a similar muscle activity across all muscles in the music piece and E major scales. The static, median and peak EMG levels were higher in left than in right forearm muscles with left ECU presenting the highest peak load of 30 %MVE. Females demonstrated a higher muscle activity than males, but this was in accordance with differences in anthropometric measures.

Beginning to Optimize Peripartum Care for Somalia-Born Women by Evaluating Labor, Postpartum and Neonatal Outcomes in the Somali Population Delivering at a Tertiary Care Center in Vermont.

Vermont has a large population of Somali immigrants and previous research has shown outcome disparities in this population. Labor curves, pregnancy and delivery outcomes information is required and critical to optimize current labor management in an institution that provides obstetrical care for this population. Data were collected for both Somalia-born and non Somalia-born parturients in pre-pregnancy, pregnancy, delivery, neonatal and cervical change categories and were compared to non Somalia-born parturients to observe differences in demographic factors and outcomes as well as labor progress. Overall labor length trended differently between the two groups, the rate of preterm birth in the vaginal delivery group in the Somali population was much lower than the unmatched control group and overall more lacerations were noted. Findings are consistent with prior studies related to reduced preterm birth rate in Somalia-born women. Observation regarding refusal of care demonstrates need for targeted research related to concerns of Somali immigrants.

Sacrococcygeal teratomas: prenatal surveillance, growth and pregnancy outcome.

OBJECTIVE: Prenatal surveillance and growth characteristics are evaluated in a cohort of fetuses with sacrococcygeal teratomas (SCT) as part of risk assessment. METHODS: Retrospective review of 23 fetuses with SCT: prenatal diagnosis, surveillance, delivery, and early postnatal outcome are reported. RESULTS: Cardiac output failure physiology requires serial evaluation. The size of the SCT determines obstetrical risks and mode of delivery. An SCT growth rate approaching >150 cm(3) per week may be associated with increased perinatal mortality risks. Maternal morbidity is related mainly to polyhydramnios and preterm labor. CONCLUSIONS: Perinatal mortality is approximately 43%. Maternal-fetal surgery for fetal physiologic deterioration is not frequent, but serial surveillance is required to minimize fetal morbidity/mortality and maternal morbidity. Rapid SCT growth rates may be associated with increased risk of perinatal mortality.

Implementation strategies, and barriers and facilitators for implementation of physical activity at work: a scoping review.

Background: Inactivity and sedentary lifestyle have led experts to recommend an increase in structured, workplace-based physical activity (PA) initiatives. Previous studies on workplace-based PA have only shown moderate and short-term effects. This has been attributed to the lack of clear implementation strategies and understanding of factors that may hinder or enable uptake of PA. To ensure long-term, sustainable outcomes, there is a need for a better understanding of implementation strategies, and barriers and facilitators to workplace-based PA. Method: A scoping review of studies investigating implementation approaches and factors affecting uptake of workplace-based PA was conducted. Qualitative and quantitative articles published in MEDLINE, Embase, Scopus, or PsycINFO between 2008 and 2018 evaluating the implementation of PA were included. Data on study characteristics, evaluation, and implementation methods applied were systematically extracted. Two reviewers extracted, coded, and organised factors affecting uptake using the Theoretical Domains Framework (TDF). Results: After dual, blinded screening of titles and abstracts, 16 articles reporting on eight studies were included in the review. Several different methods of implementation were applied, including information meeting, kick-off events, and "change agents" as the most common. A total of 109 factors influencing implementation were identified, consisting of 57 barriers and 52 facilitators. Barriers most often related to the TDF domains Environmental Context and Resources (n = 34, 36.2%), Social influences (n = 13, 13.8%), and Social/Professional Role and Identity (n = 8, 8.5%). Likewise, facilitators most often related to the TDF domains Social influences (n = 17, 19.5%), Environmental Context and Resources (n = 16, 18.4%), and Social/Professional Role and Identity (n = 9, 10.3%). Conclusion: Our review has highlighted the multilevel factors affecting the uptake of workplace-based PA and underpins the complexities in implementation of such initiatives. The published literature predominantly provides details from the employees' perspectives on factors that need to be addressed and a lack of attention to these factors will cause them to hamper uptake of PA. The analysis of barriers and facilitators provides a theoretical foundation to guide future intervention design. However, further research is needed to fully understand the success or failure of implementation processes.

Pepper with and without a sting: Brain processing of intranasal trigeminal and olfactory stimuli from the same source.

Humans have distinct and overlapping brain regions for the processing of intranasal olfactory or trigeminal stimuli. It may be assumed that trigeminal stimulants and "trigeminal-free" odorous stimuli from the same source are processed differently in the human brain. Using functional magnetic resonance imaging (fMRI), this study investigated the question whether the black pepper (Piper nigrum) derived trigeminal active compound piperine and the trigeminal-free pepper essential oil (pepperEO) are processed in relation to their degree of trigeminal stimulation. Twenty-one young healthy adults underwent a fMRI scan where piperine and pepperEO were delivered orthonasally using an olfactometer. Ratings for intensity, irritability, and pleasantness of each stimulus were obtained at the end of the scanning session. Results showed brain activation of the trigeminal network in response to piperine, and olfactory-related areas in response to pepperEO. PepperEO induced larger activations in the trigeminal network as compared to piperine. This was possibly due to the associative learning for the pungent sensations of pepperEO. In addition, conjunction analyses showed that the secondary somatosensory area, insula, and thalamus were involved in the processing of both piperine and pepperEO. In conclusion, the results strongly suggest that the cerebral representations of trigeminal irritants can be evoked by learned associations.

