Above cuff vocalisation (ACV): A scoping review.

INTRODUCTION: Patients in intensive care frequently suffer from not being able to communicate verbally. The aim of this scoping review was to study the safety and effectiveness of the above cuff vocalisation (ACV) on speech and quality of life (QOL) in patients dependent on a cuffed tracheostomy. METHODS: A scoping review was conducted. The databases Ovid Medline, Cochrane Library, and Embase were systematically searched in May 2020. We included clinical studies with patients exposed to ACV where speech, QOL or safety issues were assessed. RESULTS: Overall, 17 studies were included, of which 15 were observational and 2 were randomised controlled trials. Totally, 231 patients were included. ACV enabled most of the included patients (115/131; 88%) to speak with an audible voice or whisper (moderate quality of evidence). Voice related QOL (V-RQOL) and QOL in mechanically ventilated patients (QOL-MV) improved from pre- to post- ACV compared to a control group not tolerating a one-way speaking valve (P = .01 and P = .04, respectively) (very low quality of evidence). Several minor complications or problems were reported in 20/75 (27%) cases in addition to two serious adverse events: subcutaneous emphysema in one patient where the tracheostomy was dislodged and a distended trachea in another due to the misconnection of continuous gas to the cuff (low/ very low quality of evidence). CONCLUSION: ACV facilitated communication in patients dependent on a cuffed tracheostomy and attempting to communicate. Quality of evidence in improved V-RQOL and QOL-MV was very low. Several minor complications and two serious adverse events were reported.

Trends in and socio-demographic factors associated with caesarean section at a Tanzanian referral hospital, 2000 to 2013.

BACKGROUND: Caesarean section (CS) can prevent maternal or fetal complications. Sub-Saharan Africa has the lowest CS levels in the world but large variations are seen between and within countries. The tertiary hospital, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania has had a high level of CS over years. The aim of this study was to examine trends in the socio-demographic background of babies born at KCMC from year 2000 to 2013, and trends in the CS percentage, and to identify socio-demographic factors associated with CS at KCMC during this period. METHODS: This is a registry-based study. The analyses were limited to singletons born by women from Moshi urban and rural districts. The Chi square test for linear trend was used to examine trends in the CS percentage and trends in the socio-demographic background of the baby. The association between different socio-demographic factors and CS was assessed using logistic regression. The analyses were stratified by the mother's residence. RESULTS: The educational level of mothers and fathers and the age of the mothers of singletons born at KCMC increased significantly from year 2000 to 2013 both among urban and rural residents. Among 29,752 singletons, the overall CS percentage was 28.9%, and there was no clear trend in the overall CS percentage between 2000 and 2013. In the multivariable model, factors associated with higher odds of CS were: having been referred for delivery, maternal age above 25 and no- or primary education level of the baby's father. Among rural mothers, no- or primary education, being from the Pare tribe and para 2-3 were also associated with higher odds of CS. Being from the Chagga tribe and high parity were associated with lower odds of CS compared to other tribes and parity 1. CONCLUSIONS: The CS percentage remained high but stable over time. Large variations in CS levels between different socio-demographic groups were observed. The educational level of the parents of babies born at KCMC increased over time, possibly reflecting persistent inequitable access to the services offered at the hospital.

Behaviour of anadromous brown trout (Salmo trutta) in a hydropower regulated freshwater system.

Many Norwegian rivers and lakes are regulated for hydropower, which affects freshwater ecosystems and anadromous fish species, such as sea trout (Salmo trutta). Lakes are an important feature of many anadromous river systems. However, there is limited knowledge on the importance of lakes as habitat for sea trout and how hydropower affects the behaviour of sea trout in lakes. To investigate this, we conducted an acoustic telemetry study. A total of 31 adult sea trout (532 ± 93 mm total length) were captured by angling in river Aurlandselva, Norway, and tagged between July 20 and August 12, 2021. The tags were instrumented with accelerometer, temperature, and depth sensors, which provided information on the sea trout's presence and behaviour in lake Vassbygdevatnet. Our results indicate that there was a large prevalence of sea trout in the lake during the spawning migration, and that the sea trout were less active in the lake compared to the riverine habitats. An increase in activity of sea trout in the lake during autumn might indicate that sea trout spawn in the lake. However, the discharge from the high-head storage plant into the lake did not affect the depth use or activity of sea trout in the lake. Furthermore, the large prevalence of spawners in the lake during autumn will likely cause an underestimation of the size of the sea trout population in rivers with lakes during annual stock assessment. In conclusion, our results could not find evidence of a large impact of the discharge on the behaviour of sea trout in the lake.