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Children's early understanding of mathematics provides a foundation for later success in school. Identifying ways to enhance mathematical instruction is crucial to understanding the ideal ways to promote academic success. Previous work has identified mathematical language (i.e., the words and concepts related to early mathematical development such as more, same, or similar) as a key mechanism that can be targeted to improve children's development of early numeracy skills (e.g., counting, cardinality, and addition). Current recommendations suggest a combination of numeracy instruction and quantitative language instruction to promote numeracy skills. However, there is limited direct support of this recommendation. The goal of the proposed study is to compare the unique and combined effects of each type of instruction on children's numeracy skills in the context of picture book reading. We randomly assigned 234 children (ages 3–5) to one of four conditions where they worked with trained project staff who read picture books targeting: (a) quantitative language only (e.g., more or less), (b) numeracy only (e.g., cardinality, addition), (c) combined [quantitative language + numeracy], or (d) nonnumerical (active control) picture books. Results revealed no significant effects of the quantitative language only or numeracy only conditions, but mixed effects of the combined condition. These findings indicate that more work is needed on how mathematical language and numeracy instruction should best be delivered to preschool children. Educational Impact and Implications Statement: Significant research has highlighted the importance of quantitative language in children's early mathematics development. The findings from this study raise questions as to how to best implement such interventions. Namely, in contrast to prior work, the current interventions targeting one of the two domains did not exhibit positive results. However, mixed effects were found for the condition that combined both domains. Future work on how to best structure combined instruction is needed. [ABSTRACT FROM AUTHOR]

The article discusses the requirement for nurses and midwives in Great Britain to record their reflections that will form the basis of the professional development discussion (PDD) with a fellow registrant. Topics covered include the templates for reflective accounts provided by the Nursing and Midwifery Council (NMC), the reflections by nurses and midwives on the Code, practice-related feedback and continuing professional development (CPD), and how to write reflective accounts.

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing. [ABSTRACT FROM AUTHOR]

The article focuses on K. Robert Schwarz, research assistant at the H. Wiley Hitchcock Institute for Studies in American Music Conservatory of Music of Brooklyn College. Topics discussed include his a dissertation on composer Paul Bowles, interview of musicians conducted by him and the K. Robert Schwarz collection can be viewed at the Queens College Special Collections and Archives Department.

Summary Objective This study determined the prevalence and nature of voice problems in New Zealand (NZ) teachers using a national self-report questionnaire. Study Design Epidemiological cross-sectional survey. Methods Participants were 1879 primary and secondary teachers (72.5% females). Three prevalence timeframes were estimated. Severity of voice problems, recovery time, days away from work, symptoms, health assistance, and voice education were also investigated. Results Prevalence of self-reported vocal problems was 33.2% during their teaching career, 24.7% over the teaching year, and 13.2% on the day of the survey. Primary teachers ( P < 0.001; odds ratio [OR] = 1.74; confidence interval [CI] = 1.33–2.40), females ( P = 0.008; OR = 1.63; CI = 1.13–2.37), and those aged 51–60 years ( P = 0.010; OR = 1.45; CI = 1.11–3.00) were more likely to report problems. Among teachers reporting voice problems during the year, 47% were moderate or severe; for 30%, voice recovery took more than 1 week. Approximately 28% stayed away from work 1–3 days owing to a vocal problem and 9% for more than 3 days. Women reported longer recovery times and more days away. Symptoms associated with voice problems ( P < 0.001) were voice quality alteration (OR = 4.35; CI = 3.40–5.57), vocal effort (OR = 1.15; CI = 0.96–1.37), voice breaks (OR = 1.55; CI = 1.30–1.84), voice projection difficulty (OR = 1.25; CI = 1.04–1.50), and throat discomfort (OR = 1.22; CI = 1.02–1.47). Of the teachers reporting voice problems, only 22.5% consulted a health practitioner. Only 38% of the teachers with chronic voice problems visited an otolaryngologist. Higher hours of voice training/education were associated with fewer self-reported voice problems. Conclusions Voice problems are of concern for NZ teachers, as has been reported for teachers in other countries. There is still limited awareness among teachers about vocal health, potential risks, and specialized health services for voice problems. [ABSTRACT FROM AUTHOR]

The article reports on the 386,000 U.S. dollars received by the Queens College Music Library, which serves the Aaron Copland School of Music, from the estate of alumni Claude V. Palisca upon the death of his wife, Elizabeth Keitel.

