Trabajo interdisciplinario en las profesiones de la voz humana: retos, límites y proyecciones

El presente documento resume los principales aportes del conversatorio titulado "Trabajo interdisciplinario en las profesiones de la voz humana: retos, límites y proyecciones", organizado por Vocology Center el 18 de julio de 2023, que reunió a líderes y representantes de diversas agremiaciones relacionadas con la voz humana, incluyendo profesionales del ámbito clínico, artístico, rehabilitación vocal, voz ocupacional, pedagogía vocal y otras disciplinas afines. El propósito de este conversatorio fue promover un debate crítico sobre la naturaleza del trabajo interdisciplinario en el estudio de la voz humana. Se exploraron los desafíos que surgen al configurar equipos de trabajo que incluyan profesionales con diferentes enfoques y experticias en el abordaje de la voz, así como los límites inherentes a los diversos roles y funciones desempeñados por los profesionales especializados en este campo, junto con las cuestiones éticas emergentes en este proceso. Con un enfoque encaminado a fortalecer alianzas interdisciplinarias, el evento se centró en la búsqueda de una comunicación y colaboración más efectiva. Este documento marca un avance significativo en la comprensión y colaboración interdisciplinar en el cuidado de la voz humana.

This document summarizes the main contributions of the panel discussion titled "Interdisciplinary work in the human voice professions: challenges, limits and projections" organized by the Vocology Center on July 18, 2023. The event brought together leaders and representatives from various associations related to the human voice, including professionals from the clinical, artistic, vocal rehabilitation, occupational voice, vocal pedagogy, and other related disciplines. The purpose of this panel discussion was to promote a critical debate on the nature of interdisciplinary work in the study of the human voice. The discussion explored the challenges that emerge when teams that include professionals with different approaches and expertise address voice production, as well as the inherent boundaries of the various roles and functions performed by specialized professionals in this field, along with the emerging ethical issues in this process. With a focus on strengthening interdisciplinary collaborations, the event centered on seeking more effective communication and collaboration. This document represents a significant step forward in understanding and fostering interdisciplinary cooperation in the care of the human voice.

The medicalization of ethics or ethicalization of neuroscience: Toward a conceptual re-examination.

Thinking With a growing body of brain science, the research and technological interventions in neuroscience have led to the rise of some ethical, moral, legal, conceptual, and socioeconomic problems. These problems and the need to establish an intellectual framework to approach them framed the base of Neuroethics. Most conveniently, the normative definition of Neuroethics is declared as ethics of neuroscience and neuroscience of ethics. However, there are more critical issues to define and frame the conceptual structure of the field. The current naturalist-positivist vision in neuroscience will extend the concept that human behavior, such as decision-making, consciousness, character, and moral intuitions, are mechanical features of a machine. Arguments from philosophical and anthropological views arose around this definition, focusing on the reductionist nature of merely a positive view of the human mind and behavior. Thinking through the pearls of such an approach and what would be at stake if we fail to recognize the importance of the philosophical-anthropological aspect of neuroscience, we first review different definitions and critics of the field, then proceed to discuss two concepts of Ethicalization and Medicalization. These concepts clearly show the established positivist-naturalist view in bioethics and the issues it caused. To better understand these two concepts, we use existing discussions and literature around them in bioethics. By reviewing the existing literature and adding a philosophical view of the field, we aim to add a new approach to the field of Neuroethics. We focus on adopting an interdisciplinary approach to Neuroethics to provide the needed background vision and theory to discuss interdisciplinary issues and enable scholars and theorists to reframe the fundamental issues of the field, such as the nature and scope of Neuroethics.

Soft Robotics: A Route to Equality, Diversity, and Inclusivity in Robotics.

