Effects of Aging on Musical Performance in Professional Orchestral Musicians.

BACKGROUND: The physical and psychological demands of playing a musical instrument are likely to be affected by age-related decline in function, including physical, cognitive, psychological, and organ-related changes. However, the complex neurophysiological demands of playing a musical instrument may delay many normal aging-related changes. AIM: This study compared professional classical musicians of different ages, using a range of physical and psychological measures, to discover how increasing age might affect work performance and to identify possible risk and protective factors for physical and psychological health as the musicians age. SUBJECTS: 377 professional orchestral musicians from eight Australian orchestras (70% response rate), ages 18 to 68 yrs (mean 42.1). Multiple standardized physical and psychological tools were used to evaluate the impact of age on a range of physical and mental health variables. RESULTS: Age was not statistically associated with frequency or severity of performance-related musculoskeletal disorders, ratings of perceived exertion, QuickDASH scores, use of beta-blockers, workplace satisfaction, and most psychological tests. Differences were observed on SPIN (social anxiety) scores, with lowest scores in the oldest age group (10.66 in 55+ yrs vs 17.83 in 18-30 yrs, p=0.016). Older musicians had higher BMIs and fewer practice sessions per day than younger musicians and also were more likely to consume alcohol on 5+ days/wk (44% vs 9%, p=0.003). CONCLUSION: Advancing age does not appear to exert undue negative impacts on physical and psychological health or performance capacity of professional orchestral musicians. However, dwindling numbers in the older age groups may suggest a "survivor" effect, whereby those who develop significant age-related decrements may cease professional performance at earlier ages. Longitudinal studies on the professional trajectories of professional orchestral musicians are needed to explore this question further.

Gender Differences in Mortality and Morbidity Patterns in Popular Musicians Across the Lifespan.

Recent studies have highlighted the disturbing morbidity and early mortality of popular musicians. Most of the studies have focused on male musicians because, until recently, there were relatively few female popular musicians on which to base a population study. With the sharp increase in female popular musicians from fewer than 2% in the 1950s to 32% in the current decade, researchers are better able to examine the health status and mortality profile of female popular musicians. To this end, this paper makes what we believe is the first detailed analysis of mortality and morbidity in female popular musicians. Mortality patterns were similar for male and female musicians, and both were highly discrepant from population curves. Examination of death rates for younger (<45 yrs) and older (>45 yrs) musicians by sex and genre showed that violent deaths continued to dominate cause of death even in older musicians, accounting for 20% of all deaths, a figure three times higher than for a comparable general population. Unlike females in the general population, female gender did not bestow any protection against early death or manner of death by suicide, homicide, or accident compared with male popular musicians.

Life Expectancy and Cause of Death in Popular Musicians: Is the Popular Musician Lifestyle the Road to Ruin?

Does a combination of lifestyle pressures and personality, as reflected in genre, lead to the early death of popular musicians? We explored overall mortality, cause of death, and changes in patterns of death over time and by music genre membership in popular musicians who died between 1950 and 2014. The death records of 13,195 popular musicians were coded for age and year of death, cause of death, gender, and music genre. Musician death statistics were compared with age-matched deaths in the US population using actuarial methods. Although the common perception is of a glamorous, free-wheeling lifestyle for this occupational group, the figures tell a very different story. Results showed that popular musicians have shortened life expectancy compared with comparable general populations. Results showed excess mortality from violent deaths (suicide, homicide, accidental death, including vehicular deaths and drug overdoses) and liver disease for each age group studied compared with population mortality patterns. These excess deaths were highest for the under-25-year age group and reduced chronologically thereafter. Overall mortality rates were twice as high compared with the population when averaged over the whole age range. Mortality impacts differed by music genre. In particular, excess suicides and liver-related disease were observed in country, metal, and rock musicians; excess homicides were observed in 6 of the 14 genres, in particular hip hop and rap musicians. For accidental death, actual deaths significantly exceeded expected deaths for country, folk, jazz, metal, pop, punk, and rock.

Is Playing in the Pit Really the Pits?: Pain, Strength, Music Performance Anxiety, and Workplace Satisfaction in Professional Musicians in Stage, Pit, and Combined Stage/Pit Orchestras.