The goal of this study was to evaluate immediate and delayed effects of a caregiver-implemented picture book intervention to support children's mathematical language and numeracy skills. Eighty-four 3- to 5-year-olds (Mage = 4.14) were randomly assigned to intervention (n = 40) or active control (n = 44) conditions. Participants in the intervention condition received three researcher-designed picture books with embedded mathematical language content. The active control group received similar books without mathematical language content. All families were asked to read each book a total of four times over 4 weeks (a total of 12 reading sessions). Children were pretested, posttested, and delayed (8 weeks) posttested on mathematical language and numeracy. The intervention resulted in significant positive effects on mathematical language and numeracy at the posttest. At delayed posttest, the mathematical language effects were not statistically significant, but the numeracy effects persisted. However, when only examining the quantitative language items that aligned with the intervention, the effects of the intervention were significant at both immediate and delayed posttests. Findings suggest picture book interventions can have positive impacts on children's early skills. Educational Impact and Implications Statement: Supporting children's mathematical language and numeracy development is important for their success in later mathematics. The findings from this study demonstrate that caregivers reading a set of books with embedded mathematical language to their children over the course of 4 weeks can have strong and persistent effects on children's mathematical language and numeracy skills. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the association between children's academic and social-emotional skill levels at entry into Head Start (HS) and their subsequent academic growth through HS and into kindergarten. We first examined HS children's growth trajectories in math, reading, and receptive vocabulary skills over a period of 2.5 years (i.e., between HS entry and kindergarten). Then, we examined whether children's capabilities in academic and social-emotional skills at HS entry were associated with their academic growth trajectories. The study was guided by two competing theories on the effectiveness of early care and education (ECE) programs, the “skills-beget-skills hypothesis” and the “compensatory hypothesis.” A sample from the Head Start Family and Child Experiences Survey 2006 Cohort (FACES 2006) was analyzed using three-level growth curve modeling. Children who had lower receptive vocabulary skills at HS entry showed faster growth in receptive vocabulary skills. This result supports the compensatory hypothesis, which suggests that quality ECE programs have larger program effects for more disadvantaged children. For math and reading skills, no association between children's entry-level skills and their growth rate was found. Social-emotional skills at HS entry were positively associated with either concurrent baseline academic skills or their growth rate over time, partially supporting the skills-beget-skills hypothesis, which posits that the skills children possess before an intervention allow them to better acquire program benefits. [ABSTRACT FROM AUTHOR]