Robotics is entering our daily lives. The discipline is increasingly crucial in fields such as agriculture, medicine, and rescue operations, impacting our food, health, and planet. At the same time, it is becoming evident that robotic research must embrace and reflect the diversity of human society to address these broad challenges effectively. In recent years, gender inclusivity has received increasing attention, but it still remains a distant goal. In addition, awareness is rising around other dimensions of diversity, including nationality, religion, and politics. Unfortunately, despite the efforts, empirical evidence shows that the field has still a long way to go before achieving a sufficient level of equality, diversity, and inclusion across these spectra. This study focuses on the soft robotics community-a growing and relatively recent subfield-and it outlines the present state of equality and diversity panorama in this discipline. The article argues that its high interdisciplinary and accessibility make it a particularly welcoming branch of robotics. We discuss the elements that make this subdiscipline an example for the broader robotic field. At the same time, we recognize that the field should still improve in several ways and become more inclusive and diverse. We propose concrete actions that we believe will contribute to achieving this goal, and provide metrics to monitor its evolution.

[The collaborative project "Personalized medicine for oncology" (PM4Onco) as part of the Medical Informatics Initiative (MII)]. / Das Verbundprojekt "Personalisierte Medizin für die Onkologie" (PM4Onco) als Teil der Medizininformatik-Initiative (MII).

The collaborative project Personalized Medicine for Oncology (PM4Onco) was launched in 2023 as part of the National Decade against Cancer (NKD) and is executed within the Medical Informatics Initiative (MII). Its aim is to establish a sustainable infrastructure for the integration and use of data from clinical and biomedical research and therefore combines the experience and preliminary work of all four consortia of the MII and the leading oncology centers in Germany. The data provided by PM4Onco will be prepared in a suitable form to support decision making in molecular tumor boards. This concept and infrastructure will be extended to 23 participating partner sites and thus improve access to targeted therapies based on clinical information and analysis of molecular genetic alterations in tumors at different stages of the disease. This will help to improve the treatment and prognosis of tumor diseases.Clinical cancer registries are involved in the project to improve data quality through standardized documentation routines. Clinical experts advise on the expansion of the core datasets for personalized medicine (PM). Information on quality of life and treatment outcomes reported by patients in questionnaires, which is rarely collected outside of clinical trials, will make a significant contribution. Patient representatives are involved from the onset to ensure that the important perspective of patients is taken into account in the decision-making process. PM4Onco thus creates an alliance between the MII, oncological centers of excellence, clinical cancer registries, young scientists, patients, and citizens to strengthen and advance PM in cancer therapy.

The Value of Interdisciplinary Collaboration in Human Geography and Bioethics.

Human geography and bioethics both take pride in their interdisciplinary approaches. Relatively little cross-pollination has occurred between human geography and bioethics. This paper takes three cases to highlight the generative potentials of both disciplines, dedicating time and space to learning from each other. Through doing so, we highlight these potentials by focusing on how navigating public spaces subverts the expected uses of particular spaces. We demonstrate that these are entangled with questions of responsibility that both geographers and bioethicists might find helpful. Human geographers and bioethicists can, and should, look for non-naïve ways to care for space, and we hope for this paper to be an example of where to start in the collaborative future of our disciplines.

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada.

BACKGROUND: Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model. METHODS: A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement. RESULTS: Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken. CONCLUSIONS: This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

A social psychology of climate change: Progress and promise.

Social psychologists have conducted research relevant to environmental problems for many decades. However, the climate crisis presents a new problem with distinctive aspects and distinctive urgency. This paper reviews some of the principal ways in which social psychological research and theory have approached the topic, looking at perceptions, behaviour, and impacts linked to climate change. Each of these areas is becoming more sophisticated in acknowledging the diversity of experience among groups that vary in demographics and social roles. I close by identifying three important facets for future research: a focus on social justice, an effort to participate in interdisciplinary efforts, and an emphasis on maximizing our impact.

Seeing with Different Eyes. The Module Life & Science of the Elite-Master Program Biomedical Neuroscience.

