Creation of an Electronic Resource Repository for Differences of Sex Development (DSD): Collaboration Between Advocates and Clinicians in the DSD-Translational Research Network.

INTRODUCTION: People with differences of sex development (DSD) and their families need education about these conditions while receiving emotional and peer support to participate in shared decision-making, reduce social isolation, and optimize physical and psychosocial outcomes. Barriers to education and support include limited knowledge and awareness by healthcare providers, tension among patient and medical communities, varied quality of educational resources, and the sensitive nature of DSD. We aimed to create an electronic repository of vetted quality online resources about DSD. METHODS: The electronic resource repository (e-RR) was a collaboration between affected individuals and advocates and healthcare providers in the DSD-Translational Research Network (DSD-TRN), an NIH-supported consortium of US teams committed to standardizing and optimizing care in DSD. The e-RR development and ongoing growth involved: (1) identification of resources by the project team (3 advocates and 1 physician), (2) evaluation and feedback by DSD-TRN clinical teams, (3) creation of the e-RR, and (4) review and revision. Twitter-like descriptions accompanied each entry; resources were categorized by target age, audience, and condition. RESULTS: Thirty-seven web-based educational, peer and advocacy support, and clinician-oriented resources were reviewed. Eight of 10 DSD-TRN teams responded to a survey regarding resource inclusion. Awareness of individual resources varied widely. Consensus was achieved when opinions differed; 30 resources were included. The e-RR is available online and as a downloadable booklet at http://www.accordalliance.org/resource-guide/. CONCLUSION: The e-RR increases awareness of and access to vetted educational and support resources for those with DSD and healthcare providers. It represents important collaboration between advocates and providers.

Creative Collaboration and Collaborative Creativity: A Systematic Literature Review.

Studies of creativity emerging from cultural psychology and social psychology perspectives challenge individualist conceptions of creativity to argue that social interaction, communication, and collaboration are key elements in creativity. In recent work creative collaboration has been proposed to be "distributed" between audiences, materials, embodied actions, and the historico-socio-cultural affordances of the creative activity and environment, thus expanding the potentialities of creative collaboration beyond instances of direct human interaction and engagement. Music performance, improvisation and composition may be viewed as exemplary "laboratories" of creative collaboration through the combined elements of audiences, materials, embodied actions and historico-socio-cultural affordances and constraints. This article reports the findings of a systematic literature review of creative collaboration and collaborative creativity in music. We sought to identify what has been currently investigated in relation to these terms and concepts in music, with what methodologies and in what settings. Findings indicate that studies were undertaken in higher education, professional development and professional practice predominantly, leading to an emergent phenomenon of interest, collaborative creative learning. Musical genres were jazz, popular, western classical, contemporary and world musics across the musical processes of composing, improvising and performing. Studies in higher education and professional development settings focused on identifying those practices that supported learning rather than the nature of collaborative creative approaches or the outcomes of creative collaboration. Participants were primarily male, with small sample sizes. Methodologies were largely qualitative with an emphasis on case study using observation, interview and reflective diary methods. Further areas for research include: the investigation of gendered approaches to creative collaboration, collaborative creativity, and collaborative creative learning; the use of more diverse research methodologies and methods and techniques including large-scale quantitative studies and arts-based and arts-led approaches; and the investigation of more diverse music settings.

Beliefs and Values About Music in Early Childhood Education and Care: Perspectives From Practitioners.

This paper reports the findings of a study that aimed to identify the music beliefs and values of educators in early childhood education and care settings in Australia. The aims of the study were 2-fold: to adapt and pilot a survey of music beliefs and values which might be implemented subsequently nationally in childcare settings; and, secondly, to identify the music beliefs and values held by early childhood and care educators concerning music in children's learning. The research questions that guided this component of the study were: What is the profile of early childhood and care educators? What beliefs and values for music engagement are held by early childhood and care educators? What shapes early childhood and care educators' music beliefs and values? Findings indicated that educators' beliefs and values on all items are above the mid-point indicating overall positive attitudes toward music despite the majority having no formal qualifications in music or a history of instrumental performance and/or singing. Given the overall positive attitudes toward music we suggest there is enormous potential within this population for further professional learning and development targeted at music and its potential wider benefits in young children's learning and lives.

