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Singing voice teachers are working hard to be inclusive and progressive in the 21st century. We are aware of our power to create inclusive learning spaces that embrace our students’ identity traits including race, gender, sexual orientation, ability, neurodivergence, and more. However, body size is almost always left out of the discussion of inclusive actions in the voice studio. Fatness is a social justice issue and singing voice teachers can either affirm or further marginalize fat students in the 1:1 training setting of the voice studio. In part one, the authors offer background information on the prevalence of fatness, the history of anti-fat bias, and the experiences of fat persons in healthcare, employment, and educational settings. This context encourages voice teachers to examine implicit anti-fat bias, one of the few remaining yet still widely tolerated cultural biases. Many believe that anti-fat bias can be justified by medical facts, but this belief requires an examination of the influence of money and the media. The authors utilize a fat liberationist framework, rejecting the long-held idea that fat bodies are problematic in the performing arts, and affirming that the performing arts industry must provide opportunities for talented and well-trained performers in bodies of every size to work and tell stories that reflect our diverse world. In part two, the authors explore tangible pedagogical modifications to foster a sense of belonging for all voice students, including fat students. Micro-activism in the voice studio is a huge step toward systemic change, and it can have a profoundly positive impact on our students.

We present a case of a hamartoma of mature cardiac myocytes. This is an extremely rare tumour and the first reported paediatric case localised in the left atrium.

Introduction Kaplan–Meier survival analysis, the cornerstone of evaluating efficacy of oncology drugs in randomised controlled trials (RCTs), assumes censored patients are neither healthier nor sicker than those followed. We sought to examine whether censoring patterns differ between the control and experimental arms in one oncology journal that mandates the reporting of the number of patients censored. Methods In this retrospective review, proportion of censoring and study design data were gathered from RCTs published in The Lancet Oncology that reported Kaplan–Meier curves between May 2018 and August 2019. Differential censoring rates were analysed at the 1st, 3rd, 6th, and overall time points in each study. Analysis was stratified by curves reporting progression-free survival (PFS) or overall survival (OS) end-points. Results Of the 160 articles reviewed, 29 studies with 51 Kaplan–Meier curves were eligible. In both OS (N = 25) and PFS curves (N = 26), the absolute weighted difference in censoring between the control and experimental arms was initially positive, indicating more censoring in the control arm (first time point OS: 0.32%; PFS: 2.00%). The absolute difference then became negative, indicating more censoring in the experimental arm as time progressed (end-of-study OS: −7.54%; PFS: −9.09%). Conclusion Differences in censoring between control and experimental arms of cancer RCTs suggest that there could be systematic bias present at various study time points that may influence key results. Further investigation is needed, as possible reasons include study assignment disappointment, inappropriate follow-up length, lack of efficacy, or intolerable toxicity, each predominant at specific time points after randomisation.

Importance: Contemporary health care reform strives to fulfill the “triple aim” by, 1) reducing costs, 2) improving the care experience, and 3) improving population health. There is great need for such reform in caring for pediatric patients experiencing medical complexity and social vulnerability given that this subset of patients makes up a disproportionately large percentage of total health care utilization and expenditures. Novel Interventions in Children’s Healthcare (NICH), a novel clinical behavioral health program, was developed to address the triple aim for pediatric patients experiencing both medical and social complexity. This study describes initial NICH pilot …

Critically ill children receive fluids for multiple reasons including resuscitation, nutrition, and medications. While it is well-established that fluid overload (FO) is associated with negative outcomes in critically ill children, it is challenging for clinicians to consider all fluid sources and adjust accordingly. “Fluid creep” (FC) refers to insidious IV fluid intake (medications, flushes, etc.) in excess of standard predicted maintenance fluid requirements (MFR), and can represent a major source of fluid intake. This phenomenon has previously been described in burn patients and adults but is less well-established among pediatric patients. The prevalence of FC and whether FC contributes to fluid overload in critically ill children …

