Vocal Fatigue Experiences and Mitigation Strategies in the Sacred Harp Singing Community.

OBJECTIVES: Sacred Harp singers sing at a high volume for sustained periods of time without collective warm-up or cool-down exercises, ostensibly putting them at elevated risk for vocal fatigue (VF) and associated vocal pathologies. Participants are also likely to lack formal vocal training. The purpose of this study was to (1) assess singers' experiences with VF, (2) document singers' strategies for mitigating VF, and (3) determine whether vocal training was associated with decreased vocal difficulties. STUDY DESIGN: Self-reporting via online questionnaire containing quantitative and qualitative items. METHODS: This study employed an online questionnaire that combined demographic items, open-ended questions, and the Evaluation of the Ability to Sing Easily (EASE). Participants were recruited at one in-person event and via social media and a mailing list. RESULTS: This study returned 134 valid responses. Singers with formal choral experience scored lower on the EASE and two subscales, but length of experience had no impact. There were no correlations between vocal training and EASE scores. Women scored higher on the EASE than men and nonbinary individuals, while age, length of experience with Sacred Harp singing, and frequency of attendance at annual singing events were all negatively correlated with EASE score. Singers reported a wide range of mitigation strategies, most of which are unique to the Sacred Harp context. CONCLUSIONS: Sacred Harp singers do not appear to struggle more with VF than other populations of singers. However, a few characteristics of their practice put them at risk, and many singers would benefit from professional guidance concerning vocal health.

Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial.

Importance: Specialist palliative care benefits patients undergoing medical treatment of cancer; however, data are lacking on whether patients undergoing surgery for cancer similarly benefit from specialist palliative care. Objective: To determine the effect of a specialist palliative care intervention on patients undergoing surgery for cure or durable control of cancer. Design, Setting, and Participants: This was a single-center randomized clinical trial conducted from March 1, 2018, to October 28, 2021. Patients scheduled for specified intra-abdominal cancer operations were recruited from an academic urban referral center in the Southeastern US. Intervention: Preoperative consultation with palliative care specialists and postoperative inpatient and outpatient palliative care follow-up for 90 days. Main Outcomes and Measures: The prespecified primary end point was physical and functional quality of life (QoL) at postoperative day (POD) 90, measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Trial Outcome Index (TOI), which is scored on a range of 0 to 56 with higher scores representing higher physical and functional QoL. Prespecified secondary end points included overall QoL at POD 90 measured by FACT-G, days alive at home until POD 90, and 1-year overall survival. Multivariable proportional odds logistic regression and Cox proportional hazards regression models were used to test the hypothesis that the intervention improved each of these end points relative to usual care in an intention-to-treat analysis. Results: A total of 235 eligible patients (median [IQR] age, 65.0 [56.8-71.1] years; 141 male [60.0%]) were randomly assigned to the intervention or usual care group in a 1:1 ratio. Specialist palliative care was received by 114 patients (97%) in the intervention group and 1 patient (1%) in the usual care group. Adjusted median scores on the FACT-G TOI measure of physical and functional QoL did not differ between groups (intervention score, 46.77; 95% CI, 44.18-49.04; usual care score, 46.23; 95% CI, 43.08-48.14; P = .46). Intervention vs usual care group odds ratio (OR) was 1.17 (95% CI, 0.77-1.80). Palliative care did not improve overall QoL measured by the FACT-G score (intervention vs usual care OR, 1.09; 95% CI, 0.75-1.58), days alive at home (OR, 0.87; 95% CI, 0.69-1.11), or 1-year overall survival (hazard ratio, 0.97; 95% CI, 0.50-1.88). Conclusions and Relevance: This randomized clinical trial showed no evidence that early specialist palliative care improves the QoL of patients undergoing nonpalliative cancer operations. Trial Registration: ClinicalTrials.gov Identifier: NCT03436290.

"Like Pieces in a Puzzle": Online Sacred Harp Singing During the COVID-19 Pandemic.

