Multiple urological societies recommend chest imaging for suspicious renal masses using chest x-ray or CT as clinically indicated. The purpose of chest imaging is to assess for thoracic metastasis at the time of renal mass diagnosis. Ideally, imaging use and type are commensurate with risk related to tumor size and clinical stage. We examined current practice patterns with chest imaging compliance in the state of Michigan and implemented clinician education and value-based reimbursement incentivization on guideline adherence.
MUSIC (Michigan Urological Surgery Improvement Collaborative)-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) is a statewide initiative focusing on quality improvement for patients with cT1 renal masses. Data regarding chest imaging in MUSIC and panel discussion occurred at an in-person MUSIC meeting in October 2019. Adherence to chest imaging guidelines was made a value-based reimbursement metric at the triannual MUSIC meeting in January 2020. Adherence was defined as optional in renal masses <3 cm (CT not indicated), recommended in renal masses 3-5 cm (chest x-ray preferred), and required in renal masses >5 cm (CT preferred). The MUSIC registry was queried for percentage of patients receiving chest imaging by type. Factors associated with adherence were assessed.
There was significant practice-level variation in chest imaging rates across the 14 contributing practices, ranging from 11% to 68%. Compliance with MUSIC guidelines for chest imaging during evaluation of T1 renal masses was 81.8% overall, with only 61.8% of patients with masses >5 cm meeting the guideline requiring imaging with preference for CT. Factors associated with increased adherence included larger tumor size (T1b vs T1a) and solid (vs cystic or indeterminate) tumor (P < .05 for each). Prior to value-based reimbursement introduction, 46.7% of patients underwent imaging of either type, compared to 49.0% post-intervention. Imaging rates only slightly increased in masses >5 cm (58.3% before value-based reimbursement vs 61.2% after, P = .56) and 3-5 cm (50.0% before value-based reimbursement vs 56.2% after, P = .0585).
Chest imaging guideline adherence during the initial evaluation of cT1 renal masses is acceptable, particularly given that most masses are <3 cm, for which metastatic risk is low. However, despite consensus from major urological societies regarding imaging for masses >4-5 cm, imaging rates were low across MUSIC. After educational and value-based reimbursement incentive initiation, rates of imaging for 3-5-cm and >5-cm masses changed only slightly. There remains significant practice variability and room for improvement.

Major advances in music neuroscience have fueled a growing interest in music-based neurological rehabilitation among researchers and clinicians. Musical activities are excellently suited to be adapted for clinical practice because of their multisensory nature, their demands on cognitive, language, and motor functions, and music\'s ability to induce emotions and regulate mood. However, the overall quality of music-based rehabilitation research remains low to moderate for most populations and outcomes. In this consensus article, expert panelists who participated in the Neuroscience and Music VII conference in June 2021 address methodological challenges relevant to music-based rehabilitation research. The article aims to provide guidance on challenges related to treatment, outcomes, research designs, and implementation in music-based rehabilitation research. The article addresses how to define music-based rehabilitation, select appropriate control interventions and outcomes, incorporate technology, and consider individual differences, among other challenges. The article highlights the value of the framework for the development and evaluation of complex interventions for music-based rehabilitation research and the need for stronger methodological rigor to allow the widespread implementation of music-based rehabilitation into regular clinical practice.

Is engaging with music good for your mental health? This question has long been the topic of empirical clinical and nonclinical investigations, with studies indicating positive associations between music engagement and quality of life, reduced depression or anxiety symptoms, and less frequent substance use. However, many earlier investigations were limited by small populations and methodological limitations, and it has also been suggested that aspects of music engagement may even be associated with worse mental health outcomes. The purpose of this scoping review is first to summarize the existing state of music engagement and mental health studies, identifying their strengths and weaknesses. We focus on broad domains of mental health diagnoses including internalizing psychopathology (e.g., depression and anxiety symptoms and diagnoses), externalizing psychopathology (e.g., substance use), and thought disorders (e.g., schizophrenia). Second, we propose a theoretical model to inform future work that describes the importance of simultaneously considering music-mental health associations at the levels of (1) correlated genetic and/or environmental influences vs. (bi)directional associations, (2) interactions with genetic risk factors, (3) treatment efficacy, and (4) mediation through brain structure and function. Finally, we describe how recent advances in large-scale data collection, including genetic, neuroimaging, and electronic health record studies, allow for a more rigorous examination of these associations that can also elucidate their neurobiological substrates.

BACKGROUND: When performing, classical guitarists interact with many elements which constitute their own \"workstation\". One of those elements is the support for guitar positioning. Support dimensions, form and materials may determine posture and affect the musician\'s comfort and performance.
OBJECTIVE: To propose design requirements for new supports for guitar positioning, based on postural assessment, anthropometric criteria, self-efficacy and comfort perception.
METHODS: Nine healthy Classical Guitar students were recruited. A postural assessment was undertaken using REBA, and 3DSSPP software with three different supports for guitar positioning. After the use of each support, a questionnaire about self-efficacy and comfort perception was completed by the participants.
RESULTS: The higher scores of risk and a significant difference (ANOVA, p =≤05) regarding the left leg elevation were found with footstool usage. However, this one was identified by participants as the best support in terms of self-efficacy and comfort assessment.
CONCLUSIONS: To improve performance and prevent physical injuries for guitarists, there is a need for designing guitar positionings supports based on ergonomics principles. This paper proposes eleven guidelines for designing these supports.