Aim: Speech pathology is the first-line treatment for inducible laryngeal obstruction (ILO) and involves behavioral techniques to address symptoms and modify maladaptive laryngeal postures. Benefit from speech pathology is reliant on patients engaging in treatment sessions, regular home practice, and generalizing techniques to everyday activities. There is limited research exploring engagement in speech pathology treatment for ILO, particularly from the patient perspective. This study aimed to explore the experiences of living with ILO and how this experience may impact the way patients engage in speech pathology treatment., Study Design: Qualitative study., Methods: Semistructured interviews were completed with seven participants exploring their experiences living with ILO, their diagnostic process and their experiences with speech pathology treatment. Data were analyzed using reflexive thematic analysis to determine shared meanings across participants and themes were developed., Findings: Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Patients' reports of living with ILO and interacting with speech pathology suggested that these experiences impacted their readiness to start treatment and persist through the challenges of the treatment. Engagement appeared to be positively associated with significant ILO symptom burden and life impact, confidence in the diagnostic process, recommendation for speech pathology treatment, a tailored intervention by a patient-perceived expert in the field and working in a partnership with the speech pathologist to develop a sense of agency. Patients indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom burden and life impact., Conclusion: The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient-centered approach to therapy may help to maximize engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximize engagement in treatment for people with ILO., Competing Interests: Declaration of Competing Interest Janine Mahoney – recipient of a career development grant from the Treatable Traits Centre of Research Excellence, Newcastle. No other conflicts of interest to declare. The other authors have no conflicts of interest to declare., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate acoustic outcomes of gender-affirming voice training for trans women wanting to develop a female sounding voice and to describe what happens acoustically when male sounding voices become more female sounding., Study Design: Prospective treatment study with repeated measures., Methods: N = 74 trans women completed a voice training program of 8-12 sessions and had their voices audio recorded twice before and twice after training. Reference data were obtained from N = 40 cisgender speakers. Fundamental frequency (f o ), formant frequencies (F 1 -F 4 ), sound pressure level (L eq ), and level difference between first and second harmonic (L 1 -L 2 ) were extracted from a reading passage and spontaneous speech. N = 79 naive listeners provided gender-related ratings of participants' audio recordings. A linear mixed-effects model was used to estimate average training effects. Individual level analyses determined how changes in acoustic data were related to listeners' ratings., Results: Group data showed substantial training effects on f o (average, minimum, and maximum) and formant frequencies. Individual data demonstrated that many participants also increased L eq and some increased L 1 -L 2 . Measures that most strongly predicted listener ratings of a female sounding voice were: f o , average formant frequency, and L eq ., Conclusions: This is the largest prospective study reporting on acoustic outcomes of gender-affirming voice training for trans women. We confirm findings from previous smaller scale studies by demonstrating that listener perceptions of male and female sounding voices are related to acoustic voice features, and that voice training for trans women wanting to sound female is associated with desirable acoustic changes, indicating training effectiveness. Although acoustic measures can be a valuable indicator of training effectiveness, particularly from the perspective of clinicians and researchers, we contend that a combination of outcome measures, including client perspectives, are needed to provide comprehensive evaluation of gender-affirming voice training that is relevant for all stakeholders., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Higher education institutions (HEIs) are seeking effective ways to address the rising demand for student mental health services. Peer support is widely considered a viable option to increase service capacity; however, there are no agreed definitions of peer support, making it difficult to establish its impact on student mental health and well-being., Aims: This systematic review aims to better understand and evaluate peer support in HEIs., Method: Five databases, OpenGrey and Grey Matters were searched in May 2021. Included studies were quantitative, longitudinal (with and without a control) or cross-sectional with a control. The vote-counting method was used for synthesis. The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool., Results: Three types of peer support were represented in 28 papers: peer-led support groups, peer mentoring and peer learning. Peer learning and peer mentoring had more positive, significant results reported for the outcomes of anxiety and stress. Peer-led support groups were the only type targeting students with mental health difficulties., Conclusions: The heterogeneity of measures and outcomes prevents firm conclusions on the effectiveness of peer support for mental health and well-being. Most studies were rated 'poor' or 'fair' in their risk of bias. There is not a solid evidence base for the effectiveness of peer support. Nonetheless, HEIs can use the terminology developed in this review for shared discussions that guide more robust research and evaluation of peer support as an intervention.

