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Conclusion. Children with advanced cancer from low-income families experience higher symptom distress and worse quality of life. This disparity may be partially related to uncontrolled pain, which may respond to more intensive management. Implications for Research, Policy, or Practice. Further research is needed to evaluate reasons for poverty-related disparities in symptom distress and quality of life and explore avenues to improve equity.

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.