Interviews with musicians with hearing aids.

Objectives: Musicians who wear hearing aids are a unique subset of hearing-impaired individuals. There are a number of issues musicians experience with hearing aids, making effective hearing rehabilitation a challenge. Research suggests hearing aid satisfaction in musicians is lower partly due to their advanced listening skills, however, qualitative research addressing musicians who wear hearing aids for music is scarce. The current study aimed to record the barriers encountered by musicians who wear hearing aids when playing their instrument/singing, listening to recorded music and listening to live music.Design: Professional musicians who wear hearing aids were interviewed. Participants were questioned about their experiences with hearing loss and hearing aids, with particular emphasis on experiences listening to recorded and live music, and playing or performing music with the hearing aids.Study Sample: Eight professional musicians were interviewed, using a semi-structured interview style, with a question and prompt guide.Results: Thematic analysis revealed three main themes in the data: the musicians' journey, communication, and flexibility/adjustability.Conclusions: The results have implications for future research into specific fitting parameters for hearing aids for musicians (particularly for music performance), the need for evidence-based rehabilitation programs for musicians with hearing loss, and the need for a glossary of terms to assist communication between Audiologists and musicians.

The development and structure of the mesentery.

The position of abdominal organs, and mechanisms by which these are centrally connected, are currently described in peritoneal terms. As part of the peritoneal model of abdominal anatomy, there are multiple mesenteries. Recent findings point to an alternative model in which digestive organs are connected to a single mesentery. Given that direct evidence of this is currently lacking, we investigated the development and shape of the entire mesentery. Here we confirm that, within the abdomen, there is one mesentery in which all abdominal digestive organs develop and remain connected to. We show that all abdominopelvic organs are organised into two, discrete anatomical domains, the mesenteric and non-mesenteric domain. A similar organisation occurs across a range of animal species. The findings clarify the anatomical foundation of the abdomen; at the foundation level, the abdomen comprises a visceral (i.e. mesenteric) and somatic (i.e. musculoskeletal) frame. The organisation at that level is a fundamental order that explains the positional anatomy of all abdominopelvic organs, vasculature and peritoneum. Collectively, the findings provide a novel start point from which to systemically characterise the abdomen and its contents.

Use of Gloves to Examine Intermittent Palm Cooling's Impact on Rowing Ergometry.

ABSTRACT: O'Brien, IT, Kozerski, AE, Gray, WD, Chen, L, Vargas, LJ, McEnroe, CB, Vanhoover, AC, King, KM, Pantalos, GM, and Caruso, JF. Use of gloves to examine intermittent palm cooling's impact on rowing ergometry. J Strength Cond Res 35(4): 931-940, 2021-The aim of this study was to examine the use of gloves on intermittent palm cooling's impact on rowing ergometry workouts. Our methods had subjects (n = 34) complete 3 rowing ergometer workouts of up to 8 2-minute stages separated by 45- or 60-second rests. They were randomized to one of the following treatments per workout: no palm cooling (NoPC), intermittent palm cooling as they rowed (PCex), or intermittent palm cooling as they rowed and post-exercise (PCex&post). Palm cooling entailed intermittent cold (initial temperature: 8.1° C) application and totaled 10 (PCex) and 20 (PCex&post) minutes, respectively. Workouts began with 8 minutes of rest after which pre-exercise data were obtained, followed by a ten-minute warm-up and the workout, and 20 minutes of post-exercise recovery. Numerous physiological and performance variables were collected before, during, and after workouts, and each was analyzed with either a two- or three-way analysis of variance. Our results include, with a 0.05 alpha and a simple effects post hoc, the distance rowed analysis produced a significant workout effect with PCex, PCex&post > NoPC. There were also significant interworkout differences for heart rate (HR) (NoPC > PCex) and blood lactate concentration (NoPC > PCex, PCex&post). We conclude that lower HRs and blood lactate concentrations from intermittent cooling caused subjects to experience less fatigue during those workouts and enabled more work to be performed. Continued research should identify optimal cooling characteristics to expedite body heat removal. Practical applications suggest that intermittent palm cooling administered with gloves enhance performance by abating physiological markers of fatigue.

