Everpresent Lambda - II: Structural Stability

Ideas from causal set theory lead to a fluctuating, time dependent cosmological-constant of the right order of magnitude to match currently quoted "dark energy" values. Although such a term was predicted some time ago, a more detailed analysis of the resulting class of phenomenological models was begun only recently (based on numerical simulation of the cosmological equations with such a fluctuating term). In this paper we continue the investigation by studying the sensitivity of the scheme to some of the ad hoc choices made in setting it up.Comment: 15 pages, 6 figures, Thoroughly rewritte

Phasing out diploma in nursing: Merits and implications on nursing education in Pakistan

On 8th August, 2019, Pakistan Nursing Council announced the ceasing of the three year Diploma in Nursing which heralds a new era of the Bachelor of Science in Nursing (BScN) as the entry point for the nursing profession in Pakistan. This brings Pakistan in line with most developed and many developing countries. Continuous..

The Radiological Outcome of Thoracolumbar Spine Fracture Fixation in Short Vs Long Segment

Objectives:  The study determined the radiological outcomes of short-segment vs. long-segment fixation of thoracolumbar spine fractures. Materials and Methods:  A total of 322 patients (18 – 60 years) with thoracolumbar spine fractures were included. Preoperative X-rays and CT scans were performed on all patients to determine the integrity and orientation of the pedicle. Cobb's approach was also used to estimate the kyphotic angle on x-rays. The posterior pedicle 65 screw fixation was used in all instances. Group A (N = 161) received long segment fixation at least two levels above and below the fractured vertebra, while Group B (N = 161) received short segment fixation with pedicle screws placed in the broken level as well as one level above and below the fractured level. Results:  In Group A, the mean age was 38 years, and the mean length of fracture was 45 hours; in Group B, the mean age was 43 years, and the mean duration of fracture was 46.354 hours. A good radiological outcome was observed in 115 (71.4%) patients in group A as compared to 103 (64%) patients in group B. A radiological outcome (p-value: 0.049) of a duration greater than 8 hours was observed in both groups (A: 75.5%; B: 58.1%). Conclusion:  Short segment fixation using a pedicle screw at the level of fracture provides comparable correction to long segment fixation. Keywords:  Thoracolumbar Fractures, Short Segment, Long Segment, Radiological Outcome

Poverty and Its Determinants in Pakistan: Evidence from Pslm 2010-11

This study estimates the poverty in terms of head count ratio, poverty gap and squared poverty gap by using the fresh available PSLM data for the year 2010-11 in Pakistan. This study also finds its economic determinants by estimating multiple OLS regression.The results show that the headcount ratio, poverty gap and squared poverty gap are statistically significant 15.06 %, 2.29 % and 0.55 %, respectively in Pakistan. All of the poverty estimates arestatistically significant almost double in rural areas as compared to urban areas. The comparisons of the poverty estimates of this year with the previous ones of2007-08 at urban, rural and nationallevel show that poverty decreased statistically significantly. Among the provinces it is the highest in Baluchistan and the lowest in Sindh. The comparison of provincial poverty estimates of this year with the same ones of previous year (2007-08) depict that poverty decreased in all of the provinces, but it is statistically significant only in case of Baluchistan.Further the resultsshow that Poverty has statistically significantinverse relationship with education. Households having animals for transportation, owning residential buildings, shops and commercial buildings and living in urban areas have less poverty than those who do not. But it hasstatistically significant positive association with the household size and dependency ratio. The household size is greater in poor families than the rich ones. As far as household head’s employment status, occupation and industry is concerned, it is highest in sharecroppers,elementary occupations, and community, social services. At a policy level, it is suggested that Govt. should focus more on education and generationof employment opportunities. Further it should provide loansto lower income groups on reduced rates for housing facilities andto start their own businesses like shops.Family planning should be encouraged especially in poor families.All such policies should focus more on rural areas of especially Baluchistan and KPK in Pakistan. Keywords: Poverty; Education; Animal for transportation; Household size;  Dependency ratio; Family planning; Residential building;Shops; Pakistan