Background: Speech-language pathologists (SLPs) utilize counseling to support the psychological wellbeing of people with post-stroke aphasia, however, SLPs receive variable, usually limited, counseling education. Counseling education may be effective in improving SLPs' knowledge, skills, and confidence in counseling in post-stroke aphasia., Objectives: We aimed to evaluate the feasibility and preliminary efficacy of a novel online counseling education program for SLPs working with people with post-stroke aphasia., Method: Our study was a Phase II, two-arm pilot randomized controlled trial with a waitlist control. Participants (n = 49) were stratified by previous counseling training (≥1 day) and co-work with psychologists when addressing psychological wellbeing in post-stroke aphasia, and randomized to either the education program or waitlist control arm. We developed an education program (7-hours self-directed learning; 3-hour online workshop) for the trial. Feasibility outcomes included SLP recruitment, workshop attendance, and participant attrition at follow-up. Participants' counseling self-efficacy and self-rated competency were assessed pre- and post-program (primary endpoint) and at 5-week follow-up., Results: Forty-four (90%) participants attended the workshop with forty-one (84%) participants completing the trial. There was a significant interaction (large effect size) between time and group supporting a positive effect of the program on counseling self-efficacy, F (1,44) = 39.402, p < . 0005, η p 2  = . 472 and self-rated competency for counseling, F (1,44) = 31.824, p < . 0005, η p 2  = . 420. The effects were maintained at follow-up with self-rated competency scores demonstrating further significant improvement., Conclusions: The demonstrated feasibility and preliminary efficacy of this online counseling program warrant a future definitive trial.

Purpose: Although speech-language pathologists have provided gender-affirming voice training for trans women since the 1970s, evidence for this training's effectiveness remains weak. Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women., Method: Seventy-four trans women (19-54 years old) who wanted a more female-sounding voice were recruited through two health facilities and provided with an eight- to 12-session voice training program based on contemporary literature, usual clinical practice, and client-centered care principles. Self-reported outcomes and an audio-recorded reading sample were collected 3 months before, immediately before and after, and 3 months after training. Forty cisgender speakers were audio-recorded reading the same sample material as comparison voices. Seventy-nine naive listeners made gender-related voice ratings of an extract from these audio recordings. Training effectiveness was evaluated using group-level analyses (linear mixed-effects models) and individual-level analyses to establish what proportion of participants improved to a predetermined relevant degree., Results: Group-level analyses demonstrated positive training effects, maintained 3 months posttraining, for trans women's vocal satisfaction, perceptions of voice-related social participation, and self- and listener perceptions of their voices. Individual-level analyses also demonstrated positive effects. Two thirds of trans women increased vocal satisfaction to a relevant degree, one third who reported restricted social participation before training reduced this restriction to a relevant degree, and all were rated more female-sounding after training (although not all to a relevant degree)., Conclusions: All trans women participants made progress toward their voice goals and maintained those gains at follow-up. These findings provide evidence that gender-affirming speech-language pathology services warrant prioritization. Further research is warranted to investigate factors predicting outcomes of voice training for trans women.

Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients' individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing., Competing Interests: Conflict of interestThe authors declare no competing interests., (© Crown 2022.)