INTRODUCTION: Typically, Australian orchestral musicians perform on stage, in an orchestra pit, or in a combination of both workplaces. This study explored a range of physical and mental health indicators in musicians who played in these different orchestra types to ascertain whether orchestra environment was a risk factor affecting musician wellbeing. METHODS: Participants comprised 380 full-time orchestral musicians from the eight major state orchestras in Australia comprised of two dedicated pit orchestras, three stage-only symphonic orchestras, and three mixed stage/pit orchestras. Participants completed a physical assessment and a range of self-report measures assessing performance-related musculoskeletal disorders (PRMD), physical characteristics including strength and perceived exertion, and psychological health, including music performance anxiety (MPA), workplace satisfaction, and bullying. RESULTS: Physical characteristics and performance-related musculoskeletal profiles were similar for most factors on the detailed survey completed by orchestra members. The exceptions were that pit musicians demonstrated greater shoulder and elbow strength, while mixed-workload orchestra musicians had greater flexibility Significantly more exertion was reported by pit musicians when rehearsing and performing. Stage/pit musicians reported less physical exertion when performing in the pit compared with performing on stage. Severity of MPA was significantly greater in pit musicians than mixed orchestra musicians. Pit musicians also reported more frequent bullying and lower job satisfaction compared with stage musicians. DISCUSSION: There were few differences in the objective physical measures between musicians in the different orchestra types. However, pit musicians appear more psychologically vulnerable and less satisfied with their work than musicians from the other two orchestra types. The physical and psychological characteristics of musicians who perform in different orchestra types have not been adequately theorized or studied. We offer some preliminary thoughts that may account for the observed differences.

Intensive short-term dynamic psychotherapy for severe music performance anxiety: assessment, process, and outcome of psychotherapy with a professional orchestral musician.

This paper reports on the process and outcome of therapy using intensive short-term dynamic psychotherapy (ISTDP) with a professional musician who had suffered severe music performance anxiety over the course of his entire 30-year career. In this paper, we describe the nature of the therapy, the case history of the musician, the first assessment and trial therapy session, and the course and successful outcome of therapy. The patient underwent 10 sessions of ISTDP over a period of 4 months. This paper reports on the first 6 sessions, which were most relevant to the understanding and treatment of the patient's severe music performance anxiety. This case study is the first reported application of ISTDP to a professional musician. We believe that this case study provides initial support that moderate to severe performance anxiety, in at least some cases, has its origins in unresolved complex emotions and defences arising from ruptures to early attachment relationships.

Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study.

BACKGROUND: Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE: To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS: Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS: Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION: Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.

Musculoskeletal pain and injury in professional orchestral musicians in Australia.

UNLABELLED: This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia's eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs). METHODS: All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors. RESULTS: Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance). CONCLUSION: This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders.

How can surgical training benefit from theories of skilled motor development, musical skill acquisition and performance psychology?

Trainee surgeons must acquire expert status in the context of reduced hours, reduced operating room time and the need to learn complex skills involving screen-mediated techniques, computers and robotics. Ever more sophisticated surgical simulation strategies have been helpful in providing surgeons with the opportunity to practise, but not all of these strategies are widely available. Similarities in the motor skills required in skilled musical performance and surgery suggest that models of music learning, and particularly skilled motor development, may be applicable in training surgeons. More attention should be paid to factors associated with optimal arousal and optimal performance in surgical training - lessons learned from helping anxious musicians optimise performance and manage anxiety may also be transferable to trainee surgeons. The ways in which the trainee surgeon moves from novice to expert need to be better understood so that this process can be expedited using current knowledge in other disciplines requiring the performance of complex fine motor tasks with high cognitive load under pressure.

Liver disease in adolescents: A cohort study of high-risk individuals.