Overview of laws and regulations aimed at protecting the hearing of patrons within entertainment venues.

BACKGROUND: Recreational noise-specifically loud music experienced at music venues-has been recognized as a hazard for hearing damage and associated pathologies such as tinnitus. In Europe and other countries around the world, there is a range of regulatory and legislative approaches to managing the sound levels and minimizing the risk of hearing damage for those attending music venues. It is important to have an understanding of these different approaches to inform the development of future regulations and legislation. METHODS: In December 2018, an online search of legislative instruments was conducted, and we identified 18 items that were aimed at protecting the hearing of people attending entertainment venues. RESULTS: Twelve documents were from European jurisdictions and the remainder were from cities or states of North and South America. The regulatory measures included in the documents ranged from sound level limitations, real-time sound exposure monitoring, mandatory supply of protective devices, requirements for signage and warnings, loudspeaker placement restrictions and the provision of 'quiet spaces'. CONCLUSIONS: European countries are well advanced in terms of providing legislation and other regulatory documents aimed at protecting people at entertainment venues when compared with the rest of the world. Future research is required to assess the effectiveness of these regulatory measures in reducing the risk associated with sound exposure at music venues.

Applying the Hierarchy of Hazard Control to Regulation of Sound Levels in Entertainment Venues.

Excessive sound levels at events where amplified music is a central element pose a risk to hearing. Whereas noise exposure in the workplace has been recognized as a hazard for over a century, the potential harm resulting from recreational sound exposure has only become apparent in recent years. In occupational settings where sound levels are high, employers are required to implement risk-mitigation strategies to reduce sound exposure and protect employees in accordance with the hierarchy of controls. In principle, this same risk management approach can be applied to entertainment venues. In this paper we discuss how the measures stipulated in various policies and regulations aimed at protecting the hearing of audience members at entertainment venues fit within the hierarchy of controls. We compare the relative likely effectiveness of each of the measures and outline how the particular characteristics of entertainment venues impact on the practical application of these measures.

Exercise-based correlates to calcaneal osteogenesis produced by a chronic training intervention.

Thirty workouts on a gravity-independent device (Impulse Training Systems, Newnan GA) evoked significant calcaneal bone mineral content (BMC, +29%) and density (BMD, +33%) gains. High speeds and impact loads were produced per repetition. We examined exercise performance variables from the 30-workout intervention to identify correlates to delta (∆) calcaneal BMC and BMD variance. Workouts included hip extension and seated calf press exercises done with subject's left legs. ∆ values were obtained from the first and 12th workouts for the hip extension movement, and for the first and 24th workouts for the seated calf press exercise. Per exercise the following variables were quantified: peak force (∆PF), peak acceleration (∆PA), impulse (∆I), and dwell times (∆DT). Dwell times are the elapsed time between the end of the eccentric phase, and the start of the next repetition's concentric phase. Pearson Coefficients assessed correlations between performance and criterion variables. With hip extension ∆DT calculated with data from the first and 12th workouts, there were significant correlations with calcaneal ∆BMC (r = -0.64) and ∆BMD (r = -0.63). With seated calf press ∆DT derived as the difference from the first and 24th workouts, there was a significant correlation with calcaneal ∆BMC (r = -0.48), but only a trend (r = -0.45) with ∆BMD as the criterion. No other variables correlated with significant amounts of calcaneal ∆BMC and ∆BMD variance. Negative correlations infer shorter dwell times evoked greater gains. The gravity-independent device warrants continued inquiry to treat and abate calcaneal losses.

Evaluation of Indicators of Female Sexual Dysfunction in Adult Entertainers.

