How External Shocks and Exchange Rate Depreciations Affect Pakistan? Implications for Choice of an Exchange Rate Regime

A structural vector autoregression (VAR) model shows that external shocks are important in driving economic fluctuations in Pakistan and their importance has increased since September 11, 2001. The primary source of external shocks is foreign remittances, while foreign output has a limited effect. Keeping fixed external factors, an exogenous real exchange rate depreciation shock lowers output—a positive effect on real net exports (largely resulting from import compression rather export expansion)—is more than offset by a decline in domestic demand. The absence of common shocks with major trading partners, the importance of remittances, conventional expansionary effects on the trade balance following a real currency depreciation, and only limited evidence that credibility of anti-inflationary policy would improve with a currency peg support greater exchange rate flexibility. However, the rather large contractionary effects of real exchange rate depreciation on domestic demand suggest that greater exchange rate flexibility could destabilize aggregate output.External Shocks; Depreciation; SVAR; Pakistan; Exchange rate

Assessing Implementation of Managerial Accounting Practices: Perspective of Pakistani SMEs

With increasing production cost and growing local and international competition, accountants within Small and Medium Enterprises (SMEs) are largely encumbered with the onus of cost control. Through this paper, we empirically examine use and perceived importance of cost management accounting practices within Pakistani manufacturing SMEs. The cross-sectional study is conducted under descriptive research design. Findings from survey questionnaire of 44 manufacturing SMEs indicate that process costing method is widely used and complexity in production process is main difficulty faced by SMEs in product costing. Descriptive analysis indicates that SMEs mainly use product costing information to make pricing decisions of products, profitability calculation and in decision making for new products. SMEs prefer to employ conventional tools like planning and control, budgeting and strategic planning for decision making purposes. Limited sample size under descriptive analysis restricts applicability and generalizability. Our study makes novel contribution in the domain of cost management practices in SMEs since majority of literature is available on cost management practices adopted by only large corporates within Pakistan

To be or not to be an obstetrician / gynaecologist

Objectives: This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges.Methods: This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and themes were finalized with consensus. Conclusion was formulated by linking these themes.Results: Four themes emerged were, \u27grounds for selecting ObGyn as career\u27, \u27Motivational Factors\u27, \u27Demotivating Factors\u27 and \u27Strategies to Cope with Challenges\u27. Results showed that aptitude and passion not only have pivotal role in career selection but also helped in pursuance. Personal fulfilment and hands-on experience satisfy emotional needs, while family and friends supported participants in maintaining work-life balance and in over-coming challenges.Conclusions: Considering personal preference and aptitude at the time of career selection helps in endurance and keep motivations high, while challenges in pursuance can be overcome by strong support system

Caesarean section rate amongst obstetricians at a tertiary-care hospital of Karachi

Objective: To analyze the Caesarean Section (CS) rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex (NTSV) presentation delivering at a tertiary care hospital of Karachi over four months.Methods: This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS (n=106) were taken as cases and vaginal deliveries (n=106) as controls. This was an unmatched retrospective case-control study.Results: Mean age of patients was 26.6(SD: 4.2) years. Mean gestational-age was 38.6(SD: 1.0) weeks. Likelihood of CS was slightly less in patients who were attended by feto-maternal consultants(OR:0.81 CI:0.38-1.07) and was slightly more in patients managed by non-full-time faculty (OR:1.04 CI:0.59-1.85). Odds of CS was highest amongst consultants having average monthly volumes of 21-30 patients/month (OR:1.069 CI:0.48-2.34). However none of the above findings were statistically significant. A non-significant increase in risk of CS was observed with increase in experience of physicians (p=0.787).Conclusion: The results did not show statistically significant difference in CS rate among different groups of Obstetricians. This might indicate that managing labour according to standard guidelines can eliminate physicians’ bias. This can be further evaluated with larger multicenter prospective studies

Comparison of neonatal outcomes between category-1 and non-category-1 primary emergency cesarean section: A retrospective record review in a tertiary care hospital

Objective: To compare neonatal outcomes between Category-1 and Non-Category-1 Primary Emergency Cesarean Section.Methods: This was a retrospective analysis, conducted at Aga Khan University Hospital Karachi from January 1st 2016 till December 31st 2016. Non-probability purposive sampling technique was used. A sample size of 375 patients who had primary Emergency Caesarean Section (Em-CS) was identified by keeping CS rate of 41.5% and 5% bond on error. Data was collected from labor ward, operating theatre and neonatal ward records by using structured questionnaire.Results: In the current study, out of 375 participants who underwent primary Em-CS; majority (89.3%) were booked cases. Two-hundred-eighty-two (75.2%) were primiparous women. Two hundred and thirty (61.3%) were at term and 145(38.7%) were preterm. The main indication among Category-1 CS was fetal distress (15.7%). For Non-Category-1 CS, non-progress of labour (45.1%) was the leading cause of abdominal delivery. Except for APGAR score at one minute (p value = 0.048), no other variables were statistically significant when neonatal outcomes were compared among Category 1 and Non-Category-1 CS.Conclusion: In this study, fetal distress and non-progress of labor were the main indications for Category-1 and Non-Category-1 CS respectively. We did not find statistically significant association between indications of Em CS and neonatal outcomes. However further prospective studies are required to confirm this association

