The Monarchy and Politics

There is a tension in the British constitution concerning the role of the monarchy in political affairs. On the one hand, the monarch is expected to be politically neutral. On the other hand, the monarch is entitled to be politically active; she is permitted to express her political opinions in confidence to the elected government. Can this tension be resolved? Should it be resolved? This essay will explore both of these questions.This is the author accepted manuscript. The final version is available from Sweet and Maxwell via https://doi.org/10.2139/ssrn.262898

Yak (Bos grunniens): The Mammal of Socio-Economic Importance in Gilgit- Baltistan, Pakistan

The yaks are long-haired humped bovid, a multipurpose animal that can survive in a low oxygen and cold environment at an elevation of 2000 to 6000 meters above sea level. The animal has the ability to graze diverse foliage from coarse shrubs to short grasses. The majority of yak population is still living in central Asian highlands, which include parts of Tibet, China, Indo-Pak. Yak rearing in Pakistan is bounded to higher elevations (3,500–4,500 meters a.s.l) of Gilgit-Baltistan (GB) and Chitral, where yak is important and places the only means of livelihood through theprovision of milk, meat, and wool, hairs and hides. The GB region of Pakistan has an estimated population of 25,000 yaks and more than 100,000 yak hybrids. Yaks and yak hybrid population showed an increasing trend in GB region over the past fifteen years, but yak husbandry in the region has yet to become an economically viable activity. In previous studies where grazing and rangeland management, feeding, breeding, diseases and health hazards management were altered and reviewed lines of the literature directed our attention towards some neglected aspects of yak husbandry at GB region in comparison to other highland highlighted. The prime issues faced by yak husbandry and the yak-raising communities in GB region include low productivity, lack of grazing and rangeland management, demarcation and closure of borders (restrictions on grazing in trans-border pastures), unplanned breeding, poor disease management, lack of veterinary and extension services, lack of markets for yak produceas well as subsequent workforce. In addition, yak husbandry can be transformed into generally acceptable, environmentally favorable and economically viable agropastoral business by these highland dwellers by improving the productivity of yak and their crossbreeds, promoting sustainable rangeland management, enhancing the forage productivity of the available pasture, improving marketing conditions and developing value chains for yak meat, wool, hair and hides. That could be best achieved by strengthening the veterinary services, improving breeds and building the awareness and capacity among the herders. More focused research and studies are needed on ongoing changes in yak-farmers’ livelihood strategies that perfectly analyze the past and the present socioeconomic importance of yak keeping. Finally, such studies on the economic contribution of the yak to household income and the respective effects of different yak management approaches will help to formulate policies aiming at sustaining the poor communities of Gilgit-Baltistan

Comparison of Local Infiltration of Bupivacaine and Tramadol in Post- Operative Pain Management in Children after Inguinal Herniotomy

Introduction: Adequate pain control is essential in immediate postoperativeperiod. Different methods are being used to provide pain management but none of these is completely effective. Regional blocks are becoming more popular then systemic opioids in all age groups due to efficacy and safety of agents used. The objective of this study was to establish the effectiveness of tramadol and bupivacaine for pain control after inguinal herniotomy in children.Materials and Methods: This randomized controlled trial was conducted at pediatric surgery department, services hospital Lahore over 2 years. Two hundred and eighty four cases randomly divided into two groups B (Bupivacaine) & T (Tramadol). Bupivacaine (dose of 2 mg/kg) in group B or Tramadol (2mg/kg) in group T was infiltrated in the wound. Postoperatively pain score was measured using Wong-Baker Faces pain scale (WBFPS) at 0,1,2,4 and 8 hours. Both groups experienced side effects.Results: Age and gender distribution in both groups were comparable. Pain score in both Groups was equal at 0- hours. However at 1-hour, 2-hour and 4-hour, pain score was slightly more in Group-B, But at 8-hours mean pain score was markedly raised in Group-B as compared to Group-T (3.32 ± 1.42 vs 2.45 ± 1.35). Only complication noted in patients was vomiting which was higher in Group T.Conclusion: Locally infiltrated Tramadol is a better choice than bupivacaine as a local anesthetic for pain management in children after inguinal herniotomy. Further research is needed to elucidate any benefits it may have in other surgeries

Assessment of Environment of Pediatric Surgery Residents of Pakistan using PHEEM

Introduction: Different countries have their own residency programs in order to train new residents in the field of medicine. Some of these programs are very efficient while some have room to improve, especially in developing countries. These residency programs can play an important role in producing great consultants in the future. So it is very important to evaluate the residency program of a country so as to make sure their residents receive quality training.Materials and Methods: A cross-sectional survey was conducted in Pakistan using PHEEM questionnaire; for assessment of educational environment of pediatric surgery post graduate residents (PGR’s) of Pakistan. A questionnaire was sent to all 95 pediatric surgery residents via E-mail in February 2017 and SPSS 20 was used to analyze data.Results: The response rate from pediatric surgery PGR’s was 48.4% (n= 45).The mean age of participants was 29.69 ± 2.71 years. Most of the participants were male (76%) and in 5th year of residency (39.13%). The high scored items (mean >2.5) were only 3: question 9, 17 and 26. The mean PHEEM total score was found to be 63.06 ± 16.77. When categorized into global scales, most of the residents (84.4%) labeled educational environment into level 2. Mean PHEEM score was found significantly higher among female and those residing in province ‘Sindh’.Conclusion: We conclude that although educational environment depends upon and varies with many factors; overall it is not reported to be satisfactory by pediatric surgery PGR’s across our country. Authorities urgently need to look into the matter and take serious actions in order to improve the quality of our future consultants

