Trust in State and Nonstate Actors: Evidence from Dispute Resolution in Pakistan

This paper investigates whether information about improved public services can help build trust in state institutions and move people away from nonstate actors. We find that (truthful) information about reduced delays in state courts in rural Pakistan leads to citizens reporting higher likelihood of using them and to greater allocations to the state in high-stakes lab games. We also find negative indirect effects on nonstate actors and show that these changes are a response to improved beliefs about state actors, which make individuals interact less with nonstate actors and, we argue, induce them to downgrade their beliefs about these actors

Shift to Online Learning: Response of Pakistani Visual Art Teachers During Pandemic and Post-Covid Era

This study aims to investigate the response of Visual art teachers to educational lockdown and shift to online learning at art institutions. The study employed qualitative phenomenological research design to investigate visual artists i.e., painters, sculptors, textile designers, graphic designers, and performing artists who were faculty members in five leading art institutions of Lahore. Data were collected by conducting a total of 15 interviews from each mentioned discipline. These interviews were conducted preferably in their studios, at their homes, or at times online through WhatsApp video calls. The data was analyzed thematically by using NVIVO 12 software. Findings – It was observed that new methodologies were devised by the faculty and art institutions to mitigate the pandemic upshot, however, virtual learning made it hard for the faculty to teach practice-based subjects. As a result, the assessment criteria were also affected. The study findings provide insight for art institutions and the Higher Education Commission (HEC) to start preparing their systems to offer effective online teaching as a substitute for regular classes in Visual Arts. The researchers could not find any such study in the local context, and very few globally. Therefore, this study may serve as a baseline for further research

TCT-637 Transcatheter Aortic Valve Implantation in Patients with Small Aortic Annuli Using the Edwards SAPIEN XT 20mm Balloon-Expanding Heart Valve: Early Clinical Results from A Multi-Center Registry

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Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Decentralization in Pakistan: Context, Content and Causes

This paper provides a description of the recent decentralization reforms in Pakistan under General Musharraf. In the process, we hope to not only highlight major aspects of this reform, but also to analyze the evolution of this reform in historical context in order to better understand the potential causes behind the current decentralization. Analyzing the evolution of local government reforms in Pakistan is interesting because each of the reform experiments has been instituted at the behest of a non-representative centre using a ‘top down’ approach. The Pakistani experience shows that each of the reform experiments is a complementary change to a wider constitutional reengineering strategy devised to further centralization of political power in the hands of the non-representative centre. We argue here that the design of the local government reforms in these contexts becomes endogenous to the centralization objectives of the non-representative centre. It is hoped that analyzing the Pakistani experience will help shed light on the positive political economy question of why non-representative regimes have been willing proponents of decentralization to the local level.

Herat failure and chronic obstructive airway disease as combined comorbidities. Meta-analysis and Review

Background: The existence of COPD and heart failure in elderly population adds additional morbidity and mortality risk than if those with only one of the two comorbidities. The aim of the current metaanalysis was to explore the effect of COPD on heart failure patient in terms of all-cause mortality, cardiac mortality and recurrent heart failure hospitalization.Methods and results: A comprehensive search of PubMed, MEDLINE, Embase and Cochrane was conducted until August 2017. The total standardized mean difference, with 95% (CI), was estimated for&nbsp; fixed and random effects models to present “pooled effect” for continuous outcomes (mean ± standard deviation or median ± interquartile range) &amp; categorical outcomes (Odds risk OR). Statistical heterogeneity among studies was assessed with Cochran’s Q test and the I2 statistic.</p