Injury and the orchestral environment: part III. the role of psychosocial factors in the experience of musicians undertaking rehabilitation.

Workplace rehabilitation in the orchestral setting poses a number of challenges that arise in part due to a poor fit between generic injury insurance and medical care and the elite performance requirements of professional musicians. Currently, the orchestral profession lacks information and strategies to best deal with the unique challenges of this complex rehabilitation environment. In order to inform future directions for research and suggest possible changes of practice, the researchers conducted a qualitative case-study aimed at understanding the injury and rehabilitation experiences of professional musicians. In-depth semi-structured interviews were undertaken with three chronically injured professional cellists from a single Australian orchestra. After initial data analysis, further interviews were undertaken with a set of five orchestral management staff as a means of data triangulation. All data were analysed using a themes-based analysis-of-narrative approach. The findings indicate that injury concealment played a considerable role in the development of chronic injuries for these musicians, and management staff felt that this concealment may be the norm amongst orchestral musicians. The musicians in this study suffered emotional and psychological trauma as the result of their injuries, and two participants felt socially marginalised. During rehabilitation, the musicians in this study encountered difficulties with medical staff not understanding the elite performance requirements of orchestral work. The article proposes recommendations that may assist in dealing with the complex challenges of injury rehabilitation in the orchestral environment.

Injury and the orchestral environment: part II. Organisational culture, behavioural norms, and attitudes to injury.

The organisational culture, behavioural norms, and attitudes of a workplace have a profound influence on levels of injury and illness amongst its workers. While this is well established in Work Health and Safety literature, very little research has attempted to understand the influence of organisational culture on injury risk in the orchestral profession. To address this, the current study aimed to investigate the influence of organisational culture on injury outcomes for orchestral musicians. Using a qualitative case study methodology, in-depth semi-structured interviews were undertaken with 10 professional orchestral cellists (2 freelance and 8 fulltime members) from a single Australian orchestra. After initial data analysis, further interviews were undertaken with a set of 5 orchestral management staff as a means of data triangulation. All data were analysed using a themes-based "analysis of narrative" approach. The findings indicate that an orchestral culture exists in which musicians see injury as a sign of weakness, failure, and poor musicianship. Such negative perceptions of injury influence musicians to play through considerable levels of pain and continue performing with injuries. Because of perceived judgment from the orchestral group, musicians were found to conceal injuries from colleagues and management staff. Freelance musicians felt that disclosing injuries may lead to decreased work opportunities, and both full-time and casual musicians felt that "opening up" about injury may subject them to group judgment about their technique or musicianship. The study suggests education measures which may be effective at influencing individual behaviours and attitudes as well as cultural change initiatives which could lead to long-term positive health outcomes in the orchestral workplace.

Injury and the orchestral environment: part I. The role of work organisation and psychosocial factors in injury risk.

That orchestral musicians are exposed to a high risk of playing-related injury is well established, but despite this, little is known about how work organisation and psychosocial factors may contribute to this risk. Lack of research in this area is surprising considering the importance of these factors in managing occupational health risks in a wide range of other working populations. To address this, we conducted a qualitative study with the following aims: to investigate orchestral musicians' and managers' perceptions of those workplace environmental factors that contribute to injury, and to investigate the potential influence of work organisation and psychosocial factors on injury risk for orchestral musicians. Using a qualitative case-study methodology, in-depth, semi-structured interviews were undertaken with 10 professional orchestral cellists (2 casual and 8 full-time members) from a single Australian orchestra. After initial data analysis, further interviews were undertaken with a set of 5 orchestral management staff as a means of data triangulation. All data were analysed using a "themes-based" analysis of narrative approach. The findings indicate that musicians perceive that stress in the orchestral environment increases injury risk. The perceived stressors were divided into two broad categories: psychosocial injury risks, which included performance stress and interpersonal relationships, and combined psychosocial/physical injury risks such as work organisation and lack of control. This article evaluates the findings in terms of existing literature and makes recommendations for better management of environmental injury risk for orchestral musicians.