INTRODUCTION: Female sexual dysfunction (FSD) incorporates a wide range of sexual issues within the female population; however, it has not been evaluated among female adult entertainers. AIM: To evaluate the prevalence of FSD in women working in the adult entertainment industry. METHODS: A 53-question online survey was distributed to female adult entertainers via e-mail through collaboration with the Free Speech Coalition, the North American Trade Association of the Adult Industry. Surveys were sent by the Free Speech Coalition to those within the Performer Availability Screening Services database who met the criteria of having biological vaginas and having experience as adult entertainers. The surveys were answered anonymously. Statistical analysis was performed with Stata/IC 15.1. MAIN OUTCOME MEASURES: The survey acquired baseline characteristics, use of contraceptives, sexual activity, work vs home sexual satisfaction, and orgasm, in addition to evaluation of female sexual function using the Female Sexual Function Index survey, with a total score <26.55 indicative of FSD. RESULTS: Of the 147 respondents, 96 (65%) met inclusion criteria of adequately completing the survey, having a biological vagina, and working in the adult entertainment industry. The mean age was 34.1 ± 10.3 years (range 20-66). The average Female Sexual Function Index score was 28.7 ± 5.6, and 24.0% (23 of 96) of entertainers had scores indicative of FSD. Overall, women found their personal sex lives more satisfying when compared with their professional sex lives (3.99 ± 1.40 vs 3.08 ± 1.52, P < .01). When comparing women with FSD to those without FSD, women with FSD had less sexual satisfaction at home (2.8 ± 1.7 vs 4.4 ± 1.0, P < .01), fewer overall sexual events (7.0 ± 6.7 FSD vs 12.9 ± 10.0 non-FSD, P < .01), and fewer satisfying sexual events overall (3.3 ± 4.2 vs 10.7 ± 8.7, P < .01). CLINICAL IMPLICATIONS: FSD is prevalent among all women, including those within the adult entertainment industry, and must be addressed during patient interactions. STRENGTH & LIMITATION: This is the first study to evaluate the novel group of female adult entertainers. Despite this novel population, the study size is rather small and is susceptible to response bias. CONCLUSION: FSD appeared to be less prevalent among female adult entertainers than rates commonly quoted for the general population and was more often seen in the women with less satisfying personal sex lives. Dubin JM, Greer AB, Valentine C, et al. Evaluation of Indicators of Female Sexual Dysfunction in Adult Entertainers. J Sex Med 2019;16:621-623.

Erectile dysfunction among male adult entertainers: a survey.

BACKGROUND: Erectile dysfunction (ED) has not been evaluated among male adult entertainers. Our goal was to evaluate the prevalence of ED and use of erectile aids among men working in the adult entertainment industry. METHODS: An online survey was distributed to male adult entertainers through collaboration with the Free Speech Coalition (FSC), the North American Trade Association of the Adult Industry. Surveys were sent via email to those who met the criteria of being non-transgender men with biological penises and have experience as adult entertainers. The survey acquired baseline characteristics, use and frequency of erectile aids, and assessed erectile function using the International Index of Erectile Function (IIEF) survey. Statistical analysis was performed in Microsoft Excel. RESULTS: Of the 98 respondents, 62 met inclusion criteria. The median age was 36 (IQR 28.25-45) years. Of those included, 69.4% (43/62) used erectile aids. In men who used erectile aids, 58.1% (25/43) used for both work and personal reasons. Erectile aids were used most among young men aged 20-29 (84.2%). Overall, 38.7% (24/62) of men had ED as defined by the IIEF survey. Of note, 26.3% (5/19) of men aged 20-29 had moderate to severe ED. CONCLUSIONS: This is the first study to evaluate ED among adult male entertainers. Male entertainers between the ages of 20-29 had both the highest prevalence of moderate to severe ED and the highest erectile aid usage among all male adult entertainers.

In Their Own Words: Interviews with Musicians Reveal the Advantages and Disadvantages of Wearing Earplugs.