OBJECTIVE: The objective of this study was to determine the content validity of an assessment instrument for embouchure (the \"CODE of Embouchure\") which covers the main aspects of the construct of embouchure in brass players.
METHODS: The study design followed the Delphi technique. A select panel of 35 international experts gave their opinion via a three-round digital Delphi survey as to whether the instrument as a whole, and its items, adequately measure the construct of embouchure. Criteria for consensus and whether items should go through to the next Delphi round were pre-determined. Data were independently analyzed by two researchers. The CREDES guidelines were used for conducting and reporting of the study.
RESULTS: Consensus was reached over 64% and 73% of the closed questions in the first and third rounds, respectively. A second round was necessary to resolve intra- and inter-expert contradicting information. Finally, 5 items were added to the instrument, 3 items were removed, and 23 items were adjusted. Consensus was reached in 63 items (98%). The final multi-item assessment instrument consists of 4 domains and 64 items.
CONCLUSIONS: Content validity of most aspects of the \"CODE of embouchure\" instrument was established.

This study investigated clinical care delivered to musicians in Australia by audiologists and manufacturers of musicians\' hearing protectors (MHP).
Audiologists with experience treating musicians were invited to complete a survey on their service delivery. A second survey was administered to manufacturers of MHPs.
Four manufacturers of MHP and 31 audiologists completed the surveys. Post hoc analyses were performed comparing the responses of audiologists with more versus less clinical experience; and those with and without musical training.
There was considerable variation in the audiological care provided to musicians. Only one-third of audiologists performed pure-tone audiometry prior to MHP fitting, and there was little consistency across the sample in relation to impression taking, preferred attenuation or selection of canal length. There was also significant variation in the manufacturers\' approach to MHP, each of whom provided different recommendations regarding preferred impression techniques and material viscosity.
The results of this study reveal lack of consistency across the hearing healthcare sector with respect to care of musicians\' hearing, with potential to impact upon the satisfaction with, and usage of, MHP. There is need for evidence-based, best practice guidelines and training to support clinical audiologists in providing optimal care.

In the past decades, neuroimaging of humans has gained a position of status within neuroscience, and data-driven approaches and functional connectivity analyses of functional magnetic resonance imaging (fMRI) data are increasingly favored to depict the complex architecture of human brains. However, the reliability of these findings is jeopardized by too many analysis methods and sometimes too few samples used, which leads to discord among researchers. We propose a tunable consensus clustering paradigm that aims at overcoming the clustering methods selection problem as well as reliability issues in neuroimaging by means of first applying several analysis methods (three in this study) on multiple datasets and then integrating the clustering results. To validate the method, we applied it to a complex fMRI experiment involving affective processing of hundreds of music clips. We found that brain structures related to visual, reward, and auditory processing have intrinsic spatial patterns of coherent neuroactivity during affective processing. The comparisons between the results obtained from our method and those from each individual clustering algorithm demonstrate that our paradigm has notable advantages over traditional single clustering algorithms in being able to evidence robust connectivity patterns even with complex neuroimaging data involving a variety of stimuli and affective evaluations of them. The consensus clustering method is implemented in the R package \"UNCLES\" available on http://cran.r-project.org/web/packages/UNCLES/index.html .

Music-based interventions are used to address a variety of problems experienced by individuals across the developmental lifespan (infants to elderly adults). In order to improve the transparency and specificity of reporting music-based interventions, a set of specific reporting guidelines is recommended. Recommendations pertain to reporting seven different components of music-based interventions including intervention theory, intervention content, intervention delivery schedule, interventionist, treatment fidelity, setting, and unit of delivery. Recommendations are intended to support CONSORT and TREND statements for transparent reporting of interventions while taking into account the variety, complexity, and uniqueness of music-based interventions.

Experts were interviewed to identify criteria for evaluation of vocal performance. A scale was then constructed and inter- and intrajudge reliability assessed. Experts listened to 19 different performances, plus 6 presented a second time. Interjudge reliability for one judge was modest, but increased dramatically as the size of the judge panel increased. The most reliable items were overall score and intonation accuracy. Diction was less reliable than other items. Intrajudge reliability was higher for overall score than for any other item. A factor analysis on the test items yielded factors labelled intrinsic quality, execution, and diction. Another factor analysis, using the experts as variables, revealed two underlying evaluative dimensions. It was found that 13 experts were primarily influenced by execution, and that 8 were mainly affected by intrinsic quality. Interjudge and intrajudge reliabilities of these two groups differed.