Cervical Auscultation: A Systematic Review

Cervical auscultation refers to the technique of listening to the sounds of swallowing using a stethoscope or other measurement device such as placing microphone on the surface of the neck. This is based on the assumption that the normal biological sounds will be different from the abnormal biological sounds. The clinical applications of cervical auscultation were reviewed and discussed Keywords: Cervical auscultation, swallow sounds, swallowing assessment, biological sound

On the Supergravity Gauge theory Correspondence and the Matrix Model

We review the assumptions and the logic underlying the derivation of DLCQ Matrix models. In particular we try to clarify what remains valid at finite $N$, the role of the non-renormalization theorems and higher order terms in the supergravity expansion. The relation to Maldacena's conjecture is also discussed. In particular the compactification of the Matrix model on $T_3$ is compared to the $AdS_5\times S_5$ ${\cal N}=4$ super Yang-Mills duality, and the different role of the branes in the two cases is pointed out.Comment: 19 pages, Late

Public-Private-Partnerships for Primary Care in India, Pakistan and Bangladesh: Lessons on Pathways and Drivers

Formalised public-private-partnerships (PPPs) for primary care have proliferated in the mixed health systems of India, Pakistan and Bangladesh, managed and funded by the state. This perspective provides a process-based understanding of pathways adopted by home-grown PPPs and underlying drivers to identify lessons for advancement under Universal Health Coverage (UHC). PPPs have been deployed to respond to local primary care needs ranging from diagnostic screening, maternity services, management of government health centres, mobile clinics to urban primary care systems. Partnerships have evolved to include a diverse range of private partners and more purposeful arrangements, with increase in service volumes, innovations albeit less standardised quality of care. The pathway of PPP instigation, rollout and sustaining in South Asia is based on local starting points by sub-national governments, diffusion of practice across states, common interests and shared bureaucratic coalitions. Success drivers include administrative support beyond the health sector, simplified contractual and payment systems providing operational ease and decision space, and the use of relational management and digital monitoring for resolving issues. However, PPPs are constrained by either too little accountability or excessive accountability in contract design, trust deficits between private and government, and fire-walled PPP implementation creates disconnects from national primary care planning and regulation. Donor supported projectized PPP funding and accompanying rules of business makes PPPs implementation more cumbersome. We conclude that future attention must centrally focus on pathways and drivers to impactfully introduce, scale-up and sustain PPPs in South Asia. Emphasis must be on pathways that build on local simplified ideation, progressive adaptation and allowing contextual diversity under a larger UHC planning architecture, as opposed to centralised one-fit and heavily technocratic initiatives. Success drivers must feature in design of PPP initiatives. Furthermore, we contend that international donor assistance should shift from projectized support for PPPs to building public sector competencies for stewardship, private sector engagement skills as well as the more traditional performance management capacity

Cepstral Characteristics of Voice before, during and after Menopause: A Cross-sectional Study

ABSTRACT Background Previous studies on effects of menopause on voice characteristics have not compared the voice characteristics before, during and after menopause. It is also possible that these voice changes cannot be captured by traditional acoustic measures such as frequency and amplitude perturbation measures. Hence a robust acoustic tool such as cepstrum was chosen to capture these vocal changes before, during and after menopause and hence the present study was attempted. Method The present study followed a cross-sectional study design. The participants consisted of 25 premenopausal women, 25 perimenopausal women and 25 postmenopausal women. Sustained production of/a/ and narration was recorded using Z tool and cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) was analyzed. Results The results of one-way ANOVA revealed that there was a significant main effect of the group at p &lt; 0.05 for all the cepstral measures targeted in the study. Post hoc analysis indicated that there was no significant difference between pre and perimenopausal women for all the cepstral measures at p &lt; 0.05. However, there was a significant difference between pre and postmenopausal women and peri and postmenopausal women at p &lt; 0.05. These results suggests that postmenopausal women had overall good voice quality than pre and perimenopausal women. Conclusion Results indicated that post menopausal women had increased cepstral measures when compared to pre and perimenopausal women. Further, studies are required to correlate laryngeal examination and hormonal levels with that of the voice changes before, during and after menopausal women. How to cite this article Balasubramanium RK, Bhat JS. Cepstral Characteristics of Voice before, during and after Menopause: A Cross-sectional Study. Int J Phonosurg Laryngol 2014;4(2):50-54. </jats:sec

EFFICACY OF MANIPAL MANUAL OF SWALLOWING ASSESSMENT IN IDENTIFYING ASPIRATION

Background: There are also many formal assessment tools available for the assessment of swallowing. Among these, there are few published clinical dysphagia assessment tools that provide detailed assessment of swallowing. One of the tool which has been psychometrically validated and standardized for the Indian population is Manipal Manual for Swallowing Assessment (MMSA) which involves the assessment of structure, sensory and motor functions along with trial feed. This test is used in the present study to check for its efficacy in the identification of aspiration.Method: A total of 25 individuals participated in the study. All the individuals were diagnosed to have Dysphagia based on MMSA [35]. All the 25 individuals underwent MMSA test. Individuals with suspected aspiration and no aspiration were identified by experienced speech pathologists in the field of swallowing disorders. All these individuals were subjected to videofluroscopy testings to confirm aspiration. Concurrent validity for MMSA was established through the measurement of sensitivity, specificity, positive predictive value, negative predictive value and the efficiency.Results: Results revealed that 77% of the individuals with aspiration were actually aspirators whereas 67 % of the predicted individuals with no aspiration were actually the non aspirators and hence this test can be used to identify individuals with aspiration with overall efficiency of 72 %.Conclusions: Results revealed a high sensitivity and specifivicity for MMSA. Thus, MMSA is proven a valuable tool in the dysphagia assessment, in particularly aspiratio