BACKGROUND: Musicians are at risk of hearing loss from sound exposure, and earplugs form part of many musicians' hearing conservation practices. Although musicians typically report a range of difficulties when wearing earplugs, there are many who have managed to successfully incorporate earplugs into their practice of music. OBJECTIVE: The study aim was to provide a detailed account of earplug usage from the perspective of the musician, including motivating factors, practical strategies, and attitudes. METHODS: In-depth interviews with 23 musicians were transcribed and content analysis was performed. Responses were coded and classified into three main themes: advantages, disadvantages, and usage patterns and strategies, together with an overlapping fourth theme, youth perspectives. RESULTS: Several positive aspects of wearing earplugs were identified, including long-term hearing protection and reduced levels of fatigue and pain. Musicians reported that earplugs present few problems for communication, improve sound clarity in ensembles, are discreet, and are easy to handle. However, earplugs also present challenges, including an overall dullness of sound, reduced immediacy, and an impaired ability to judge balance and intonation due to the occlusion effect, all of which influence usage habits and patterns. CONCLUSION: The experiences of the younger musicians and long-term users of earplugs indicate that practice, persistence, and a flexible approach are required for successful earplug usage. In time, there may be greater acceptance of earplugs, particularly amongst a new generation of musicians, some of whom regard the earplugs as a performance enhancement tool as well as a protective device.

Inaccuracies in calculating predicted body weight and its impact on safe ventilator settings.

In many centres, height is used as a determinant for calculating predicted body weight. This predicted body weight is then multiplied to generate the desired tidal volume. The approach exhibits some mathematical effects: (1) any errors in height measurement are multiplied by 5.5 when generating the tidal volume (assuming 6 ml/kg); (2) any errors in height measurement have a greater impact on shorter patients. The aim of this study was to: (1) establish the current practice of setting a tidal volume in England; (2) assess the implications of inaccurate height measurements on tidal volume settings using the most common practice; (3) identify the most accurate and precise method of determining height to aid accurate application of a lung protective strategy. The six extra corporeal membrane oxygenation centres in the UK, and the 34 intensive cares with the highest admission figures were identified from the intensive care national audit and research centre database. Most frequent practice was to use of a 1-m tape on the supine patient on admission. Inaccuracies in height estimation using a 1-m tape resulted in a standard deviation of 23 ml and a spread of over 120 ml tidal volume in individual patients.There are a number of methods of estimating height in a supine patient but the most accurate appeared to be simply using a 2-m tape.

Description and evaluation of a hearing conservation program in use in a professional symphony orchestra.

Professional orchestral musicians risk permanent hearing loss while playing their instruments. Protecting the hearing of these musicians in the workplace is critical to their ongoing ability to play their instruments, but typical workplace hearing conservation measures can have very damaging effects on the product (music) and the musicians' abilities to hear one another sufficiently. To enable effective intervention, orchestras as employers must encourage engagement with hearing protection programs and implement controls while preserving the integrity of the music. To achieve this, typical approaches used in other industries must be redesigned to suit this unique workplace. In response to these challenges, the Queensland Symphony Orchestra (Brisbane, Australia) introduced a comprehensive hearing conservation strategy in 2005 based upon best practice at the time. This strategy-which has been regularly refined-continues to be implemented on a daily basis. This investigation aimed to assess the successes, difficulties, and practical viability of the program. To achieve this a process evaluation was carried out, incorporating archival analyses, player and management focus groups, and an interview with the program's administrator. Results show the program has successfully become integrated into the orchestra's and the musicians' daily operations and significantly contributes to managing the risk of hearing loss in this population. While there is room for improvement in the orchestra's approach-particularly regarding usable personal protective devices and improved education and training, results are encouraging. This study provides a basis for those wishing to implement or evaluate similar paradigms.

Sound Practice-improving occupational health and safety for professional orchestral musicians in Australia.