Aims: The primary aim of this study was to provide normative formant frequency (F) values for male and female speakers of Australian English. The secondary aim was to examine the effects of speaker sex, age, vowel quality, and geographical location on F., Method: The first three monophthong formant frequencies (F 1 , F 2 , and F 3 ) for 244 female and 135 male speakers aged 18-60 years from a recent large-scale corpus of Australian English were analysed on a passage reading task., Results: Mixed effects linear regression models suggested that speaker sex, speaker age, and vowel quality significantly predicted F 1 , F 2 , and F 3 (P = 0.000). Effect sizes suggested that speaker sex and vowel quality contributed most to the variations in F 1 , F 2 , and F 3 whereas speaker age and geographical location contributed a smaller amount., Conclusion: Both clinicians and researchers are provided with normative F data for 18-60 year-old speakers of Australian English. Such data have increased internal and external validity relative to previous literature. F normative data for speakers of Australian English should be considered with reference to speaker sex and vowel but it may not be practically necessary to adjust for speaker age and geographical location., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training., Aim: The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery., Method: A case report and literature review was undertaken., Results: Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70-344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85-134 Hz across these tasks., Conclusion: This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention., Competing Interests: None declared, (© 2022 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Objective: To develop a self-efficacy questionnaire for voice modification related to gender affirmation and to examine the internal consistency and test-retest reliability of the questionnaire among a cohort of trans women., Methods: This study was undertaken in two phases. In phase I, four Speech- Language Pathologists (SLPs) and four trans women informed the development of the Self-Efficacy Scale for Voice Modification in Trans Women (SES-VMTW). In phase II, using classical test theory, data from 31 Australian and 27 Swedish trans women who completed the SES-VMTW twice with an interim period of 3-6 weeks were analyzed for internal consistency and test-retest reliability. During this second phase, the 19 items of the SES-VMTW were subcategorized by consensus among the authors into like groups., Results: Phase I resulted in the 19-item SES-VMTW and four subcategories were identified: 1) Change (items related to changing voice); 2) Perception (items related to the ability to perceive changes in voice; 3) Psychological (items related to engaging in voice practice despite psychological barriers; 4) Logistical (items related to engaging in voice practice despite logistical barriers). In Phase II, initial psychometric analysis was applied to the full questionnaire as well as to the subcategories. The Cronbach's alpha for the full questionnaire (α = 0.86) at both the test and retest timepoints indicates a high level of internal consistency. Item-total correlation analysis indicated that individual items correlated with the questionnaire total score, but that they generally correlated more strongly with the total score for the relevant subcategory. The Cronbach's alpha for the four subcategories of the SES-VMTW were variable but all coefficients exceeded 0.6, thus supporting the reliability of the new scale. Good test-retest reliability was demonstrated for the full questionnaire (intraclass correlation coefficient = 0.84; 95% confidence interval, 0.73-0.90, P < 0.001) and was moderate to good for the four subcategories., Conclusion: The findings of the current study are promising, suggesting that both the full SES-VMTW and the four subcategories can provide consistent and reliable insight into self-efficacy for trans women aiming to modify their voice as part of their gender affirmation., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Gender affirming voice training is a service provided by speech language pathologists to members of the trans and gender diverse community. While there is some evidence to support the effectiveness of this training, the evidence base is limited by a lack of prospective studies with large sample sizes. Finally, there has been only limited research investigating the effectiveness of this training when delivered on intensive (compressed) schedules, even though such schedules are used in clinical practice and may have practical benefits such as increasing service access for this vulnerable population., Methodology: This study aimed to investigate and compare the effectiveness gender affirming voice training among 34 trans individuals presumed male at birth who shared a goal of developing a 'female-sounding voice'. Among these 34 participants, 17 received their training on a traditional schedule (one 45-minute session per week over 12 weeks) and 17 on an intensive scheduled (three 45-minute sessions per week over 4 weeks). Building on a previous mixed methodological study which indicated that these two training groups were equally satisfied with training outcomes, the current study utilised a wide range of self-report, acoustic, and auditory-perceptual outcome measures (including self-ratings and listener-ratings of voice) to investigate training effectiveness., Discussion: Results from this study indicated that both training programs were similarly effective, producing positive statistically significant change among participants on a range of outcome measures. Participants in both groups demonstrated significant auditory-perceptual and acoustic voice change and reported increased satisfaction with voice, increased congruence between gender identity and expression, and a reduction in the negative impact of voice concerns on everyday life. However, as has been the case in past studies, training was not sufficient for all participants to achieve their specific goal of developing a consistently 'female-sounding voice'., Conclusion: This study provides evidence to suggest that gender affirming voice training for transfeminine clients may be similalrly effective whether delivered intensively or traditionally. This study provides evidence to support the practice of using a wide range of outcome measures to gain holistic insight into client progress in gender affirming voice training programs., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background/aim: Scales used to collect perceptual ratings related to a speaker's gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps., Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors "very feminine/very masculine" and "very female/very male." Trans participants also rated their satisfaction with their current voice on a VAS with anchors "very satisfied/very unsatisfied." Correlation coefficients were calculated to investigate the relationship between collected ratings., Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training., Discussion/conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice., (© 2021 S. Karger AG, Basel.)

