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Submission content Introduction: At the end of a particularly hectic night shift on the intensive care unit (ICU) I found myself sitting in the relatives' room with the mother and aunt of a young patient, listening to their stories of her hopes and aspirations as she grew up. She had been diagnosed with lymphoma aged 14 and received a bone marrow transplant from her younger sister. Fighting through treatment cycles interposed with school studies, she eventually achieved remission and a portfolio of A-levels. Acceptance into university marked the start of a new era, away from her cancer label, where she studied forensic science and took up netball. Halfway through her first year she relapsed. Main body: When I met this bright, ambitious 20-year-old, none of this history was conveyed. She had been admitted to ICU overnight and rapidly intubated for type-1 respiratory failure. The notes contained a clinical list of her various diagnoses and treatments, with dates but no sense of the context. Rules regarding visitation meant her family were not allowed onto the unit, with next-of-kin updates carried out by designated non-ICU consultants to reduce pressures on ICU staff. No photos or personal items surrounded her bedside, nothing to signify a life outside of hospital. She remained in a medically-induced coma from admission onwards, while various organ systems faltered and failed in turn. Sitting in that relatives' room I had the uncomfortable realisation that I barely saw this girl as a person. Having looked after her for some weeks, I could list the positive microbiology samples and antibiotic choices, the trends in noradrenaline requirements and ventilatory settings. I had recognised the appropriate point in her clinical decline to call the family in before it was too late, without recognising anything about the person they knew and loved. She died hours later, with her mother singing 'Somewhere Over the Rainbow' at her bedside. Poignant as this was, the concept of this patient as more than her unfortunate diagnosis and level of organ failure had not entered my consciousness. Perhaps a coping mechanism, but dehumanisation none-the-less. Conclusion(s): Striking a balance between emotional investment and detachment is of course vital when working in a clinical environment like the ICU, where trauma is commonplace and worst-case-scenarios have a habit of playing out. At the start of my medical career, I assumed I would need to consciously take a step back, that I would struggle to switch off from the emotional aspects of Medicine. However, forgetting the person behind the patient became all too easy during the peaks of Covid-19, where relatives were barred and communication out-sourced. While this level of detachment may be understandable and necessary to an extent, the potential for this attitude to contribute to the already dehumanising experience of ICU patients should not be ignored. I always thought I was more interested in people and their stories than I was in medical science;this experience reminded me of that, and of the richness you lose out on when those stories are forgotten.
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The purpose of this instrumental case study was to examine preservice music educators' perceptions of teaching voice lessons to elementary and secondary students during an online synchronous fieldwork experience. I used Garrison et al.'s Community of Inquiry (CoI) framework to analyze the participants' perceptions of cognitive presence (i.e., triggering events, exploration, integration, and resolution), social presence (i.e., emotional expression, open communication, and group cohesion), and teaching presence (i.e., structure and design of the fieldwork experience). During initial lessons, participants cited mostly triggering events and exploration, which occurred alongside indicators of social presence. Participants cited technological challenges associated with online synchronous learning (i.e., teaching presence) may have hindered instances of integration and resolution. Music teacher educators may consider using the CoI framework to structure collaborative and supportive online synchronous fieldwork experiences.
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INTRODUCTION: At the start of the COVID-19 pandemic, people with dementia living in the community experienced the sudden loss of their usual activities, and videoconferencing was widely adopted by music groups whilst face-to-face sessions were not possible. This paper reports the findings of a proof-of-concept study of online singing for people living with dementia and their carers, focusing on the experiences of the participants. METHOD: People with dementia and their care partners were invited to take part in 10 weeks of online singing sessions. Each session lasted 1 hour, and comprised time for talking, warming up and singing familiar songs. Participants completed standardised outcome measures at baseline and after 10 weeks. Dyads were invited to take part in a semi-structured interview. RESULTS: In total, 16 pairs were recruited. The response to the online singing group was mostly positive. Participants were able to use the technology to join the sessions, and reported few technical problems. Despite the limitations of online singing, the experience was frequently reported to be enjoyable. Some participants described longer-term benefits, such as improved mood and better relationship between care partners. Some felt online sessions had advantages over face-to-face ones; for example, they were more accessible. However, participants who had previously been attending face-to-face sessions felt that the online singing was a "better than nothing" substitute. CONCLUSIONS: Online singing cannot recreate the experience of group singing face-to-face, and it requires some technical knowledge, but it provides a worthwhile alternative in a time of need for some people with dementia and their carers. Furthermore, for some people online singing may be preferable due to its accessibility. Given the potential for online singing to include people who cannot go out for any reason and its relatively low cost, providers may wish to consider hybrid online/in-person singing groups in future.