UNLABELLED: Little is known about the health and behavior of adolescent offenders as they relate to abnormalities of liver biochemistry and hepatitis C virus (HCV) infection. A large study of male juvenile offenders was undertaken that allowed a re-evaluation of the normal limits of alanine aminotransferase (ALT), associations with elevated ALT, and HCV antibody positivity. Young offenders (age 12-19 years) serving community orders participated in a wide-ranging health survey and laboratory assessment between October 2003 and December 2005. Normal ranges for liver biochemistry were calculated from the 95th percentile of males at the lowest risk for liver disease. The final sample comprised 682 males, of whom 439 (64%) gave blood. The calculated upper limit of normal for ALT was 28 IU/L. Seventeen percent of adolescents had an elevated ALT. Strong associations with elevated ALT included HCV antibody positivity [odds ratio (OR) 14.6], overweight and obesity (OR 6.9), and elevated total cholesterol (OR 3.6). More than 90% of adolescents with elevated ALT levels had 1 or more features of the metabolic syndrome. HCV antibody was positive in approximately 3% of the cohort, with the most significant risk factor being injecting drug use (OR 7.8; P < 0.01). The new infection rate was 3.7% per year. CONCLUSION: New upper limits for ALT provide greater sensitivity for the early diagnosis of liver disease in adolescents. High rates of HCV infection and obesity-related liver disease exist in this group, and targeted interventions are needed to reduce future health-related morbidity.

Relationship between weight, speaking fundamental frequency, and the appearance of phonational gaps in the adolescent male changing voice.

This 12-month prospective longitudinal study used acoustic analysis to identify phonational gaps in the vocal range of adolescent boys undergoing voice change and to investigate the relationship between the appearance of phonational gaps, weight gain, and changes in speaking fundamental frequency (SF0). Eighteen pubescent boys were recorded producing three descending and three ascending glides over their physiological voice range using the vowel "ah." Recordings were digitized over the range 0-16 kHz and then analyzed to determine both the frequency range and appearance and frequency characteristics of the phonational gaps. Data were plotted against changes in weight and SF0 both as an indicator of pubertal development and to test the hypothesis that changes in weight and SF0 were related to the appearance of phonational gaps. Results indicated that minimum F0 decreased significantly over the time period and phonational gaps increased significantly, but there were no significant changes in maximum F0 or range. Individual data indicated the initial appearance of a lower-frequency gap followed by a higher-frequency gap before the long-term establishment of a midrange gap. At time 5, all boys in the weight range 42.7-44.9 kg had either low- or high-range gaps. The SF0 for this group varied from 117 to 216 Hz. All boys heavier than 54.8 kg had highly variable phonational gaps. SF0 range for this group was 99.5-151 Hz. Transitory low- then high-frequency phonational gaps appeared before the establishment of a midrange phonational gap. In this study, these phonational gaps were associated with certain weight ranges and rapid weight gain, with changes to boys' speaking voices, and with loss of ability to use the mid- and falsetto vocal range.

Views from the inside: young offenders' subjective experiences of incarceration.

This study examined the incarceration experiences of 16 adolescent males in a maximum-security detention facility. A semistructured interview was conducted with each detainee and recorded on audiocassette. Data were analysed using phenomenological descriptive methodology. Detainees' experiences were characterised by a prison culture of bullying, substance use, and antagonism with youth workers; inadequate service provision and a lack of rehabilitative programming; and a sense of loss through reduced autonomy and dislocation from important others. These experiences gave rise to a range of negative feelings and emotions and promoted thinking about past and future behaviours. The incarceration experience placed detainees into a state of readiness for positive change but failed to provide them with the necessary skills to effect and sustain this change. Promotion of antisocial behaviour, lack of deterrence, and insufficient rehabilitative programming were identified as factors of the incarceration setting likely to contribute to the high rates of recidivism.

Substance use and treatment seeking in young offenders on community orders.