Oral nutrition supplements are commonly used to increase the nutrient intake of children who are undergoing treatment for cancer. However, little research has been conducted systematically examining preferences for oral supplements in this population. This study aims to address a gap in the literature by examining taste preferences of oral nutrition supplements routinely recommended for children undergoing treatment for cancer. Twenty-one children undergoing treatment for cancer and 38 healthy control subjects participated in an acute double-blinded feeding trial. A variety of energy drinks, available both commercially and in the hospital, were sampled. Patients rated the taste of the drinks on a 10-cm coloured analogue scale. A commercially-based drink (Moove™) rated the highest in the blinded and branded tests for the treatment (mean rating out of 10, 6.44 ± 2.69 and 7.26 ± 2.33, respectively) and control groups (mean rating, 7.61 ± 1.91 and 7.70 ± 2.32, respectively). Taste ratings were significantly higher for commercially available supplements over the hospital-prepared supplements, (p = 0.041), with no main effect for tasting condition (i.e. blinded versus branded, p = 0.902). There was a statistically significant trend such that ratings, when the brand that was known decreased for hospital supplements, while ratings for commercially available supplements increased (p = 0.014). Fresh milk-based supplements were the preferred type of oral nutrition supplement in a cohort of paediatric oncology patients. The data also suggest that commercially available products are more likely to be accepted than hospital-prepared supplements. This pilot study supports the need for further research in the area of oral nutrition supplements for paediatric oncology patients as a way of determining a reliable way to estimate preferences and therefore maximise compliance. Results from this research could be also used as the basis for designing research to study the effects of flavour fatigue and long-term compliance with oral nutrition supplements in this population.

A retrospective study was designed to determine whether socio-demographic and clinical factors at onset, previously shown to relate to outcome, differentiated those with a single episode with no persistent symptoms of schizophrenia from other outcome groups. In a geographically determined sample of 436 people with schizophrenia spectrum disorder and a minimum followup period of at least 6 years, 68 people (15.6%) had a single episode with complete remission. The single episode group differed significantly from the rest of the sample at onset on nine variables. On a logistic regression, employment status independently predicted single episodes. Although those with single episodes differed from the rest of the sample on a number of variables, they did not differ significantly at onset from the other better outcome group (repeated episodes without persistent symptoms) on any variables with the exception of insight. Two possibilities are considered: (1) the two better outcome groups differed very little at onset but subsequent treatment or experiences accounted for the differences in outcome; or (2) important differences, not routinely assessed at onset, influenced outcome. The implications of these findings for research into the prevention of relapse in psychosis are considered.

The relationship between obsessional personality traits and Obsessive Compulsive Disorder (OCD) has long been the subject of debate. Although clinicians have asserted for nearly a hundred years that such a relationship exists, empirical investigations have failed to provide consistent support; however, none of these empirical investigations have undertaken analyses that control for the effect of mood variables. Employing a non-clinical sample, Rosen and Tallis (1995) [Behaviour, Research and Therapy, 4, 445-450] found that when mood variables are taken into account, a unique relationship between obsessional traits and obsessional symptoms emerges. A replication was undertaken on a large group of individuals with OCD. After the effects of depression and anxiety were removed from a correlational analysis, obsessional symptoms were found to be significantly associated with obsessional and passive aggressive traits. Obsessive Compulsive Disorder was not associated with any other grouping of traits as specified in the DSM-III-R (Axis II) classification system.

In the light of recent research suggesting that obsessive-compulsive disorder is more likely to be associated with constellations of personality traits other than obsessive-compulsive personality traits, the present study was undertaken to explore this relationship further and to remove the possibly confounding effects of general pathology, anxiety and depression. By using a non-clinical sample and partialling out the effects of anxiety and depression, it was found, contrary to recent research, that specific obsessional symptoms were only related to the traits of obsessive-compulsive personality disorder.

Seasonal affective disorder (SAD) is a depressive disorder which occurs during the winter and remits in the spring and summer. It differs from non-seasonal depression in its seasonal variation and in the presence of neurovegetative symptoms such as increased appetite and hypersomnia. This review is aimed at clinical practitioners and presents a detailed description of the syndrome before discussing the assessment of SAD and the current treatment of choice of phototherapy. Particular attention is paid to the impotant issue of differential diagnosis during assessment and the practicalities involved in the administration of light therapy during treatment.