Consociationalism vs. Incentivism in Divided Societies: A Question of Threshold Design or of Sequencing?

Scholarship on constitutional design for post-conflict or divided societies focuses a great deal of attention on two issues: (1) the processes and timing by which constitutional rules should be established and (2) whether constitutions should reflect a consociationalist or incentivist approach to governance. Scholars are increasingly willing to entertain the possibility that constitutions drafted during period of transition from civil war or authoritarianism need not, and often should not, answer immediately all questions that constitutions tend to answer; however, they tend to assume that the question of whether constitutions should be consociationalist or incentivist is one that should not be deferred. And, as a practical matter, most constitutions make an initial choice between the two and seem to assume that the initial choice will be a permanent one. This article explores Afghanistan\u27s constitutional history since the fall of the Taliban. It argues that Afghanistan\u27s history sheds light on the strengths and weaknesses of consociationalism and incentivism and provides tantalizing evidence that, as in Afghanistan, people drafting democratic constitutions for a post-conflict or divided society should have prescribed a transition from one type of governance to the other During a period in which civil wars are raging in many continents and post-conflict constitutions will need to be drafted, the lessons of Afghanistan should prove enormously valuable

Plexiform neurofibromatosis of vulva

Plexiform Neurofibromatosis of vulva is a rare, benign tumor of genital tract arising from nerve sheath of peripheral nerve. It may present as solitary lesion or as part of Von Recklinghausen’s disease. Genitourinary neurofibroma is rare, however clitoris and labia majus happen to be the most frequent location of neurofibromatosis involving female genital tract. We present a case of plexiform neurofibroma arising from left labia majora in a young patient having features of Von Recklinghausen's disease. She complained of discomfort while walking due to rubbing of pedunculated mass arising from her labia majora. We carried out the surgical excision of the mass followed by primary repair of labia majora. She has been followed up on out-patient basis for about three months without any recurrence so far

Patient-Specific Pre-Treatment VMAT Plan Verification Using Gamma Passing Rates

Continuous gantry motion, continuous beam modulation, and variable dose rate are used in volumetric modulated arc therapy (VMAT) to obtain highly conformal radiation therapy dose distributions. Several errors during daily radiation therapy treatment can be sources of uncertainties in dose delivery. These errors include monitor unit calculation errors and other human mistakes. Due to the uncertainties in the excessively modulated VMAT plan, the intended dose distribution is not delivered perfectly, leading to a mismatch between the measured and planned dose distributions. This necessitates an extensive and effective quality assurance (QA) program for both machine and patient. In this study, VMAT QA plan verification of 62 head and neck (HN) and 19 prostate cases was done using Octavius 4D setup with its associating VeriSoft gamma analysis software. The plans showed a maximum 3D gamma passing rate with 4 mm/3 % gamma acceptance criteria, i.e., 99.7 % for the HN cancer cases and 99.5 % for the prostate cancer cases. Local gamma analysis was also performed for both regions. Furthermore, 2D and volumetric gamma analyses were also carried out. Gamma analysis with respect to different axis was also carried out. It was known that the transversal axis showed    the highest gamma passing rate in both HN and prostate cases, i.e., 99.17 % and 98.3 %, respectively. The transverse axis came to be a better fit for the planned dose distribution

Serum zinc status of neonates with seizure

Background: Seizure is a common neurological disorder in neonatal age group!. Primary metabolic derangement is one of the important reason behind this convulsion during this period. Among primary metabolic derangement hypoglycemia, is most common followed by bypocalcaemia, hypomagnesaemia, low zinc status etc. As causes of many cases of convul­sion remain unknown in neonate. Objectives: To see the zinc status in the sera of neonate with convulsion. So that if needed early intervention can be taken up and thereby prevent complications. Method: A total of 50 neonates (1-28 days) who had convulsion with no apparent reasons of convulsion were enrolled as cases and 50 healthy age and sex matched neonates were enrolled as controls. After a quick clinical evaluation serum zinc status was estimated from venous blood by atomic absorption method in Chemistry Division, Atomic Energy Centre. Low zinc was considered if serum value was <0.7mg/L. Results: Among a total of 50 cases 6% had low zinc value & 2% of controls also had low zinc level. The mean serwu zinc level of cases and controls were 1.57±0.95 and 2.37±1.06 mmol/1 respectively (p<0.01). Conclusion: From the study it is seen that low zinc value is an important cause of neonatal seizure due to primary metabolic abnormalities. So early recognition and treatment could save these babies from long term neurological sequelies

Synthetic aperture radar and optical remote sensing image fusion for flood monitoring in the Vietnam lower Mekong basin: a prototype application for the Vietnam Open Data Cube

Flood monitoring systems are crucial for flood management and consequence mitigation in flood prone regions. Different remote sensing techniques are increasingly used for this purpose. However, the different approaches suffer various limitations, including cloud and weather effects (optical data), and low spatial resolution and poor colour presentation (synthetic aperture radar data). This study fuses two data types (Landsat and Sentinel-1) to overcome these limitations and produce better quality images for a prototype flood application in the Vietnam Open Data Cube (VODC). Visual and quantitative evaluation of fused image quality revealed improvement in the images compared with the original scenes. Ground-truth data was used to develop the study flood extraction algorithm and we found a good agreement between our results and SERVIR Mekong (a joint initiative by the US agency for International Development (USAID), National Aeronautics and Space Administration (NASA), Myanmar, Thailand, Cambodia, Laos and Vietnam) maps. While the algorithm is run on a personal computer (PC), it has a clear potential to be developed for application on a big data system

Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence

Background: Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients

Surgical-pathological findings in type 1 and 2 endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study on GOG-210 protocol

To report clinical and pathologic relationships with disease spread in endometrial cancer patients

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.</p> <p>Methods</p> <p>This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. <it>Pearson's </it>chi-square test, <it>t</it>-test and Mann-Whitney test were performed.</p> <p>Results</p> <p>The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.</p> <p>Conclusions</p> <p>Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.</p

Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective

Background: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of Patients with infantile spasms from Pakistan. Methods: All Patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned above. The type of drug distribution was random according to the availability, cost and ease of administration. Results: Fifty six cases fulfilled the inclusion criteria. 62.5% were males. Mean age at onset of seizures was 5 +/- 1.4 months. Fifty two (92.8%) Patients demonstrated hypsarrythmia on electroencephalography. 64.3% cases were identified as symptomatic while 19.6% were cryptogenic and 16.1% were idiopathic. Eighteen Patients received ACTH while 38 Patients received Vigabatrin as first line therapy. Initial response to first line therapy was similar (50% for ACTH and 55.3% for Vigabatrin). Overall, the symptomatic and idiopathic groups responded better to Vigabatrin. The relapse rate was higher for ACTH as compared to Vigabatrin (55.5% vs. 33.3%) when considering the first line therapy. Four Patients evolved to Lennox-Gastaut variant, all of these Patients had initially received Vigabatrin and then ACTH. Conclusion: Vigabatrin and ACTH showed no significant difference in the initial treatment of infantile spasms. However, Patients receiving ACTH were 1.2 times more likely to relapse as compared to the Patients receiving Vigabatrin when considering monotherapy. We suggest that Vigabatrin should be the initial drug of choice in Patients presenting with infantile spasms. However, larger studies from developing countries are required to validate the therapeutic trends observed in this study

Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale.

INTRODUCTION: Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. METHODS AND ANALYSIS: The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02746003; Pre-results