Both international and Australian studies reveal very low rates of treatment utilization for substance abuse among young offenders despite very high problematic rates of substance abuse among this group. The current study reports on substance use patterns of a representative sample of 712 young offenders serving community orders with the New South Wales Department of Juvenile Justice (Australia) and their history of and attitudes toward treatment. Most (87%) young offenders had used marijuana, and 47% had used amphetamines in the last 12 months. One third of the sample reported problematic use of alcohol (being drunk at least weekly, on average). Forty-three percent reported that they engaged in crime to maintain their substance use. On the substance abuse scale of the Adolescent Psychopathology Scale-Short Form, 36.4% of the sample fell into the moderate to severe problem range. Despite such problems, treatment motivation was poor: 10% reported willingness to access treatment for their drug problems. Eighteen percent reported accessing some form of treatment in the past; the most common form of help seeking was approaching their family (12%). Self-reported access to other drug treatments was even lower, with the more intensive treatments revealing low rates of treatment completion. Despite almost 40% of the sample revealing significant substance abuse problems, referral for treatment was also low, with only 18% of the sample being offered an appointment with juvenile justice drug and alcohol workers. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders with substance abuse problems.

Acoustic and perceptual appraisal of vocal gestures in the female classical voice.

Long-term average spectra (LTAS) have identified features in the sounds of singers and have compared different vocal qualities based on energy changes that occur during different vocal tasks. In this study, we compared the perceptual ratings of vocal quality of expert pedagogues with acoustic measures performed on LTAS. Fifteen expert judges rated 24 samples with six repeats of six advanced singing students under two conditions: "optimal" (O), which represented the application of the maximal open throat technique; and "suboptimal" (SO), which represented the application of the reduced open throat technique. LTAS were performed on each singing sample, and two conventional assessments of peak energy height [singing power ratio (SPR)] and peak area [energy ratio (ER)] were calculated on each LTAS. Perceptual scores, SPR, and ER were rank ordered. We then compared perceptual rankings with rankings of acoustic measures (SPR and ER) to assess whether these acoustic measurements matched the perceptual judgments of vocal quality. Although we found the expected significant relationship between SPR and ER, there was no relationship between perceptual ratings of vocal samples or singers based on SPR or ER. These findings suggest that because LTAS measures are not consistent with perceptual ratings of vocal quality, such measurements cannot define a voice of quality. Future research with LTAS to assess vocal quality should consider alternative measures that are more sensitive to subtle differences in vocal parameters.

Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP).

INTRODUCTION: Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety. METHODS: Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session. CASE DESCRIPTION: The 'case' was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition. DISCUSSION AND EVALUATION: The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety. CONCLUSION: Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Development and validation of a music performance anxiety inventory for gifted adolescent musicians.

Music performance anxiety (MPA) is a distressing experience for musicians of all ages, yet the empirical investigation of MPA in adolescents has received little attention to date. No measures specifically targeting MPA in adolescents have been empirically validated. This article presents findings of an initial study into the psychometric properties and validation of the Music Performance Anxiety Inventory for Adolescents (MPAI-A), a new self-report measure of MPA for this group. Data from 381 elite young musicians aged 12-19 years was used to investigate the factor structure, internal reliability, construct and divergent validity of the MPAI-A. Cronbach's alpha for the full measure was .91. Factor analysis identified three factors, which together accounted for 53% of the variance. Construct validity was demonstrated by significant positive relationships with social phobia (measured using the Social Phobia Anxiety Inventory [Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7(1), 73-79; Beidel, D. C., Turner, S. M., & Morris, T. L. (1998). Social Phobia and Anxiety Inventory for Children (SPAI-C). North Tonawanda, NY: Multi-Health Systems Inc.]) and trait anxiety (measured using the State Trait Anxiety Inventory [Spielberger, C. D. (1983). State-Trait Anxiety Inventory STAI (Form Y). Palo Alto, CA: Consulting Psychologists Press, Inc.]). The MPAI-A demonstrated convergent validity by a moderate to strong positive correlation with an adult measure of MPA. Discriminant validity was established by a weaker positive relationship with depression, and no relationship with externalizing behavior problems. It is hoped that the MPAI-A, as the first empirically validated measure of adolescent musicians' performance anxiety, will enhance and promote phenomenological and treatment research in this area.

Effects of topical anesthetic and flexible fiberoptic laryngoscopy on professional sopranos.