From its beginnings in 2018, the international elite-master program Biomedical Neuroscience of TUM School of Medicine and Health at Technical University of Munich was guided by two convictions: First, excellent research depends not only on the mediation of scientific knowledge and skills, but also on a multifaceted understanding of science itself. Second, teaching must recognize and support not only student's growing expertise but also their personal and professional development. To this end, the module Life & Science was designed. It gives students the opportunity to explore neuroscience from different angles to deepen the epistemological, sociological, and cultural understanding of their chosen profession.

From urban ecology to urban enquiry: How to build cumulative and context-sensitive understandings.

This paper positions urban ecology as increasingly conversant with multiple perspectives and methods for understanding the functions and qualities of diverse cities and urban situations. Despite progress in the field, we need clear pathways for positioning, connecting and synthesising specific knowledge and to make it speak to more systemic questions about cities and the life within them. These pathways need to be able to make use of diverse sources of information to better account for the diverse relations between people, other species and the ecological, social, cultural, economic, technical and increasingly digital structures that they are embedded in. Grounded in a description of the systemic knowledge needed, we propose five complementary and often connected approaches for building cumulative systemic understandings, and a framework for connecting and combining different methods and evidence. The approaches and the framework help position urban ecology and other fields of study as entry points to further advance interdisciplinary synthesis and open up new fields of research.

Importance of methodological pluralism in deriving counterfactuals for evidence-based conservation.

Most protected area impact research that uses counterfactuals draws heavily on quantitative methods, data, and knowledge types, making it valuable in producing generalizations but limited in temporal scope, historical detail, and habitat diversity and coverage of ecosystem services. We devised a methodological pluralistic approach, which supports social science qualitative methods, narratives, mixed methods, and interdisciplinarity, to fully unlock the potential of counterfactuals in ensuring a place-based and detailed understanding of the socioecological context and impacts of protected areas. We applied this approach to derive possible counterfactual conditions for the impact of a montane protected area on 40 years of vegetation change in the Cape Floristic Region-a global biodiversity hotspot and UNESCO World Heritage Site in South Africa. We incorporated diverse methods, knowledge, and information sources, drawing on before-after protected area comparisons for inside and outside the protected area. A significant increase in shrubland vegetation (17-30%) was observed and attributed primarily to a decline in frequent burning for grazing. This also occurred outside the protected area and was driven by socioeconomic drivers and not by concerns over biodiversity conservation or land degradation. Had the protected area not been established the area would have seen intensification of cultivation and increased road networks, buildings, and water storage in dams. Our approach increased historical temporal coverage of socioecological change and contextualized assumptions around causality. Protected area impact evaluation should reengage in place-based research that fully incorporates pluralism in methodologies for constructing counterfactuals in a way that builds regional and global understanding from the local level upward. We devised 10 key principles for deriving counterfactuals grounded in methodological pluralism, covering aspects of collaboration, cocreation, inter- and transdisciplinarity, diverse values and lived experiences, multiple knowledge types, multiple possible causal mechanisms, social science qualitative methods, perceptions, perspectives, and narratives.

