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The English art song in the 20th-century presents a performance challenge unique in the solo song repertoire. Unlike the corresponding bodies of German Lied and French mélodie, which proceeded from a well-ingrained national tradition of music and poetry, the English art song had no such background. The many British composers who have contributed to the song literature of this century reflect varied backgrounds and influences. Lennox Berkeley combined his English heritage with the French background of his mother's family, largely self-taught musical skills and an innate sensitivity to poetry to become one of the most prominent song composers of this century. He trained with Nadia Boulanger, gaining exposure to the formal and melodic techniques of Faure and the neo-classicism of Stravinsky. Berkeley composed a total of seventy-eight solo songs. His acceptance and furtherance of a fundamentally traditional songmaker's craft place him more directly in the post-war line of succession of English song than Benjamin Britten, whose innovative musical techniques place him in the vanguard of new music.This document explores those aspects of Berkeley's life and work that contribute to his compositional choices. It provides an overview of all of Berkeley's known solo songs as well as a more detailed analysis of Five Songs (Walter de la Mare), Five Poems CW.H. Auden) and Another Spring. The paper illustrates the qualities of Berkeley's songs which justify his inclusion among the most successful art song composers of this century

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Diagnostic and evaluative methods used in voice care are mostly designedfor the speaking voice, and are not necessarily directly applicable to thesinging voice. This thesis investigated the possibilities of fine tuning, improvingand quantifying the voice status assessment of the singer, focusingespecially on the Western operatic female voice. In Paper I, possible singer-specific Voice Range Profile (VRP) characteristicsand tasks were explored and VRP data for 30 professional female Western opera singers was collected. Vocal productions were controlled for a physiological VRP (VRPphys) and for a stage performance context (VRPperf) and outcome differences were identified. Task design was critical for the(VRPphys) but had very little effect on the VRPperf. Significant voice category differences (between soprano,mezzo-soprano and contralto) were limited to frequencyrelated metrics. Two new VRP metrics, the area above 90 dB (Perc90dB) and the sound pressure level extent (SPLext), were found to be key metrics to the study of VRPs for singers. Paper II investigated, in conjunction with the VRP, whether the sound pressure level (SPL) or the skin acceleration level (SAL) was more correlated to the subglottal pressure (Ps). SAL was much less F0 dependent than SPL and facilitated the interpretation of VRP data. However, the correlation between SAL and Ps was found to be weaker than that between SPL and Ps. Papers III and IV explored the mapping of self-perceived impairmentrelated difficulties into the VRP. A modified phonetograph was tested first with a healthy singer population and then with a singer-patient group. Subjects used a button device to communicate their self-perceptions while singing, and were consistent in task replications as well as across different tasks. Healthy singers pressed mostly at the extreme limits of the VRP, where loss of vocal control could be expected and their presses were mostly concentrated on the periphery of the VRP area. Singer patient button- press patterns were distinct from patterns observed in healthy singers. Singer patients pressed mainly inside the VRP boundaries, in the higher range and at intermediate intensities. In Paper V, the Voice Handicap Index for singers was translated and adapted to Swedish (Röst Handikap Index för sångare or RHI-s). The questionnaire was found to be a reliable and a valid instrument. High correlations between general perceptual patient VAS ratings and the questionnaire scores underscored the instrument’s internal coherence. Overall, patient scores (including subscales) were significantly higher than healthy singer scores. The results showed implicitly the necessity and usefulness of adapting clinical procedures to specific patient populations.Together, the results of these five papers can ultimately be of value tovoice clinicians who are treating singers. The results obtained also contributeto the understanding of the singing voice and underline the importance ofproperly documenting the singing voice. / QC 20100726

The aim of the dissertation thesis is to clarify the impact of a posture on the quality of voice performance. Through the method of a natural experiment, the authors carries out a research about the importance of a postural function in connection to building up basic voice skills. We will observe, both from theoretical and practical point of view if and through which means can we influence the incorrect postural habits and how these changes affect voice performance. The methodological handbook is a natural output which takes into account the relation of the postural function, breath and its development with assistance of vocal hearing as a corrector of the quality of voice performance. The outcomes of the research that helped to verify the new methodological approach approved correctness of suggested methods and their general validity. As a result, a knowledgeable teacher can use the new teaching method at all levels of students'musical development. KEY WORDS: Voice performance, postural function, diaphragm, vocal hearing, breath excercises with fonation.