Multimedia Traffic Engineering in Next Generation Networks

Due to high speed Internet and Multimedia applications, future wireless communication are expected to support multimedia traffic such as voice, video and text with a variety of Quality of Service (QoS) requirements and make efficient use of radio resources. Such kind of traffic requires high level of QoS guarantees. Traffic management is a process of regulating the traffic over network. Since, multimedia traffic is more sensitive, therefore it requires special measures while transmission, especially in wireless networks. There are different queuing disciplines which are used to police the traffic, the Priority Queue and RIO (RED with In/Out) are queuing disciplines, PQ is used to prioritize the traffic, and the later is used to drop the lower priority packets at the time of congestion. Proposed solution is the integration of Priority Queue with RIO, which will serve as a classifier to prioritize the traffic and then it will also serve as a scheduler by dropping lower priority traffic when the congestion state occur. Simulation results show that by applying proposed Traffic Management Strategy (PriRIO), it assigns stable bandwidth to the Multimedia Traffic Flow and enhances its throughput. It also shows that Packet Losses for Multimedia Traffic are very minor, that is, equivalent to none. Further, delay values for Multimedia traffic also remain below the Best Effort traffic flows. Thus, on the basis of these simulation results and analysis, PriRIO outperforms significantly, as compare to other Traffic Management Strategies

Factors associated with failed induction of labour in a secondary care hospital

Objective: To assess the factors associated with failed induction of labour (IOL) in a secondary care hospital.Method: This is a retrospective cross sectional study on women admitted for labour induction in Aga Khan Hospital for women Karimabad from 1st Jan, 2009 to 31st Dec, 2009. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean Section.Result: Eighteen percent of our pregnant population who underwent induction of labour failed to deliver vaginally. About 25% of 328 nulliparous women had failed induction. With a Bishop score of \u3c5 in 84.3%. In 28.2% with prolonged latent phase of more than 20 hours in Caesarean section had to be performed.Conclusion: Nulliparity, poor Bishop score and prolonged latent phase had strongest association with failed Induction of Labour. Macrosomia, gestation age, bad obstetric history and pre labour rupture of membranes were other significant risk factors for emergency caesarean sections in IOL

Predictors of mortality in hospitalized patients with influenza: A five-year experience from a tertiary care centre in Pakistan

Influenza outbreaks are associated with significant morbidity. Our aim was to determine the factors associated with increased mortality in hospitalized patients admitted with diagnosis of influenza, at a tertiary care center in Pakistan. This study included all adult patients with an influenza infection, confirmed by realtime reverse-transcriptase polymerase-chain-reaction (RT-PCR) at Aga Khan University Hospital Pakistan. In our study, 112 patients with laboratory-confirmed influenza virus infection were admittedat our hospital from the 1st of January 2013 to the 31st of December 2018. Eighty-nine patients (79.46%) were managed in ward or special care units and 23 patients (20.5%) received treatment in intensive care unit (ICU). The overall mortality in our study was 15/112 (13.4%) with the mortality rate of ICU patients being 47.8% while the mortality rate of patients treated in special care units and wards was only 4.5%. The mean age of patients with influenza infection was 58.1 years (±16.6). Influenza virus type A was found in 87 patients (77.6%), while influenza type B was present in only 25 (22.4%) patients. Out of the 15 non-survivors, 14 had influenza A. Only 17 patients (15.2%) were found to have positive culture of respiratory specimen, out of which 3 were non-survivors and 14 were survivors. Our analysis identified septic shock (odds ratio 45.24; 95%, confidence interval 6.20-330; p\u3c0.001), renal failure (odds ratio 10.88; 95%, confidence interval 1.61-73.52; p=0.01) and ICU stay (odds ratio 17.22; 95%, confidence interval 2.68-110.5; p=0.003) as independent risk factors associated with in-hospital mortality

How External Shocks and Exchange Rate Depreciations Affect Pakistan? Implications for Choice of an Exchange Rate Regime

A structural vector autoregression (VAR) model shows that external shocks are important in driving economic fluctuations in Pakistan and their importance has increased since September 11, 2001. The primary source of external shocks is foreign remittances, while foreign output has a limited effect. Keeping fixed external factors, an exogenous real exchange rate depreciation shock lowers output—a positive effect on real net exports (largely resulting from import compression rather export expansion)—is more than offset by a decline in domestic demand. The absence of common shocks with major trading partners, the importance of remittances, conventional expansionary effects on the trade balance following a real currency depreciation, and only limited evidence that credibility of anti-inflationary policy would improve with a currency peg support greater exchange rate flexibility. However, the rather large contractionary effects of real exchange rate depreciation on domestic demand suggest that greater exchange rate flexibility could destabilize aggregate output

How External Shocks and Exchange Rate Depreciations Affect Pakistan? Implications for Choice of an Exchange Rate Regime

A structural vector autoregression (VAR) model shows that external shocks are important in driving economic fluctuations in Pakistan and their importance has increased since September 11, 2001. The primary source of external shocks is foreign remittances, while foreign output has a limited effect. Keeping fixed external factors, an exogenous real exchange rate depreciation shock lowers output—a positive effect on real net exports (largely resulting from import compression rather export expansion)—is more than offset by a decline in domestic demand. The absence of common shocks with major trading partners, the importance of remittances, conventional expansionary effects on the trade balance following a real currency depreciation, and only limited evidence that credibility of anti-inflationary policy would improve with a currency peg support greater exchange rate flexibility. However, the rather large contractionary effects of real exchange rate depreciation on domestic demand suggest that greater exchange rate flexibility could destabilize aggregate output