Background: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice., Objective: The current research aimed to cooperatively consider coaches' vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use., Methods: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches' voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken., Results: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4-14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches' work-systems continued to influence coaches' voices in dynamic and complex ways., Conclusions: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form 'part' of broader mechanisms to support coaches' voice use and vocal health at work.

WHAT IS KNOWN ON THE SUBJECT?: There are insufficient nurses to meet current demand for mental health care. This is an international concern. Within England, the impact of staff shortages on the quality of patient care in forensic high secure settings has been highlighted by the national regulatory body for hospitals. Forensic hospital nursing is a distinct specialism within mental health. Forensic nurses must negotiate the therapeutic, ethical and practical challenges of caring for high-risk patients in a locked environment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: There has been no previous study to ask frontline high secure forensic nurses, union representatives, senior nurses and workforce leads about what factors may be affecting recruitment and retention in their setting. As well as the specialized and challenging nature of the work, participants identified that workforce sustainability was affected by unequal working terms and conditions, the hospital locations and wider national factors, such as changes to how nurse training was funded. They also identified that some strategies that were employed to address workforce shortages, such as day-to-day movement of staff within the hospital and incentive packages for new recruits could be demotivating for established staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Forensic high secure nursing workforce strategies should include training, development and career pathways that are specific to the specialism and extend beyond preceptorship for newly qualified staff. There should be clear and equitable employment terms and conditions with remuneration packages that are consistent within and between organizations. Hospital managers should address the effect that movement of staff between wards may have on nurses' morale, therapeutic relationships and safety culture. ABSTRACT: Introduction There has been no previous study of stakeholders' views on recruitment and retention concerns in high secure forensic settings. Aim To identify factors affecting recruitment and retention in high secure hospitals, from the perspectives of stakeholders with experience in forensic mental health nursing. Method Framework analysis of data from fifteen interviews and three focus groups with frontline nurses, nurse leaders, recruitment leads and union representatives from three high secure hospitals in England. Results Six themes emerged from the data: (a) the unique nature of high secure nursing; (b) the impact of short staffing; (c) wider factors affecting the high secure nursing workforce; (d) the location; (e) staff being on different terms and conditions of work; (f) recruitment strategies. Discussion Multiple factors are likely to simultaneously affect high secure hospital recruitment and retention. Findings on the unique nature of high secure work reflect previous qualitative research. The themes of location, working terms and condition and recruitment strategies have not been previously identified in forensic nursing research. Implications for practice Employers should ensure that employment terms and conditions are equitable and consistent. Furthermore, hospital managers should address the effect that movement of staff between wards may have on morale and therapeutic relationships., (© 2021 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Purpose The aim of the study was to examine associations between speaking fundamental frequency ( f os ), vowel formant frequencies ( F ), listener perceptions of speaker gender, and vocal femininity-masculinity. Method An exploratory study was undertaken to examine associations between f os , F 1 - F 3 , listener perceptions of speaker gender (nominal scale), and vocal femininity-masculinity (visual analog scale). For 379 speakers of Australian English aged 18-60 years, f os mode and F 1 - F 3 (12 monophthongs; total of 36 F s) were analyzed on a standard reading passage. Seventeen listeners rated speaker gender and vocal femininity-masculinity on randomized audio recordings of these speakers. Results Model building using principal component analysis suggested the 36 F s could be succinctly reduced to seven principal components (PCs). Generalized structural equation modeling (with the seven PCs of F and f os as predictors) suggested that only F 2 and f os predicted listener perceptions of speaker gender (male, female, unable to decide). However, listener perceptions of vocal femininity-masculinity behaved differently and were predicted by F 1 , F 3 , and the contrast between monophthongs at the extremities of the F 1 acoustic vowel space, in addition to F 2 and f os . Furthermore, listeners' perceptions of speaker gender also influenced ratings of vocal femininity-masculinity substantially. Conclusion Adjusted odds ratios highlighted the substantially larger contribution of F to listener perceptions of speaker gender and vocal femininity-masculinity relative to f os than has previously been reported.