Importancia del pluralismo metodológico en la derivación de situaciones contrafactuales para la conservación basada en evidencias Resumen La mayoría de las investigaciones sobre el impacto de las áreas protegidas que usan situaciones contrafactuales se basan en gran medida en métodos cuantitativos, datos y tipos de conocimiento, por lo que son muy valiosas para producir generalizaciones, pero limitadas en el enfoque temporal, el detalle histórico y la diversidad de hábitats y cobertura de los servicios ambientales. Diseñamos una estrategia metodológica pluralista, la cual apoya los métodos cualitativos de las ciencias sociales, narrativas, métodos mixtos e interdisciplinarios para utilizar por completo el potencial de las situaciones contrafactuales para asegurar un conocimiento detallado y basado en el lugar del contexto socio ecológico y el impacto de las áreas protegidas. Aplicamos esta estrategia para derivar las posibles condiciones contrafactuales del impacto de un área protegida montañosa sobre 40 años de cambio de vegetación en el reino florístico del Cabo ­ un punto caliente de biodiversidad y Sitio de Patrimonio Mundial de la UNESCO en Sudáfrica. Incorporamos varios métodos, conocimientos y fuentes de información a partir de las comparaciones antes­después dentro y fuera del área protegida. Observamos un incremento significativo en la vegetación del matorral (17­30%), el cual atribuimos principalmente en la disminución de la quema frecuente para el pastoreo. Esto también ocurrió fuera del área protegida y fue causado por factores socioeconómicos y no por preocupación por la conservación de la biodiversidad o por la degradación del suelo. De no haberse establecido el área protegida, la zona habría sufrido una intensificación de cultivos y un incremento de carreteras, edificios y almacenamiento de agua en presas. Nuestra estrategia incrementó la cobertura histórica temporal del cambio socio­ecológico y contextualizó las suposiciones sobre la causalidad. La evaluación del impacto del área protegida debe volver a la investigación basada en el lugar que incorpora de lleno el pluralismo en la metodología para construir situaciones contrafactuales de una forma que genere conocimiento regional y global a partir del nivel local y hacia arriba. Diseñamos diez principios clave para derivar las situaciones contrafactuales basados en el pluralismo metodológico, la cobertura de los aspectos de colaboración, creación conjunta, inter­ y transdisciplinariedad, valores diversos y experiencias vividas, varios tipos de conocimiento, diferentes mecanismos causales posibles, métodos cualitativos de las ciencias sociales, percepciones, perspectivas, historias y narrativas.

Opinion Models, Election Data, and Political Theory.

A unifying setup for opinion models originating in statistical physics and stochastic opinion dynamics are developed and used to analyze election data. The results are interpreted in the light of political theory. We investigate the connection between Potts (Curie-Weiss) models and stochastic opinion models in the view of the Boltzmann distribution and stochastic Glauber dynamics. We particularly find that the q-voter model can be considered as a natural extension of the Zealot model, which is adapted by Lagrangian parameters. We also discuss weak and strong effects (also called extensive and nonextensive) continuum limits for the models. The results are used to compare the Curie-Weiss model, two q-voter models (weak and strong effects), and a reinforcement model (weak effects) in explaining electoral outcomes in four western democracies (United States, Great Britain, France, and Germany). We find that particularly the weak effects models are able to fit the data (Kolmogorov-Smirnov test) where the weak effects reinforcement model performs best (AIC). Additionally, we show how the institutional structure shapes the process of opinion formation. By focusing on the dynamics of opinion formation preceding the act of voting, the models discussed in this paper give insights both into the empirical explanation of elections as such, as well as important aspects of the theory of democracy. Therefore, this paper shows the usefulness of an interdisciplinary approach in studying real world political outcomes by using mathematical models.

The practice of historical ecology: What, when, where, how and what for.

In recent decades, there has been a growing number of studies exploring the historical dimensions of the interconnectedness of human societies and the environment. A core approach in this field is historical ecology. We analyzed 544 historical-ecological papers to assess patterns and trends in the field. We found a high degree of interdisciplinarity with a focus on local case studies, of periods of fewer than 500 years, analyzing archival sources through quantitative approaches. The proportion of papers containing management recommendations has increased over time. To make historical ecology globally relevant, more effort should be made to utilize studies across languages, borders and worldviews. We call for high standards regarding the use of social scientific methodologies. Lastly, we argue that fostering longer-term studies and assessing the real-life impact of policy recommendations emerging from historical ecology can help the discipline better contribute solutions to the challenges facing humanity in an uncertain future.

A cross-disciplinary approach to learning medical physiology and behavioral skills involving drama students performing as simulated patients.