The use of fine-wire EMG to investigate shoulder muscle recruitment patterns during cello bowing: the results of a pilot study.

The physical mechanics of music making is important both in the prevention of injuries and in guiding how music is performed and taught. Electromyography has potential as a resource in understanding the loads involved in instrumental playing; however, only a small number of projects have been undertaken, and little is understood on the muscle activity used during bowing on string instruments. This study aimed to measure the muscle activity at the bowing shoulder of a cellist during cello playing and to establish if fine-wire EMG is useful in understanding muscle recruitment in string players without interfering with normal playing ability. This project used a combination of fine-wire and surface EMG to evaluate the muscular load placed on the right shoulder of a professional cellist whilst playing a set of various bowing exercises. The results indicated that different bowing techniques produced statistically different muscle activity levels, with the supraspinatus muscle in particular maintaining higher mean contraction (20% MVC) during all bowing patterns tested. Fine-wire EMG was useful in measuring shoulder muscle load and did not interfere with normal playing technique of the subject. Overall, the study presents a working protocol from which future studies may be able conduct further research.

A study of right shoulder injury in collegiate and professional orchestral cellists: an investigation using questionnaires and physical assessment.

UNLABELLED: Cellists sustain high levels of playing-related injury and are particularly susceptible to right shoulder pain, yet no studies have attempted to propose a mechanism for disease or establish possible causal factors. The aim of this study was to investigate shoulder injury levels and causes in two populations: professional orchestral cellists and college-level student cellists. METHODS: A questionnaire and physical testing protocol was applied to both groups of participants, eliciting information on lifestyle, playing habits, and self-reported injury rates as well as physical data on shoulder strength, range of motion, and signs of injury. RESULTS: Right shoulder injuries are common among both student (20%) and professional (42%) cellists and seem to be associated with measures indicating potential lack of strength in the scapular stabilisers as well as potential degenerative changes in the rotator cuff. Significant differences were found in the lifestyle and playing habits of the two groups. There were increased signs of pain and stiffness in the professionals and evidence of decreased muscular support in the students. Male cellists showed less scapular stability; female cellists, however, generally had higher levels of pain. CONCLUSIONS: These results indicate that injuries at the shoulder, potentially involving impingement-type pathologies, are a common cause of pain in cellists. Based on this study, future research for cello players could focus on targeted interventions, such as exercises for the scapular stabilisers and muscles of the rotator cuff.

Tub bathing versus traditional sponge bathing for the newborn.

OBJECTIVE: To compare selected effects of tub bathing versus traditional sponge bathing in healthy, term newborns and their mothers' ratings of pleasure and confidence with the bath. DESIGN: Randomized controlled study. SETTING: The maternity unit of an eastern Canadian hospital. PARTICIPANTS: One hundred two mother-baby pairs were randomly assigned to an experimental tub bath or a sponge bath control group. INTERVENTIONS: Fifty-one newborns were tub bathed and 51 sponge bathed according to the study protocols for their initial and one additional bath. MAIN OUTCOME MEASURES: (a) Newborn temperature stability was assessed by recording axillary temperatures pre- and postbath, (b) umbilical cord healing was identified by daily observations and infection control surveillance, (c) infant contentment was quantified by applying the Brazelton Neonatal Behavioral Assessment Scale, and (d) maternal pleasure with the bath and confidence with bathing at discharge were self-rated on a 5-point scale. RESULTS: Tub-bathed babies experienced significantly less temperature loss (t = 4.79, p = .00) and were significantly more content (t = -6.48, p = .00) than were those who were sponge bathed. No differences in cord healing scores were found. Mothers of tub bathed babies rated their pleasure with the bath significantly higher than did mothers of sponge bathed babies (t = 4.15, p = .00). No differences in maternal confidence were noted. CONCLUSIONS: Tub bathing is a safe and pleasurable alternative to sponge bathing in healthy, term newborns.