This study examined the acoustic and perceptual effects of topical anesthetic and flexible fiberoptic laryngoscopy (FFL) against a control condition on the singing voices of ten professional sopranos. Recordings of a section of an aria, various scales, and a messa di voce exercise were obtained in the three experimental conditions. Acoustic analyses of the same aria section recorded during the three conditions were similar with respect to the distribution of energy across the spectrum (LTAS) and vibrato rate and extent. The ability of the participants to achieve their highest and lowest notes or to complete the messa di voce was also not affected by the anesthetic or FFL. Perceptual ratings of a variety of parameters by experienced singing teachers also revealed little difference across conditions with only "appropriate velopharyngeal closure" found to differ in one comparison. These results indicate that highly experienced operatic sopranos are either not affected by or appear to have the ability to compensate for the presence of anesthetic and the FFL. The most likely explanation is that this group of singers relied on a solid vocal technique. Results will need to be replicated on less accomplished singers before concluding that this medical procedure does not affect the operatic singing voice.

Vibrato changes following imagery.

OBJECTIVES: This study investigated acoustic change in singers' vibrato following imagery and non-imagery tasks. STUDY DESIGN: The study used a fully randomized cross-over (six conditions × two times) block design, in which each singer received each intervention in random order. Data were analyzed using the general linear model (GLM). Main effects for time and condition and interaction effects (time × condition) were calculated for each dependent measure. METHODS: Six classically trained female singers recorded an 8-bar solo before and after three nonvocal, 25 minute tasks. Each singer performed the tasks in a different randomized order in a single sitting. Task 1 involved imagery of the breath directed up and down as far from the larynx as possible; Task 2 used Braille music code, enabling the singer to engage in tactile, kinesthetic and visual imagery related to music but unrelated to breath function; Task 3 was a nonimagery activity requiring the completion of a cloze passage about breath function. From the 11 longest notes in each solo, spectrograms of the partials were produced and assessed for pre- to post-test changes in vibrato rate, vibrato extent, and sound pressure level (SPL). RESULTS: Only the breathing imagery task produced significantly more moderate and regular vibrato rates. Vibrato extent was not responsive to any intervention. CONCLUSIONS: Findings indicate that breathing imagery regulates singers' vibrato in a manner consistent with that of a more proficient, warmed-up voice.

Assessing Linearity in the Loudness Envelope of the Messa di Voce Singing Exercise Through Acoustic Signal Analysis.

Messa di voce (MDV) is a singing exercise that involves sustaining a single pitch with a linear change in loudness from silence to maximum intensity (the crescendo part) and back to silence again (the decrescendo part), with time symmetry between the two parts. Previous studies have used the sound pressure level (SPL, in decibels) of a singer's voice to measure loudness, so as to assess the linearity of each part-an approach that has limitations due to loudness and SPL not being linearly related. This article studies the loudness envelope shapes of MDVs, comparing the SPL approach with approaches that are more closely related to human loudness perception. The MDVs were performed by a cohort of tertiary singing students, recorded six times (once per semester) over a period of 3 years. The loudness envelopes were derived for a typical audience listening position, and for listening to one's own singing, using three models: SPL, Stevens' power law-based model, and a computational loudness model. The effects on the envelope shape due to room acoustics (an important effect) and vibrato (minimal effect) were also considered. The results showed that the SPL model yielded a lower proportion of linear crescendi and decrescendi, compared with other models. The Stevens' power law-based model provided results similar to the more complicated computational loudness model. Longitudinally, there was no consistent trend in the shape of the MDV loudness envelope for the cohort although there were some individual singers who exhibited improvements in linearity.

The effects of office ergonomic training on musculoskeletal complaints, sickness absence, and psychological well-being: a cluster randomized control trial.

This study explored whether musculoskeletal complaints can be reduced by the provision of ergonomics education. A cluster randomized controlled trial study was conducted in which 3 units were randomized to intervention and received training and 3 units were given a leaflet. The effect of intervention on knowledge, workstation practices, musculoskeletal complaints, sickness absence, and psychological well-being were assessed at 6 and 12 months. Although there was no increment of knowledge among workers, significant improvements in workstation practices in the use of monitor, keyboard, and chair were observed. There were significant reductions in neck and upper and lower back complaints among workers but these did not translate into fewer days lost from work. Workers' stress was found to be significantly reduced across the studies. In conclusion, office ergonomics training can be beneficial in reducing musculoskeletal risks and stress among workers.