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This study combines particle measurements and acoustic measurements to study aerosols generated in breathing, speaking, singing and coughing. Particle measurements are carried out using a portable measurement chamber designed specially for the study. Acoustic measurements of voice production are conduced to standardize measurements in human aerosol emission and to reveal possible reasons for the individual differences in particle generation. Understanding mechanisms of human aerosol generation is important in trying to understand how the airborne transmission of pathogens takes place and furthermore in assessing how to minimize the risk of transmission. The results can be used in the context of all airborne diseases. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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Viral RNA in fine (< 5 µm) aerosols from 13 patients infected by the SARS-CoV-2 virus were obtained using the Gesundheit-II (G-II) equipment which collects respiratory emissions. The collection was performed in isolation wards of the National Centre for Infectious Diseases of Singapore under an approved protocol. The patients breathed normally for 30 minutes, talk, and sing for 15 minutes each (with 30 minutes rest in between activity) into a specially designed aerosol collector in two size fractions. The coarse fraction (> 5 µm) and the fine aerosols (< 5 µm) are subsequently collected and subjected to PCR analysis for their viral load quantification. Viral RNA detected from 59% of the patients showed that patients earlier in illness were more likely to emit detectable RNA, and loads differed significantly between breathing, talking, and singing. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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Summary Objective The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil. Material and Methods This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing). Results In this study, the mean age of the singers was 35.8 (Standard deviation=±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (p=0.03;prevalence ratio - PR: 2.33;CI: 1.04 – 5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (p=0.001;PR: 9.13;CI: 2.47-64.42). Conclusions The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.
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Introduction/Aim: Although there remains insufficient evidence regarding singing programs as effective strategies for achieving clinically significant health outcomes, this non-pharmacological intervention appears to be subjectively low-risk and well-tolerated by people with advanced chronic respiratory diseases (CRD). Method(s): A meta-synthesis was undertaken to examine the current qualitative evidence regarding the experiences of singing for lung health programs in adults with advanced CRD and their careers. Electronic databases (Medline, CINAHL, PsycINFO, and EMBASE) were searched for qualitative studies published in English. Qualitative data was extracted and analysed, which generated descriptive and analytical themes. Result(s): Themes identified from seven included studies consisted of anticipation and reluctance to participate;physical and psychological benefits;new sense of purpose and enjoyment;social connection and achievement;and broad views regarding program structure and content. The themes were categorised into three time points to explore participants' perspectives before, during and after engaging in the singing program. Over time participants transitioned from anxiety to mastery of their chronic condition as the singing program progressed. Participants, however, raised concerns regarding several singing technicalities, the lack of ongoing support after the singing programs' conclusion and the social impacts of transitioning the sessions online during the COVID-19 pandemic. Conclusion(s): The increasing body of qualitative literature suggests that participants enjoyed the singing program and derived psychological, social and health benefits, not necessarily captured in quantitative studies. Future work should explore participants' experiences through qualitative, longitudinal methods to gain further insight into the acceptability and feasibility of singing programs and inform broader implementation of the intervention.
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Aims: ENO Breathe is an online breathing and wellbeing programme for people with Long COVID focusing on breathing re-training using singing techniques. Aim(s): to assess whether ENO Breathe improves health related quality-of-life (HRQoL) in people with persistent breathlessness following COVID-19. Method(s): A parallel-group, single-blind, RCT, comparing ENO Breathe(6 weeks) with usual care in adults, with persisting breathlessness +/- anxiety, following assessment at an NHS Long COVID clinic. Primary Outcome: change in HRQoL using the RAND SF-36 Mental(MHC) and Physical(PHC) Health Composite Scores. Secondary Outcomes: CAT, VAS for breathlessness (rest, walking, stairs, and running), Dysp-12, GAD-7. Participant experience was assessed using focus groups and free-text responses. Result(s): 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days symptomatic;ENO Breathe(n=74), Control(n=76). ENO Breathe was associated with improvement in MHC of 2.42 points (95%CI 0.03 to 4.80, p=0.045), but not PHC 0.6 (-1.33 to 2.52, p=0.541). VAS breathlessness (running) favoured ENO Breathe -10.48(-17.23 to -3.73, p=0.003). Three participant experience themes were identified 1) improvements in symptoms;2) feeling that the programme was complementary to standard care;3) the particular suitability of singing and music to address their needs. Conclusion(s): An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery.