La prestation de soins critiques et d'orthophonie en milieu pédiatrique nécessite beaucoup de travail pour atteindre le niveau de soins souhaité. Plusieurs facteurs contribuent à ce problème, parmi lesquels la pénurie de ressources, les besoins pressants et l’augmentation du nombre d’enfants malades. Parmi les solutions proposées, beaucoup pensent que la télémédecine synchrone peut être utile en donnant un accès virtuel immédiat aux compétences à distance. Ainsi, l'expertise pourrait être instantanément disponible via une plateforme permettant une communication efficace et capable de soutenir les soins pédiatriques. La télémédecine s’est beaucoup développée dans la prestation des soins critiques et de réadaptation pédiatriques, et ce aux plans diagnostique et thérapeutique. Pourtant, peu d’études ont examiné la faisabilité et évalué l’impact de la télémédecine sur la qualité des soins critiques et de réadaptation pédiatrique. L'objectif principal de cette thèse était d'évaluer la faisabilité de la télémédecine synchrone dans deux contextes pédiatriques, critique et réadaptation, et d'évaluer son influence sur le processus de prestation de soins pédiatriques. Le premier article présente les résultats d'une revue systématique qui synthétisait des études évaluant l'impact des modèles de télémédecine synchrone sur les résultats cliniques dans les établissements de soins de courte durée en pédiatrie. Les résultats ont révélé que l’utilisation de la télémédecine synchrone avait pour effet d’améliorer la qualité des soins, de diminuer le taux de transfert, de réduire de la durée du séjour, de modifier ou renforcer le plan de soins médicaux, de réduire les complications et la gravité de la maladie, et de diminuer le taux de mortalité hospitalière et standardisé. Cependant, la revue de l’état de connaissances a révélé que la qualité des études incluses était faible et que des preuves de haute qualité étaient nécessaires. Le deuxième article, fondé sur un devis pré/post, évalue la faisabilité de la télémédecine à domicile en orthophonie et son impact sur la satisfaction des enfants et orthophonistes, le coût économique, et les performances vocales. Cette étude a montré que la télémédecine en orthophonie était faisable et que les enfants et les orthophonistes étaient satisfaits du service. En outre, l'utilisation de la télémédecine en orthophonie a permis d'améliorer la voix et de faire économiser de l'argent aux parents. Le troisième article évalue la faisabilité de la mise en place d’une plate-forme de télémédecine synchrone dans l’unité des soins intensifs pédiatriques (USIP). Pour qu'une solution de télémédecine synchrone à l’USIP soit faisable, elle nécessite une bonne préparation préalable à la mise en œuvre de la plate-forme de télémédecine synchrone pour être réellement utile. Avec des médecins résidents compétents et autonomes, l’utilité d’une plate-forme de télémédecine synchrone reliant les intensivistes pédiatriques hors site et les médecins résidents sur site à l’USIP est faible. Cette étude a ajouté qu'un tel service pourrait être plus bénéfique que le modèle traditionnel des soins (face à face) pour les communications avec d'autres établissements de soins de santé éloignés, où le besoin d'expertise d'un intensiviste en soins intensifs pédiatriques est plus important. Ces trois études permettent de conclure que la télémédecine synchrone est réalisable et peut avoir un impact sur la qualité des soins intensifs et de réadaptation pédiatrique. On peut déduire de cette thèse qu'il est important de prendre en compte le contexte dans lequel la technologie sera mise en œuvre. Traiter le contexte de l’USIP et celui de réadaptation de la même manière n'aboutit pas aux mêmes résultats et une innovation technologique pourrait réussir dans un contexte et échouer dans un autre. / Delivering critical and speech-language pathology care in pediatric settings requires much hard work to reach the desired level of care for children. Several factors contribute to this problem, including resources shortage, pressing needs, and the growing number of ill children. Among the proposed solutions, many believe that synchronous telemedicine can play a role by providing virtual and immediate access to remote skills, with expertise could be made instantly available through a platform that allows efficient communication and is able to support pediatric care. Telemedicine has developed significantly in the provision of critical care and pediatric rehabilitation in terms of diagnosis and therapy. Yet, few studies have examined the feasibility and evaluated the impact of telemedicine on the quality of pediatric critical care and rehabilitation. The main objective of this dissertation was to assess the feasibility of synchronous telemedicine in two pediatric settings—critical care and rehabilitation—and to evaluate its influence on the process of providing pediatric care. The first article presented the results of a systematic review that synthesized studies evaluating the impacts of synchronous telemedicine models on clinical outcomes in pediatric acute care settings. The findings revealed that the use of synchronous telemedicine improved quality of care and resulted in a lower transfer rate, a shorter length of stay, a change in or reinforcement of the medical care plan, a reduction in complications and illness severity, and a low hospital standardized mortality rate. However, the review of the state of knowledge revealed that the quality of the included studies was weak, so more high-quality evidences is needed. The second article, which used a pre/post design, assesses the feasibility assessed the feasibility of home-based telepractice in speech-language pathology (TSLP) and its impact on satisfaction among the children and speech-language pathologists, economic cost, and voice performance. This study showed that TSLP is feasible and that both the children and the speech-language pathologists were satisfied with the service. In addition, the use of TSLP demonstrated more voice improvement at less cost to the parents. The third article evaluated the feasibility of implementing a synchronous telemedicine platform in a pediatric intensive care unit (STEP-PICU). For a STEP-PICU to be feasible and truly helpful, it needs good preparation for the implementation of the telemedicine solution. With competent and autonomous fellows (a fellow is a physician who has completed their residency and elects to complete further training in a subspecialty), the usefulness of an synchronous telemedicine (STM) platform linking off-site pediatric intensivists and on-site fellows in a PICU is limited. This study added that such a service could be more beneficial than the traditional model of care (face to face) for communications with other remote healthcare facilities, where there is a greater need for the expertise of a pediatric critical care intensivist. These three studies allow us to conclude that STM is feasible and can have an impact on the quality of pediatric intensive care and rehabilitation. This thesis underscores the importance of taking into consideration the context in which the technology will be implemented. Treating the PICU and the rehabilitation contexts in the same way does not lead to the same results, and a technological innovation that succeeds in one setting may fail in another.