The Sound Practice Project is a 5-year study involving baseline evaluation, development, and implementation of musician-specific work health and safety initiatives. A cross-sectional population physical and psychological survey and physical assessment were conducted at the same time, with an auditory health assessment conducted later. The results were used to guide the development of a series of targeted interventions, encompassing physical, psychological, and auditory health components. This paper provides an overview of the project but focuses on the health findings arising from the cross-sectional survey. Three hundred and seventy-seven musicians from the eight professional symphony orchestras in Australia took part in the cross-sectional study (about 70% of eligible musicians). Eighty-four percent (84%) of musicians reported past performance-related musculoskeletal disorder (PRMD) episodes; 50% were suffering a current PRMD. Of the 63% who returned hearing surveys, 43% believed they had hearing loss, and 64% used earplugs at least intermittently. Noise exposure was found to be high in private practice, although awareness of risk and earplug use in this environment was lower than in orchestral settings. Improved strategic approaches, acoustic screens and recently developed active earplugs were found to provide effective new options for hearing protection. With respect to psychosocial screening, female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians were significantly more anxious compared with the oldest musicians. Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia; 32% returned a positive depression screen and 22% for post-traumatic stress disorder (PTSD). PRMDs and trigger point discomfort levels were strongly associated with increasing severity of psychological issues such as depression and music performance anxiety.

Hearing and hearing conservation practices among Australia's professional orchestral musicians.

Orchestral musicians are an at-risk population for noise-induced hearing loss. Following strategic approaches to mitigate exposure, many must use earplugs to safeguard their hearing, although reported usage rates are poor. Australia has progressive hearing conservation programs within many of its orchestras, yet little is known of earplug usage rates, abilities with earplugs or self-perceived hearing loss in this population. To help direct and inform future approaches to hearing conservation in Australia's orchestras a questionnaire assessing hearing conservation behaviors and the prevalence of self-perceived hearing loss was distributed. A total of 580 musicians across eight professional orchestras were surveyed, with 367 completed surveys (63%) returned. Eighty percent of respondents reported a risk of hearing damage in the orchestra, 64% used earplugs of some type at least some of the time and 83% found this use difficult/impossible. Forty-three percent reported a hearing loss, including 54% in pit orchestras and 46% of those ≤50 years of age. Brass players were least likely to use earplugs, most likely to report usage difficulties and most likely of those ≤50 years of age to report a hearing loss. While earplug usage rates in Australia are encouraging and may be linked to hearing conservation measures in the orchestras, the widespread difficulty reported with the use of these earplugs, the prevalence of self-reported hearing loss and the continued vulnerability of those most at-risk indicate improvements in both earplug design and further education for musicians are required to progress hearing conservation options for this population.

A clinical trial of active hearing protection for orchestral musicians.

Orchestral musicians-an at-risk group for noise-induced hearing loss-have consistently reported great difficulty using hearing protection while performing or rehearsing, even when using earplugs specifically designed for musicians. A recent innovation in this field has been electronic earplugs that claim to deliver very high quality sound and only attenuate when sound levels become excessive. This study investigated these claims, aiming to determine whether professional orchestral musicians were able to use these devices and whether they were preferred to existing earplugs. Initially clinical and laboratory testing was carried out on the devices, indicating some spectral alteration of processed sound occurred, however claims of attenuation properties were validated. Following this, 26 orchestral musicians used the devices during rehearsals and performances for at least four weeks, providing feedback throughout this period. While musicians preferred the devices to previous earplugs, they identified issues including difficulty with orchestral balance, perception of dynamics and quality of sound provided by the devices. Results indicate these earplugs are a very positive step towards a usable hearing conservation tool for orchestral musicians to use in conjunction with other risk mitigation measures.

Sound exposure of professional orchestral musicians during solitary practice.