Background: Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches., Objective: This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors., Methods: This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis., Results: Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1-2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes., Conclusions: These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

Objective: This study explored trans women's experience and awareness of their vocal communication and voice use within sporting environments., Study Design: Mixed methods study., Methods: Twenty trans women were interviewed about their voice use and vocal communication during sport and its impact on their level of participation. The participants also completed the Transsexual Voice Questionnaire for Male-to-Female Transsexuals., Results: Three core themes emerged from analysis of the interview data. These were: importance of voice in a sport setting, voice production in sporting environments, and psychosocial moderators of voice within the sporting environment. Trans women perceived their voices to be the main barrier to their participation in sport. These women reported that the strong gendered environment of sport made them anxious that they would not be identified as women because their voice was not always congruent with their physical appearance. However, maintaining feminine voice was deemed less critical if participants felt comfortable at their sporting club and had strong relationships with their teammates and coaches. Findings from the Transsexual Voice Questionnaire for Male-to-Female Transsexuals supported the interview data as to the impact that voice has in the lives of trans women., Conclusion: Voice is critical for trans women who wish to integrate and be accepted as women in sporting environments. Participants suggested that voice training should target achieving a gender congruent voice and include minimalizing perceived barriers such as vocal fatigue and maintaining adequate breath support., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

The 2007 amendments to the Mental Health Act, 1983 in England and Wales enabled non-medics to take on the role of legally 'responsible clinician' for the overall care and treatment of service users detained under the Act, where previously this was the sole domain of the psychiatrist as Responsible Medical Officer. Following state sanction as an 'Approved Clinician', certain psychologists, nurses, social workers or occupational therapists may be allocated as a Responsible Clinician for specific service users. Between 2007 and 2017 only 56 non-medics had become Approved Clinicians. This study reports on a first national survey of 39 non-medical Approved Clinicians. Descriptive statistics and thematic analysis of free text answers are presented here. The survey results show the limited uptake of the role, save for in the North Eastern region of England. Non-medical Approved Clinicians were motivated by a combination of altruistic intents (namely a belief that they could offer more psychologically-informed, recovery-oriented care) and desire for professional development in a role fitting their expertise and experience. Barriers and facilitators to wider uptake of the role appear to be: organisational support, attitudes of psychiatrist colleagues and a potentially lengthy and laborious approvals application process. The survey is a starting point to further research on the interpretation and implementation of the range of statutory roles and responsibilities under English and Welsh mental health law., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to provide a systematic review of the aspects of verbal communication contributing to listener perceptions of speaker gender with a view to providing clinicians with guidance for the selection of the training goals when working with transsexual individuals., Method: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were adopted in this systematic review. Studies evaluating the contribution of aspects of verbal communication to listener perceptions of speaker gender were rated against a new risk of bias assessment tool. Relevant data were extracted, and narrative synthesis was then conducted. Meta-analyses were conducted when appropriate data were available., Results: Thirty-eight articles met the eligibility criteria. Meta-analysis showed speaking fundamental frequency contributing to 41.6% of the variance in gender perception. Auditory-perceptual and acoustic measures of pitch, resonance, loudness, articulation, and intonation were found to be associated with listeners' perceptions of speaker gender. Tempo and stress were not significantly associated. Mixed findings were found as to the contribution of a breathy voice quality to gender perception. Nonetheless, there exists significant risk of bias in this body of research., Conclusions: Speech and language clinicians working with transsexual individuals may use the results of this review for goal setting. Further research is required to redress the significant risk of bias.

The professional development discussion (PDD) will be an essential component of revalidation with the Nursing and Midwifery Council. The Unite/CPHVA professional officers who participated in the pilot found the PDD to be the most beneficial part of the revalidation process. This article explores the experience of a PDD from both the revalidatee and the fellow registrant perspective. It goes on to make recommendations for ensuring an effective PDD.