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Through the lens of contagion theory, this paper examines the act of sanitizing tactile references in popular music at a time of legislated and extreme isolation. "Sweet Caroline" is an infectious tune that embraces togetherness and intimacy both lyrically and through its live performance. However, on March 22, 2020, Neil Diamond posted on Twitter a clip of himself, alone in front of a fireplace, singing a modified version of his hit song which reworked the lyrics of "touching hands" to "washing hands" and "touching me, touching you" to "don't touch me, I won't touch you." More viral than COVID-19 itself, the revised "Sweet Caroline" has spread to over five million viewers in a couple of short weeks. Touch, during the COVID-19 pandemic, has become devalued at a time when it should be celebrated as a point of comfort in the present and as hope for the future. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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One fundamental question about any novel pathogen is: how does it transmit? Answering this question will help to protect ourselves from the agent, at least until effective vaccines and antiviral therapies can be developed, especially if it is an agent of moderate to high lethality. Initially, at the start of the Coronavirus disease 2019 (COVID-19) pandemic, more emphasis was placed on handwashing rather than on droplet and aerosol transmission. Although severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2)-infected secretions such as saliva can spread the virus to hands, it became increasing evident that the virus mostly transmitted through close contact (though not necessarily touching), whilst people were breathing, talking, laughing, singing, coughing and sneezing near one another. During such respiratory activities, droplets and aerosols are produced together, and the amount of transmission due to these differentsized liquid particles will likely vary between individuals at different stages of their infection and illness. This question became even more complex as it emerged that viral transmission can occur for several days before symptom onset, and that asymptomatic cases can also shed just as much virus and potentially transmit it just as well as symptomatic cases. This chapter summarizes our understanding of how SARS-CoV-2 transmits and the infection control precautions to reduce this. © 2023 by World Scientific Publishing Co. Pte. Ltd.
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OBJECTIVE: To document the case of a high transmission rate of SARS-CoV-2 generating a cluster linked to an indoor choir rehearsal hold at the beginning of the COVID-19 pandemic in France. METHOD: Case study. Data were obtained via a questionnaire. RESULTS: Twenty-seven participants, including 25 singers, 1 conductor and 1 accompanist attended a choir practice on March 12, 2020. The practice was indoor and took place in a non ventilated space of 45 m2. No choir member reported having been symptomatic for COVID-19 between March 2 and March 12.The mean age of the participants was 66.9 (range 35-86) years. The secondary attack rate was 70%: 19/27 participants were diagnosed with COVID-19 from 1 to 12 days after the rehearsal with a median of 5.1 days. Thirty-six percent of the cases needed a hospitalization (7/19), and 21% (4/19) were admitted to an ICU. The index cases were asymptomatic and possibly multiple. CONCLUSION: In the absence of valid barrier measures to prevent COVID-19 transmission, indoor choir practice should be suspended during the SARSCoV-2 surging phases. Transmission of the virus among gatherings from asymptomatic cases is a crucial issue and a main challenge to COVID-19 control.
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Within the field of music education, there is extensive literature that speaks to the importance of singing for an individual's musical development (Williams, 2019;Welch, 2012). Aside from its musical benefits, Welch (2012) identifies the role of singing in improved respiratory and cardiac function, communication skills, and sense of social inclusion. With a more thorough understanding of TIVC, music educators will be better equipped to assess their students' voices and address their vocal needs during voice change. By expanding vocal pedagogy lessons to include voice change and its impact on vocal anatomy, music educators can provide clarity for adolescent boys as they navigate their changing voices.
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The prevalence of anxiety has increased dramatically due to COVID-19, so effective preventive interventions are welcome. The main objective of our study was to compare the acute relaxation response (RR) induced by Tibetan singing bowl (TSB) sound-based treatment against progressive muscle relaxation (PMR) and a control waiting list group (CWL) in a single treatment session in an adult nonclinical anxious population. In this cross-sectional randomized control trial, 50 participants selected based on high state anxiety were randomly assigned to one of the experimental groups. Pre/post self-reported anxiety, electroencephalographic activity (EEG), and heart rate variability (HRV) were recorded at baseline (T1), minute 15 (T2), minute 30 (T3), and minute 45 (T4). The TSB group showed significant reductions in alpha power (from T2 to T4) and increased HRV (from T3 to T4) compared with the PMR and CWL groups. Moreover, TSB and PMR both showed significant reductions in self-reported anxiety compared with CWL, with this effect being more evident in the TSB group. We concluded that a single session of TSB treatment was able to induce a more evident psychological/physiological relaxation response compared with PMR and CWL. TSB could be a relevant acute intervention in stressful situations or crisis intervention and while waiting for conventional interventions.