Humidified high flow nasal cannula oxygen therapy in acute bronchiolitis

Background: Bronchiolitis is a major cause of morbidity and leading cause of hospitalization, mostly in early childhood without coexisting illnesses. Traditionally dry oxygen is provided at 100% concentration via low flow nasal prongs. However, the latest studies have revealed that oxygen therapy via heated, humidified, high flow nasal cannula (HFNC) allows the delivery of high inspired gas flows which is better than the traditional one. Methods: All previously healthy children between 1 and 24 months of age with an established clinical diagnosis of moderate to severe bronchiolitis (clinical severity score ≥4) were enrolled for study. The patients were divided into two groups: Patients in Group 1 received HFNC oxygen therapy (HFNC group) while those in Group 2 received conventional oxygen therapy (non-HFNC group). The patients were randomized in each arm by simple randomization. Outcome parameters measured were duration of hospital stay, duration of pediatric intensive care unit (PICU) stay, oxygen saturation (SPO2), respiratory rate, adverse event (respiratory failure), need for intermittent positive pressure ventilation or continuous positive airway pressure. Results: Out of 100 patients studied, 50 received HFNC oxygen and 50 received conventional oxygen. There was early and better improvement in SPO2 and respiratory rate (p<0.001), decreased length of hospital stay (p<0.001) and PICU stay (p<0.01) among the patients in HFNC group as compared to non-HFNC group. The most common adverse event during the hospital course was respiratory failure which was seen among 4 patients in non-HFNC group and none among HFNC group developed such complication. Conclusion: The use of HFNC oxygen therapy in infants hospitalized with acute bronchiolitis reduces PICU and hospital stay as well as the potential complications which will substantially reduce the hospital cost

Ultrasonographic Biometry of the Ovaries of Pregnant Kundhi Buffaloes

Sixteen gravid uteri of 1st, 2nd, 3rd and 4th month of pregnant Kundhi buffaloes were collected from Hyderabadslaughterhouse for this study. The ovaries were separated from gravid uteri of Kundhi buffaloes and ultrasonographicbiometry was performed by ultrasound machine (HS-2000, Honda electronics Co. Ltd., Japan). The ovaries wereexamined for presence of follicles and/or corpus luteum. The length, width and height of ovaries and corpus luteum (CL)were recorded and measured. The average weight of ovaries with corpus luteum during 1st, 2nd, 3rd and 4th month's ofpregnancy was 4.6 + 0.345, 5.90 + 1.134, 6.10 + 1.179, and 6.50 + 1.139 gms, respectively. The average weight of CLduring 1st, 2nd, 3rd and 4th month of pregnancy was 2.0 +0.162, 2.4 + 0.35, 2.6 + 0.27, and 3.0 + 0.49 gm, respectively.The average weight of ovaries of non-gravid uterus of same buffaloes was 2.7 + 0.35, 3.6 + 1.10, 3.9 + 1.15, and 4.2 +1.09 gm during 1st, 2nd, 3rd and 4th month of pregnancy respectively. The average size of the left and right ovary was 29.0+ 1.2 mm and 20.01 + 2.15 mm respectively and the average size of CL was 17.13 + 3.15 mm. There was significantincrease in the weight, length, width and height of ovaries and corpus leutum as pregnancy advances than non-pregnantbuffaloes. A greater number of ovarian structure (follicles) was found at the time of oestrus than anoestrus period

Foetus-in-Foetu

Foetus-in-foetu is a rare malformation in which a monozygotic diamniotic parasitic twin is incorporated into the body of its fellow twin and grows inside it. Less than 100 cases have been reported in literature. One day old newborn male was admitted with antenatal diagnosis of abdominal mass. It was cystic/solid in nature with pressure effects on left ureter and urinary bladder, most likely to be a germ cell tumour. Birth history was uneventful. Exploratory laparotomy was performed and the mass was excised. Physical examination confirmed the diagnosis of foetus-in-foetu. Although it is a rare condition, imaging may play an important role in the correct prospective diagnosis of foetus-in-foetu. Surgical excision is the recommended treatment

The role of micro health insurance in providing financial risk protection in developing countries- a systematic review.

BACKGROUND: Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting. METHODS: We conducted a systematic search for published literature using the search terms Community based health insurance AND developing countries , Micro health insurance AND developing countries , Mutual health insurance AND developing countries , mutual OR micro OR community based health insurance Health insurance AND impact AND poor Health insurance AND financial protection and mutual health organizations on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization. RESULTS: Twenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on household savings, assets and consumption patterns. CONCLUSION: Our review suggests that MHI, targeted at the low-income households and tailored to suit the cultural and geographical structures in the various areas of Pakistan, may contribute towards providing protection to the households from catastrophe and impoverishment resulting from health expenditures. This paper emphasizes the need for further research to fill the knowledge gap that exists about the impact of MHI, using robust study designs and impact indicators