Objective: To explore the occupational voice use and vocal health of elite football coaches., Study Design: This pilot study explored coaches' voice use patterns and vocal demands across workplace environments. Each coach's experiences of voice symptoms and voice problems were also investigated., Methods: Twelve Australian professional football coaches participated in a mixed-methods data collection approach. Data were collected through acoustic voice measurement (Ambulatory Phonation Monitor), semistructured interviews, and a voice symptom questionnaire (Voice Capabilities Questionnaire)., Results: Acoustic measures suggested heavy vocal loads for coaches during player training. All participants reported experiencing voice symptoms. They also suggested that the structure of their working week, workplace tasks, and vocal demands impacted on their voices. Despite this, participants reported little previous reflection or awareness of what impacted on their voices. Coaches typically did not consider how to support their voices during daily work and discussed experiencing voice symptoms as an inevitable part of their jobs., Conclusions: This study demonstrates that occupational vocal demands may negatively impact on sports coaches' vocal health. This is particularly important, considering coaches' heavy vocal loads across coaching tasks and reported negative occupational vocal health experience. Furthermore, coaches' limited insight into voice use and vocal health management may impact on their vocal performance and health. Given the exploratory nature of this study, further research into coaches' occupational vocal health is warranted., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The quality of NHS record keeping and documentation has been a cause for concern in recent serious case reviews and inquiries. It is also a source of health professional referral to fitness to practise panels. Community practitioner record keeping is governed by national legislation as well as local policy. Recent developments in record keeping practice, not least the progressive move to electronic records, mean that legislation and policy must be reinterpreted to take account of new challenges and dilemmas. As community practitioners frequently work collaboratively with colleagues from other professions and organisations, efforts must be made to develop a shared understanding of the content and handling of records containing personal confidential information.

Purpose of Review: This review covers recent research findings that demonstrate the effectiveness of speech pathology intervention in enabling male-to-female transsexual individuals to portray their gender identity through speech. Research reports that extend our understanding of communication characteristics that contribute to perceptions of sex in male-to-female transsexuals are identified. Current issues related to the measurement of therapy effectiveness are also presented., Recent Findings: Earlier studies confirmed that an increase in voice pitch is achievable for many transsexuals. However, it is now accepted that pitch is not the sole contributor to perceptions of gender. Recently, modification of vocal resonance has been shown to increase perceptions of a speaker as female. There is evidence that encouraging precise articulation results in increased perceptions of the speaker as female. Evidence for the contribution of voice quality and loudness to perceptions of gender is inconclusive. Speech rate does not appear to contribute significantly to gender perceptions.Ecologically valid measures of the individual's vocal functioning and its impact on everyday life in clinical assessment of male-to-female transsexuals are needed to provide meaningful measures of therapy outcome., Summary: There continues to be a need for ongoing research into communication characteristics that contribute to perceptions of gender. It is essential to include the perspective of the individual when evaluating therapy outcome.

Operatic sopranos need to be audible over an orchestra yet they are not considered to possess a singer's formant. As in other voice types, some singers are more successful than others at being heard and so this work investigated the frequency range of the singer's formant between 2000 and 4000 Hz to consider the question of extra energy in this range. Such energy would give an advantage over an orchestra, so the aims were to ascertain what levels of excess energy there might be and look at any relationship between extra energy levels and performance level. The voices of six operatic sopranos (national and international standard) were recorded performing vowel and song tasks and subsequently analyzed acoustically. Measures taken from vowel data were compared with song task data to assess the consistency of the approaches. Comparisons were also made with regard to two conditions of intended projection (maximal and comfortable), two song tasks (anthem and aria), two recording environments (studio and anechoic room), and between subjects. Ranking the singers from highest energy result to lowest showed the consistency of the results from both vowel and song methods and correlated reasonably well with the performance level of the subjects. The use of formant tuning is considered and examined.