The early years of physiology education in medical curricula provide unique challenges. As well as inculcating concepts that are seen as difficult, modern curricula require that students learn in context in case-based learning courses. Additionally, regulating bodies stress that the soft skills of compassion, communication, and empathy are embedded throughout curricula. This has driven work in our organization involving drama and final-year medicine students during which they collaborate in realistic simulations of doctor/patient interactions. We adapted this transdisciplinary approach to second-year physiology tutorials. This emphasized the holistic importance of physiology to patient care, while also embedding "human factors" skills from the very earliest stages of the curriculum. After preparing by attending acting classes based on aspects of Konstantin Stanislavski's "System," the authors supervised tutorials in which drama students participated in a "physiology of hypofertility" session for second-year medical students, playing a 34-year-old woman with premature menopause (or their partner). Opinion (from all students) was evaluated by Likert questionnaires (which included open questions). A focus group of drama students was also interviewed, and the conversation was recorded for thematic analysis. Positive Likert scores were recorded for the authenticity of the tutorials, skills development, fostering empathy, and motivating students to improve. All participants evaluated the tutorial as highly enjoyable. These scores are reflected in positive open commentary on the questionnaires and in the focus group interviews. The results suggest that even basic science tutorials give opportunities for interdisciplinary study and enhancement of behavioral skills while gaining enthusiastic student acceptance.NEW & NOTEWORTHY This work details how physiology tutorials for early years medical students are transformed by taking the clinical case off the two-dimensional page and instead having the case scenario acted by drama students. This adds context and authenticity. The benefits are twofold: emphasizing the importance of physiology to the budding clinician and embedding empathy and compassion from the earliest points in a clinician's career.

What can pediatricians learn from adult inherited metabolic diseases?

The field of inherited metabolic diseases (IMD) has initially emerged and developed over decades in pediatric departments. Still, today, about 50% of patients with IMD are adults, and adult metabolic medicine (AMM) is getting more structured at national and international levels. There are several domains in which pediatricians can learn from AMM. First, long-term evolution of IMD patients, especially those treated since childhood, is critical to determine nutritional and neuropsychiatric outcomes in adults so that these outcomes can be better monitored, and patient care adjusted as much as possible from childhood. Conversely, the observation of attenuated phenotypes in adults of IMD known to present with severe phenotypes in children calls for caution in the development of newborn screening programs and, more largely, in the interpretation of next-generation sequencing data. Third, it is important for pediatricians to be familiar with adult-onset IMD as they expand our understanding of metabolism, including in children, such as oxysterols and glycogen metabolism. Last, the identification of common molecular and cellular mechanisms in neurodevelopment and neurodegeneration opens the way to synergistic therapeutic developments that will benefit both fields of pediatric and adult medicine. Overall, these observations underline the need of strong interdisciplinarity between pediatricians and adult specialists for the diagnosis and the treatment of IMD well beyond the issues of patient transition from pediatric to adult medicine.

The growing interdisciplinarity of developmental psychopathology: Implications for science and training.

The field of developmental psychopathology has grown exponentially over the past decades, and has become increasingly multifaceted. The initial focus on understanding abnormal child psychology has broadened to the study of the origins of psychopathology, with the goals of preventing and alleviating disorder and promoting healthy development. In this paper, we discuss how technological advances and global events have expanded the questions that researchers in developmental psychopathology can address. We do so by describing a longitudinal study that we have been conducting for the past dozen years. We originally planned to examine the effects of early adversity on trajectories of brain development, endocrine function, and depressive symptoms across puberty; it has since become an interdisciplinary study encompassing diverse domains like inflammation, sleep, biological aging, the environment, and child functioning post-pandemic, that we believe will advance our understanding of neurobehavioral development. This increase in the breadth in our study emerged from an expansion of the field; we encourage researchers to embrace these dynamic changes. In this context, we discuss challenges, opportunities, and institutional changes related to the growing interdisciplinarity of the field with respect to training the next generation of investigators to mitigate the burden of mental illness in youth.

Understanding psychosis complexity through a syndemic framework: A systematic review.

