Patients with a Blom® tracheostomy tube (containing a cuff) can vocalize while on mechanical ventilation, which can significantly improve the patient\'s quality of life. This is brought by the purpose-built structure of the tracheostomy tube that allows the expiration to be expelled through the glottis. However, this characteristic may complicate the measurement of the patient\'s tidal volume, as most of the expiration does not return to the ventilator. Owing to the necessity of insertion of the speech cannula, which acts as an inner cannula, to enable patient vocalization, the air passage likely becomes constricted, thus increasing airway resistance. Difficulty in applying appropriate positive end-expiratory pressure (PEEP) and ventilator auto-triggering may also be problematic. Therefore, alveolar ventilation is predicted to decrease without adjusting the ventilation settings. Our experience using the Blom® tracheostomy tube revealed some problems, and we provide suggestions for patient management. We herein report on the experience of a patient having inserted the Blom® tracheostomy tube receiving mechanical positive pressure ventilation during vocal training.

Communication among nonhuman animals is often presented as rigid and inflexible, reflecting emotional states rather than having any cognitive basis. Using the world\'s smallest monkey, the pygmy marmoset (Cebuella pygmaea), with the smallest absolute brain size amongst simian primates as a case study, I review the role of cognition in the development and usage of vocalizations in pygmy marmosets and present new data on the instrumental use of babbling and of food associated vocalizations. Pygmy marmosets have several contact calls that differ in the psychoacoustic properties for sound localization as well as the distance at which they carry through the rainforest. Marmosets use these calls strategically based on distance from neighbors. Marmosets alter spectral and temporal aspects of call structure when exposed to new groups and when newly mated. They display population specific vocal dialects. Young pygmy marmosets engage in extensive babbling behavior rewarded by parents that helps the young develop adult vocal structures, but older monkeys also use babbling instrumentally in conflict situations. Specific food referential calls generally relate to food preferences, but food calls are suppressed in the presence of animate prey. Unmated animals systematically combine a long distance call with food calls as though advertising for mates. Taken together, these examples show that even small brained primates use their vocal signals flexibly and strategically in response to a variety of environmental and social conditions.

BACKGROUND: Territorial songbirds vocalise intensively before sunrise and then decrease their vocal activity. This creates a communication network that disseminates essential information for both males and females. The function of dawn chorus in birds has been frequently interpreted according to seasonal variation of singing as the breeding season advances, but potential differences in seasonal variation of song and calls for the same species have not been taken into account.
METHODS: We chose Dupont\'s Lark as a model species to study whether the seasonal pattern of dawn chorus differs between singing and calling activity, because in this species most daily songs and calls are uttered at dawn. We registered vocal activity of Dupont\'s Lark before and around dawn in three different populations, through repeated sampling over the entire breeding season of two consecutive years.
RESULTS: We found that dawn singing parameters remained constant or presented an increasing trend while dawn calling activity decreased as breeding season advanced. We also found different daily patterns for singing and calling, with birds calling mostly during the first 30 minutes of dawn choruses and singing peaking afterwards.
CONCLUSIONS: The different time patterns of songs and calls may indicate that they serve diverse functions at dawn in the Dupont\'s Lark. Relaxation of dawn calling activity after the first month of the breeding season would suggest that dawn calling may be mainly related to mate attraction, while constant dawn singing throughout the breeding period would support a relationship of dawn singing to territorial defence. Our study highlights that the type of vocalisation used is an important factor to consider in further research on dawn choruses, since results may differ depending on whether calls or songs are analysed.

BACKGROUND: Vocalizations are part of the spectrum of the \'negative\' behavioral and psychological symptoms of dementia (BPSD). We describe a patient with moderate-stage mixed dementia of Alzheimer\'s disease and cerebrovascular disease and a left orbitofrontal lesion exhibiting vocalization. The use of \'redirection\' has been demonstrated to be an effective nonpharmacological means of controlling BPSD, while reducing caregiver distress.
METHODS: A 78-year-old right-handed African-American female presented with complaints of worsening memory and BPSD, causing significant caregiver distress. Throughout the evaluation, she constantly vocalized her son\'s name and made a continuous grunting noise, correlating with increased anxiety/agitation. We utilized a redirection technique, which achieved the immediate reduction of the vocalization symptoms. Caregiver psychoeducation was provided allowing them to use the redirection technique at home.
CONCLUSIONS: In patients with dementia exhibiting negative symptoms of BPSD, using nonpharmacologic techniques (i.e. redirection) may be indicated. Psychotropic medications rarely address negative BPSD symptoms, while simultaneously decreasing patient\'s quality of life. Nonpharmacologic approaches are beneficial as first-line therapy for negative BPSD.