It is broadly acknowledged that professional orchestral musicians risk noise-induced hearing pathologies due to sound exposure in rehearsal and performance. While much has been published regarding orchestral sound levels, little is known of the sound exposure these musicians experience during solitary practice, despite the many hours they spend engaged in this activity. This study aimed to determine sound exposure during solitary practice of 35 professional orchestral musicians, representing players of most orchestral instruments. To allow cross-comparison, participants were assessed playing similar repertoire in a controlled environment, recording simultaneously at each ear to determine sound exposure levels. Sound levels were recorded between 60 and 107 dB L(Aeq), with peak levels between 101 and 130 dB L(C,peak). For average reported practice durations (2.1 h per day, five days a week) 53% would exceed accepted permissible daily noise exposure in solitary practice, in addition to sound exposure during orchestral rehearsals and performances. Significant inter-aural differences were noted in violin, viola, flute/piccolo, horn, trombone, and tuba. Only 40% used hearing protection at any time while practicing. These findings indicate orchestral musicians at risk of noise-induced hearing loss in ensemble face significant additional risks during solitary practice. Data presented will enable more effective and targeted management strategies for this population.

The audiological health of horn players.

Among orchestral musicians, horn players are one of the most at-risk groups for noise-induced hearing loss (NIHL). To investigate this group further, pure tone audiometry and a 14-item questionnaire were used to assess the hearing health, as well as attitudes and practices regarding hearing conservation, among 142 French horn players attending an international horn conference in Brisbane, Australia. Of this study's French horn players, 11.1% to 22.2%, and 17.7% to 32.9% of those aged ≤40 years, showed some form of hearing loss (corrected for age and gender) typical of NIHL, using conservative versus lenient criteria, respectively. Stepwise multiple regression analyses showed no obvious predictor of hearing loss in this study's participants. Of the 18% of participants who reported using hearing protection, 81% used this protection "sometimes" and 50% used generic, foam, or other inferior forms of protection. Continued efforts to better manage the hearing health of horn players is warranted particularly as any hearing loss will affect a horn player's ability to perform and therefore his or her livelihood. Managing the hearing health of horn players will be challenging, however, with no simple predictor of NIHL loss being identified in this study's sample.

Hearing conservation and noise management practices in professional orchestras.

Hearing conservation and noise exposure management for professional orchestras is a difficult issue resistant to standard control measures as used in other industries with excessive noise problems. Although there has been a great deal of research into this area in terms of the audiological status of musicians and their exposure to noise, there are relatively few industry-specific strategies that can be adopted by an orchestra looking to address these issues. Australia does not have a uniform approach to hearing conservation management in its orchestras; however, each orchestra actively grapples with the challenges of balancing legal, practical, and artistic concerns. This study systematically investigated hearing conservation practices, noise exposure management, and audiological screening protocols in eight professional orchestras. The research involved personal interviews with staff at each orchestra, including inspection of venues and facilities. While all these orchestras were aware of the risks and were actively taking significant steps to reduce noise exposure, a range of approaches, with varying degrees of effectiveness and understanding of the issue, were found across the sector. There was limited evidence of educational programs for either the musicians at risk of excessive noise exposure or the staff responsible for devising and implementing control measures. In addition, the reported use of adequate personal hearing protection by musicians was poor. As Australia has recently introduced a national approach to workplace health and safety, a similar approach to noise and audiological management across the country's orchestral sector is proposed, drawn from existing research and practice. This will enable both consistent procedures and meaningful dialogue between the orchestras on the topics of hearing conservation, audiological monitoring, and educational practices.

Nature of orchestral noise.

Professional orchestral musicians are at risk of exposure to excessive noise when at work. This is an industry-wide problem that threatens not only the hearing of orchestral musicians but also the way orchestras operate. The research described in this paper recorded noise levels within a professional orchestra over three years in order to provide greater insight to the orchestral noise environment; to guide future research into orchestral noise management and hearing conservation strategies; and to provide a basis for the future education of musicians and their managers. Every rehearsal, performance, and recording from May 2004 to May 2007 was monitored, with the woodwind, brass, and percussion sections monitored in greatest detail. The study recorded dBALEQ and dBC peak data, which are presented in graphical form with accompanying summarized data tables. The findings indicate that the principal trumpet, first and third horns, and principal trombone are at greatest risk of exposure to excessive sustained noise levels and that the percussion and timpani are at greatest risk of exposure to excessive peak noise levels. However, the findings also strongly support the notion that the true nature of orchestral noise is a great deal more complex than this simple statement would imply.