Energy Efficiency in Transportation along with the Belt and Road Countries

China’s huge investment in the “belt and road initiative” (BRI) may have helped improve the economic level of participating countries, but it may also be accompanied by a substantial increase in greenhouse gas (GHG) emissions. The BRI corridors aim to bring regional stability and prosperity. In such efforts, energy efficiency due to increased transport has been overlooked in the recent literature. This paper employed a data envelopment analysis of the slack-based measurement (SBM) for bad output to assess the transport energy efficiency of 19 countries under the BRI economic corridors. By using the most cited transport-related input variables, such as vehicles, labor, motor oil, jet fuel, and natural gas, this study first analyzes the transport energy efficiency by first assuming the output variables individually and then takes two years as a pre- and post-BRI case by considering the aggregated output model. The results show an increase in economic activity but a decline in transport energy efficiency in terms of consumption and emissions

Early Versus Delayed Feeding in Paediatric Patients Following Stoma Reversal in a Resource Limited Environment

Introduction: Institution of early enteral nutrition is essential after stoma reversal. There is no consensus on the time feeding should be started after closure of a stoma in children. It is established that after stoma reversal early achievement of full feed and early discharge affects the overall cost in resource limited countries. Materials and Methods: This Randomized control trial was conducted in the Paediatric Surgery Department of Services Hospital, Lahore. Over a period of 1 year, from April 2016 to March 2017, a total of 100 cases were included.  In group A, early feeding (after 36 to 48hours) and in group B delayed (after 5days) feeding was given to the patients. Time for restoration of full feed and length of hospital stay and complications were compared in both groups. Each patient was observed in the ward till discharge and followed up to 30 days in the out-patient department. The data was recorded and analyzed in SPSS version 20. Independent sample t-test was applied to obtain the p-value for comparing the means. P-value ≤ 0.05 was considered significant. Results:  In both groups age, weight and etiology of stoma was comparable.  The full feed was achieved within 56.66 ± 7.77 hours in group A and 156.76 ± 7.96 hours in group B (P<0.005). Mean length of hospital stay was 5.84 ± 0.84 days in group A, while it was 9.50 ± 0.76 days in group B (P<0.005). Conclusion: Early enteral feeding after stoma reversal is well tolerated and beneficial. It is suggested that early feeding protocol should be encouraged in a resource limited environment

DNA Pre-alignment Filter using Processing Near Racetrack Memory

Recent DNA pre-alignment filter designs employ DRAM for storing the reference genome and its associated meta-data. However, DRAM incurs increasingly high energy consumption background and refresh energy as devices scale. To overcome this problem, this paper explores a design with racetrack memory (RTM)--an emerging non-volatile memory that promises higher storage density, faster access latency, and lower energy consumption. Multi-bit storage cells in RTM are inherently sequential and thus require data placement strategies to mitigate the performance and energy impacts of shifting during data accesses. We propose a near-memory pre-alignment filter with a novel data mapping and several shift reduction strategies designed explicitly for RTM. On a set of four input genomes from the 1000 Genome Project, our approach improves performance and energy efficiency by 68% and 52%, respectively, compared to the state of the art proposed DRAM-based architecture

Sub-categorization of Pediatric Small Round Blue Cell Tumors using Immunohistochemistry

Introduction: The category of Small Round Blue Cell Tumors includes neoplasms that are undifferentiated and contain similar-looking growth of small round blue cells having bigger nuclear size as compared to the cytoplasm (high N/C). It includes Non-Hodgkins Lymphoma, Synovial Sarcoma, Ewings Sarcoma/ Primitive Neuroectodermal Tumor, Rhabdomyosarcoma, Hepatoblastoma, Retinoblastoma, Neuroblastoma, Neuroendocrine carcinoma, Nasopharyngeal Carcinoma, Desmoplastic Small Round Cell Tumor, Dysgerminoma, and Wilm's tumor. Immunohistochemistry can be very helpful in the accurate diagnosis of this diverse group of tumors. Objective: The objective of the study is to sub-categorize pediatric malignant small round blue cell tumors using immunohistochemistry. Study design: Descriptive cross-sectional studySetting: Meezan private lab, Faisalabad, PakistanDuration of study: 4 years, from January 2017 to December 2020.Sample size: 46 cases.Sampling technique: Non-probability purposive samplingMaterials and Methods: 46 cases, which fulfilled the inclusion and exclusion criteria were selected for the study. All these cases were subjected to immunohistochemistry. The IHC technique used was based on the Peroxidase anti-peroxidase (PAP) method. Based on site and morphological clues, initially Leukocyte common antigen (LCA), Myogenin, Cytokeratin (CK), Desmin, Chromogranin, Neuron Specific Enolase (NSE), S-100, Smooth Muscle Actin (SMA), and CD99 were used. Further immune stains panels were used afterward, as and when needed like CD20, CD3, CD30, BCL2, CD117, Ki-67, Tdt, Synaptophysin, SMA, CD56, Melan A, HMB45, and WT1.Results: Among all the malignant Small Round Cell Tumors, Rhabdomyosarcoma was the highest in frequency i.e. 8 (17.4%), followed by Ewing’s sarcoma/PNET 7(15.2%). Both Diffuse Large B cell lymphoma and Neuroblastoma were 5 each in number (10.9%). Non-Hodgkins lymphoma as a whole was 13 (28.2%), including 5 cases (10.9%) of diffuse large B cell lymphoma, 4 cases (8.7%) of T lymphoblastic lymphoma, 3 cases (6.5%) of Burkitt’s lymphoma, and only 1 case (2.2%) of NK/T cell lymphoma.Conclusion: Immunohistochemistry is an essential tool for accurate sub-categorization of pediatric small round blue cell tumors