Psychotic conditions pose significant challenges due to their complex aetiology and impact on individuals and communities. Syndemic theory offers a promising framework to understand the interconnectedness of various health and social problems in the context of psychosis. This systematic review aims to examine existing literature on testing whether psychosis is better understood as a component of a syndemic. We conducted a systematic search of 7 databases, resulting in the inclusion of five original articles. Findings from these studies indicate a syndemic characterized by the coexistence of various health and social conditions, are associated with a greater risk of psychosis, adverse health outcomes, and disparities, especially among ethnic minorities and deprived populations. This review underscores the compelling need for a new paradigm and datasets that can investigate how psychosis emerges in the context of a syndemic, ultimately guiding more effective preventive and care interventions as well as policies to improve the health of marginalised communities living in precarity.

[The transition of adolescents with sickle cell disease: an interdisciplinary exchange]. / La transition des adolescents drépanocytaires, un échange interdisciplinaire.

With the rising incidence of sickle cell disease, this chronic pathology is becoming the most common genetic disease in France. Advances in care have led to a marked improvement in life expectancy. Caregivers in pediatric facilities are therefore increasingly confronted with the question of the transition to adulthood of the adolescents they have been following since birth. As nurses working in Robert-Debré's transfusion and curative medicine unit, in 2022, adolescents accounted for 57 % of sickle cell patients enrolled in our transfusion exchange program. Adolescence is a period of major change, and the repercussions of the disease are all the more pronounced. This raises the issue of transferring them to the adult sector.

A poetic inquiry: the role of the social sciences and humanities in revitalising AIDS.

For the past four decades, biomedical science has transformed clinical outcomes for HIV and AIDS. However, the social, economic and gendered determinants of HIV remain largely intact. The social science and humanities offer concepts and methods for articulating why these remain intractable. I used poetic inquiry - an arts-based, qualitative approach - as I reviewed literature on the "end of AIDS, and post-AIDS". As I did so, I considered what contribution the social sciences and humanities could make in moving us closer to these ideals. Several themes and found poems emerged in this reading: (1) how language oversimplifies complex social realities; (2) the voices of people living with HIV and AIDS must be included; (3) HIV and AIDS intersects with social inequalities; (4) social and structural issues are no barrier to HIV prevention and (5) the need for radical interdisciplinarity. The paper concludes that the end of AIDS requires responses that are integrated, holistic and that radically challenge our silo'd disciplinary boundaries and frames. The social sciences and humanities are key to this charge.

Integrating Comprehensive Rehabilitation Care to Multimorbidity Approach: A Challenge for the Chilean Public Health System.

The multimorbidity approach involves promotional and preventive strategies. The demand for rehabilitation services has grown exponentially in recent years, leading to the urgency of rethinking care delivery. In Chile, there are laws, programs, and guidelines that, from their theoretical basis, include a person-centered care focus. But in real practice, multiple barriers trigger important fragmentation of care. In response, a new strategy has been proposed to answer whether comprehensive rehabilitation care based on multimorbidity positively impacts the health system performance, people's functionality, and quality of life, which will be implemented as a pilot study with a national scale-up focus.

El enfoque de multimorbilidad implica estrategias promocionales y preventivas. La demanda de servicios de rehabilitación ha crecido exponencialmente en los últimos años, lo que ha llevado a la urgencia de repensar la organización y entrega de prestaciones. En Chile existen leyes, programas y lineamientos que, desde su base teórica, incluyen un enfoque de atención centrado en la persona. Pero en la práctica real, múltiples barreras generan una importante fragmentación de la atención. En respuesta, se ha propuesto una nueva estrategia para responder si una rehabilitación integral basada en el enfoque de la multimorbilidad impacta positivamente en el desempeño del sistema de salud, la funcionalidad de las personas y la calidad de vida, que se implementará como un estudio piloto con un enfoque de escalamiento nacional.