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BACKGROUND: Postnatal depression (PND) affects 13% of new mothers, with numbers rising during the COVID-19 pandemic. Despite this prevalence, many women have difficulty with or hesitancy towards accessing pharmacological and/or psychological interventions. Group-based mother-baby activities, however, have a good uptake, with singing improving maternal mental health and the mother-infant relationship. The recent lockdowns highlight the importance of adapting activities to an online platform that is wide-reaching and accessible. AIMS: The SHAPER-PNDO study will primarily analyse the feasibility of a 6-week online singing intervention, Melodies for Mums (M4M), for mothers with PND who are experiencing barriers to treatment. The secondary aim of the SHAPER-PNDO study will be to analyse the clinical efficacy of the 6-week M4M intervention for symptoms of postnatal depression. METHODS: A total of 120 mothers and their babies will be recruited for this single-arm study. All dyads will attend 6 weekly online singing sessions, facilitated by Breathe Arts Health Research. Assessments will be conducted on Zoom at baseline and week 6, with follow-ups at weeks 16 and 32, and will contain interviews for demographics, mental health, and social circumstances, and biological samples will be taken for stress markers. Qualitative interviews will be undertaken to understand the experiences of women attending the sessions and the facilitators delivering them. Finally, data will be collected on recruitment, study uptake and attendance of the programme, participant retention, and acceptability of the intervention. DISCUSSION: The SHAPER-PNDO study will focus on the feasibility, alongside the clinical efficacy, of an online delivery of M4M, available to all mothers with PND. We hope to provide a more accessible, effective treatment option for mothers with PND that can be available both during and outside of the pandemic for mothers who would otherwise struggle to attend in-person sessions, as well as to prepare for a subsequent hybrid RCT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04857593 . Registered retrospectively on 22 April 2021. The first participants were recruited on 27 January 2021, and the trial is ongoing.
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Activities such as singing or playing a wind instrument release respiratory particles into the air that may contain pathogens and thus pose a risk for infection transmission. Here we report measurements of the size distribution, number, and volume concentration of exhaled particles from 31 healthy musicians playing 20 types of wind instruments using aerosol size spectrometry complemented with in-line holography in a strictly controlled cleanroom environment. We find that playing wind instruments carries a lower risk of airborne disease transmission than speaking or singing. We attribute this to the fact that the resonators of wind instruments act as filters for particles >10 µm in diameter, which were found in high abundance right after a brass mouthpiece but very rarely at the instrument bell end. We have also measured the size-dependent filtering properties of different types of filters that can be used as instrument masks. Based on these measurements, we calculated the risk of airborne transmission of SARS-CoV-2 in different near- and far-field scenarios with and without masking and/or distancing. We conclude that in all cases where there is a possibility that the musician is infectious, the only safe measure to prevent airborne transmission of the disease is the use of well-fitting and well-filtering masks for the instrument and the susceptible person. © 2022 The Author(s)
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BACKGROUND: Choir singing is an activity that engages individuals all over the world with a broad demographic representation. Both qualitative and quantitative studies have examined the benefits of the activity but very few have examined the effects when someone loses access to it and stops singing. OBJECTIVES: Examining the governmental and organisational responses precipitated by the COVID-19 pandemic, we asked what happens when a choir singer loses all of their routines associated with regular participation in choir singing. MATERIALS AND METHODS: One national choir organization in Sweden (n = 3163) and one in Norway (n = 1881) were approached with a short survey. This comprised questions relating to the issue "what do you as a choir singer misses the most?" Each participant was asked to rate the importance of a number of elements that pertain to the experience of choir singing. RESULTS: The social aspect of singing emerged as having the strongest weight in terms of perceived loss that is, it was the element that the participants missed the most. Professional singers report that they miss the aesthetic experiences, flow, and all the physical aspects (physical training, voice training, and breathing training) to a greater degree as compared to reports from the amateurs. The importance of aesthetic experiences and physical components appeared to rise with increasing number of years that an individual had engaged with choir singing. CONCLUSION: In the Scandinavian setting, the social aspect has a stronger weight than the other components and this seemed to be more significant in Norway compared to Sweden.