Sacred Harp singers the world over gather weekly to sing out of The Sacred Harp, a collection of shape-note songs first published in 1844. Their tradition is highly ritualized, and it plays an important role in the lives of many participants. Following the implementation of lockdown protocols to combat the COVID-19 pandemic, groups of Sacred Harp singers quickly and independently devised a variety of means by which to sing together online using Zoom ("zinging"), Jamulus ("jamzinging"), and Facebook Live ("stringing"). The rapidity and creativity with which Sacred Harp singers developed ways to sustain their activities attests to the strength and significance of this community of practice, and in this article I describe each modality and provide an account of how it came to be developed and widely used. As a participant-observer, I completed extensive fieldwork across these digital sites and conducted semi-structured interviews with 22 other singers. I found that online singing practices have reshaped the Sacred Harp community. Many singers who did not previously have the opportunity to participate now have access, while others have lost access due to technological barriers or lack of interest in online activities. At the same time, geographical barriers have disintegrated, and singing organizers must make an effort to maintain local identity. A stable community of singers has emerged in the digital realm, but it is by no means identical to the community that predated the pandemic. I also identify the ways in which online singing has proven meaningful to participants by providing continuity in their personal and communal practice. Specifically, online singing allows participants to access and celebrate their collective memories of the Sacred Harp community, carry out significant rituals, and continue to grow as singers. While no single modality replicates the complete Sacred Harp singing experience, together they function "like pieces in a puzzle" (as one singer put it), allowing individual participants to access many of the elements of Sacred Harp singing that are most meaningful to them.

Statistical analysis plan for the Surgery for Cancer with Option of Palliative Care Expert (SCOPE) trial: a randomized controlled trial of a specialist palliative care intervention for patients undergoing surgery for cancer.

BACKGROUND: The impact of specialist palliative care intervention in patients undergoing surgery for cancer has not been studied extensively. The SCOPE randomized controlled trial will investigate the effect of specialist palliative care intervention in cancer patients undergoing surgery for selected abdominal malignancies. The study protocol of the SCOPE Trial was published in December 2019. METHODS AND DESIGN: The SCOPE Trial is a single-center, single-blind, prospective, randomized controlled trial that will investigate specialist palliative care intervention for cancer patients undergoing surgery for selected abdominal malignancies. The study plans to enroll 236 patients that will be randomized to specialist palliative care (intervention arm) and usual care (control arm) in a 1:1 ratio. RESULTS: The primary outcome of the study is the Functional Assessment of Cancer Therapy-General (FACT-G) Trial Outcome Index (TOI) at 90 days postoperatively. Secondary outcomes of the study include the total FACT-G score at 90 days postoperatively, days alive at home without an emergency room visit within 90 days of operation, and all-cause mortality at 1 year after operation. Time frames for all outcomes will start on the day of surgery. CONCLUSION: This manuscript serves as the formal statistical analysis plan (version 1.0) for the SCOPE randomized controlled trial. The statistical analysis plan was completed on 6 April 2021. TRIAL REGISTRATION: ClinicalTrials.gov NCT03436290 . Registered on 16 February 2018.

Oesophagectomy for squamous cell carcinoma: lessons from a decade of consecutive resections.

The aim of this study was to analyse the outcome following oesophageal resection for squamous cell carcinoma (SCC) in a large volume unit. Between 1987 and 1997, 166 patients with SCC underwent oesophagectomy. The outcomes and pathological characteristics of this cohort were then analysed. Operative mortality was 6% (10 patients). Anastomotic leak occurred in 11 (6.6%). A history of previous respiratory disease and anastomotic leak were independent predictors of early mortality (P=0.02). Pathological examination demonstrated the presence of stage I disease in 8, stage IIa in 58, stage IIb in 14 and stage III in 87 patients. Kaplan-Meier survival at 1, 3 and 5 years for all patients was 71.6%, 44.6% and 33.5%. Five-year survival was 87.5% for stage I, 47.1% for stage IIa, 27.4% for stage IIb and 14.5% for stage III. On multivariate analysis, pathological stage (P=0.001) and presence of involved lymph nodes were independent adverse predictors of survival (P<0.0001). In conclusion, oesophagectomy for SCC carries an acceptable risk, which is higher for those having a respiratory disease and those developing an anastomotic leak. The good survival observed in early pathological stages and the presence of long-term survivors amongst those with locally advanced disease are encouraging.