The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease.

OBJECTIVE: Current means of grading twin-twin transfusion syndrome does not characterize cardiovascular aspects adequately. We sought to develop a score that describes the magnitude of cardiovascular severity in twin-twin transfusion syndrome. STUDY DESIGN: Fetal echocardiograms of 150 monochorionic/diamniotic twins were reviewed. Blinded to Quintero stage, we applied a cardiovascular score to each twin set and compared it to the Quintero grade. The score is a composite of variables that include ventricular hypertrophy, dilation, function, valve regurgitation, great artery size, and diastolic properties in the recipient and umbilical artery flow in the donor. Doppler indices of vascular and ventricular function were measured. RESULTS: Mean age was 21 +/- 3 weeks. Discrepancy was noted in degree of severity between Quintero and cardiovascular stages. The score correlated well with myocardial performance index of the recipient right ventricle (r2 = .65). CONCLUSION: We describe the spectrum of cardiovascular abnormalities that are seen in twin-twin transfusion syndrome and propose a scoring system for assessment of severity.

Antenatal diagnosis and management of congenital cystic adenomatoid malformation.

One of the most enigmatic pulmonary lesions encountered in the prenatal period is the congenital cystic adenomatoid malformation (CCAM). This review presence current thinking on pathogenesis, prenatal assessment, fetal intervention, and management for this pulmonary malformation. Careful delivery planning by utilizing a multidisciplinary approach will optimize neonatal outcomes.

Steady-state levels of aquaporin 1 mRNA expression are increased in idiopathic polyhydramnios.

OBJECTIVE: Polyhydramnios is a condition associated with significant perinatal morbidity. While the exact pathophysiology of this condition is unknown in the absence of obvious anatomic or organic etiologies, impaired intramembranous water transport has been shown. Previous studies from our laboratory have shown that the water channel aquaporin 1 (AQP1) is expressed in human fetal membranes from term pregnancies with normal amniotic fluid (AF) volume. Therefore, we hypothesized that in pregnancies with idiopathic polyhydramnios, AQP1 expression might be reduced in fetal membranes from pregnancies with this AF volume disorder. STUDY DESIGN: Placentas were collected from women at term (37-40 weeks) who presented with either polyhydramnios (amniotic fluid index [AFI] >24.0 cm) or normal AF volume (AFI 5.0-23.9 cm). Immediately after delivery, the membranes (amnion and chorion) directly overlying the placenta and the free-floating reflected membranes were sampled (total of 4 samples from each placenta). RNA was isolated from each sample and expression was quantified using real-time reverse transcriptase polymerase chain reaction (PCR) and relative quantification of gene expression. RESULTS: Relative to pregnancies with normal AF volume, there was an increase in expression of the water channel AQP1 in all regions of the fetal membranes. The greatest increase (33-fold) was seen in the reflected amnion. CONCLUSION: AQP1 expression is increased in polyhydramnios. This finding suggests that alterations in AQP1 expression may be a compensatory response to and not a cause of idiopathic polyhydramnios. We speculate that therapies focused on regulating AQP1 expression may be useful for treating this condition.

Perivascular Adipose Tissue: A Novel Regulator of Vascular Tone in the Rat Pregnancy.

Perivascular adipose tissue (PVAT) contributes to vasoregulation. The role of this adipose tissue bed in pregnancy has not been examined. Here, we tested the hypothesis that PVAT in pregnant rats decreases resistance artery tone. Mesenteric arteries from nonpregnant (NP) and late pregnant (LP) rats were exposed to phenylephrine (PHE) or KCl in the presence (+) versus absence (-) of PVAT. The LP PVAT(+) vessels showed a 44% decrease in sensitivity to PHE in the presence of PVAT. There was no attenuation of the contractile response to KCl when PVAT was present. The LP arteries perfused with LP or NP PVAT underwent vasodilation; unexpectedly, NP vessels in the presence of PVAT from LP rats sustained a 48% vasoconstriction. The PVAT attenuates vasoconstriction by a mechanism that involves hyperpolarization. The vasoconstriction observed when nonpregnant vessels were exposed to pregnant PVAT suggests pregnant vessels adapt to the vasoconstricting influence of pregnant PVAT.

Legal consequences and ethical dilemmas of pain perception in persistent vegetative states.

"Persistent vegetative state" (PVS) describes brain-damaged patients who survive their injuries in a sleeplike, insensible state, with periodic awakenings. Due to technological advances, such individuals can sustain biological existence for prolonged periods of time. Their existence results in a dichotomy between the legal and medical interpretations of persistent vegetative states, giving rise to ethical conflicts. The author reviews the limitations in our understanding of what PVS signifies for the afflicted individual, and explores the conflicts arising from such limitations that may impact an individual's right to live or die. The author concludes that the medical community has yet to adopt consistent clinical criteria to diagnose PVS and that a universal standard for PVS is needed to avoid the abuse of vegetative individuals' rights.

Fetal thoracic and bladder shunts.

Congenital obstructive lesions involving the bladder and the lung can lead to serious complications for the newborn. The in-utero placement of a diverting shunt in the fetal bladder or thoracic cavity can decrease the morbidity and mortality associated with these obstructive conditions. This review focuses on the indications for prenatal evaluation, technique, and outcomes for those fetuses with a lower urinary tract obstruction, congenital pleural effusion or macrocystic congenital cystic adenomatoid malformation after placement of a vesicoamniotic or thoracoamniotic shunt.