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OBJECTIVES: Over time, papers or reports may come to be taken for granted as evidence for some phenomenon. Researchers cite them without critically re-examining findings in the light of subsequent work. This can give rise to misleading or erroneous results and conclusions. We explore whether this has occurred in the widely reported outbreak of SARS-CoV-2 at a rehearsal of the Skagit Valley Chorale in March 2020, where it was assumed, and subsequently asserted uncritically, that the outbreak was due to a single infected person. STUDY DESIGN: Review of original report and subsequent modelling and interpretations. METHODS: We reviewed and analysed original outbreak data in relation to published data on incubation period, subsequent modelling drawing on the data, and interpretations of transmission characteristics of this incident. RESULTS: We show it is vanishingly unlikely that this was a single point source outbreak as has been widely claimed and on which modelling has been based. CONCLUSION: An unexamined assumption has led to erroneous policy conclusions about the risks of singing, and indoor spaces more generally, and the benefits of increased levels of ventilation. Although never publicly identified, one individual bears the moral burden of knowing what health outcomes have been attributed to their actions. We call for these claims to be re-examined and for greater ethical responsibility in the assumption of a point source in outbreak investigations.
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COVID-19 , Humans , COVID-19/epidemiology , SARS-CoV-2 , Disease Outbreaks , Washington , MoralsABSTRACT
The COVID-19 pandemic has led to restrictions such as social distancing and mandatory wearing of face masks. Singing and religious gatherings have been linked to infection clusters, and between 2020 and 2021 indoor congregational singing and chanting were prohibited in the United Kingdom. We evaluated attitudes to face mask use and their acceptability as well as changes within places of worship since their reopening in July up to autumn 2020. In this cross-sectional study, participants were recruited using convenience sampling through selective targeting of religious organisations and social media. Participants self-enrolled and completed an online questionnaire, which included open and closed questions. We used multivariable logistic regression to identify factors associated with face mask acceptability. We performed thematic analysis to evaluate responses to open questions. A total of 939 participants were included in the analysis. Median age was 52.7 years and 66.1% were female, while 80.7% identified as Christian. A majority (672/861; 78.0%) of participants would find it acceptable to wear a face mask and reduce their singing or chanting volume if required, even though 428/681 (49.1%) found face masks to be uncomfortable. Multivariable regression found that younger age was associated with a higher acceptability of face masks (adjusted OR (aOR): 0.98 (95% confidence interval (95% CI) 0.96-1.00), p = 0.0218). The majority of respondents stated that religious services had become shorter, attended by fewer people and with reduced singing or chanting. Most (869/893, 97.3%) stated their place of worship complied with government guidelines, with 803/887 (90.5%) reported that their place of worship enforced face mask wearing and 793/887 (89.4%) at least moderately happy with precaution measures. Our study demonstrates the significant impact of COVID-19 in places of worship but a high degree of compliance with guidelines. Face masks, despite practical difficulties, appeared to be more acceptable if there was an incentive of being able to sing and chant.
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Background: Management of Long COVID (LC) is hugely challenging for clinicians. This pilot study evaluated a breathing retraining and singing programme (SingStrong for LC) to address common LC symptoms. The study hypothesized that this intervention would improve symptoms impacting disordered breathing and participant wellbeing. Methods: The 10-week, bi-weekly online programme was comprised of a 45-min class of mindfulness, breathing retraining, vocal exercises, and singing. Sessions were recorded for non-attenders and conducted by a trained vocal coach experienced in respiratory cohorts. Persons with a confirmed COVID-19 diagnosis and persisting symptoms were invited to participate. Demographic and COVID-19 data were collected, and the DePaul Symptom Questionnaire Short Form (DSQ- SF) and COVID-19 Yorkshire Rehab Screen questionnaires were administered. Post-intervention focus groups were also conducted. Results: Of 27 (F = 23(85%)) participants recruited, data from 21 who completed at least 10 (50%) classes were analysed. Participants showed significant pre-post-intervention improvements in all breathlessness symptoms (at rest: P < 0.001; dressing: P = 0.01; stairs: P < 0.001), fatigue (P = 0.03), usual activities (P = 0.04), pain/disability (P = 0.03), voice quality (P = 0.01), and communication/cognition (P = 0.04). Pre-post number of instances meeting DSQ-SF criteria for myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) decreased by a net of nine cases (14.3%). No association between COVID-19 hospitalisation status and diagnosis of ME/CFS was identified. Qualitative feedback from eight participants was overwhelmingly positive with all reporting improvements in breathing and general well-being. Conclusion: The SingStrong programme shows promise as a viable treatment option for LC sufferers. Future studies are required to further investigate the efficacy of this intervention.