Fiscal Response to Terrorism in Pakistan: The Role of Institutions

This study empirically estimates the fiscal consequences of terrorism in Pakistan by using annual time series data from 1984 to 2016. By employing the autoregressive distributed lag (ARDL) technique, the study has gauged the impact of terrorist incidents on two important facets of fiscal policy, namely, tax revenue and defense spending. The results reveal that terrorism has detrimental ramifications for fiscal policy in Pakistan. Specifically, on the one hand, an increase in terrorist incidents tends to bring a fall in tax revenue while on the other hand, they induce a rise in defense outlays, thus deteriorating both fronts of the fiscal position. Notably, the moderating role of institutional quality appears significant and indicates that institutional quality has not only a significant direct impact on fiscal policy, but it also helps in completely mitigating (reducing) the harmful impact of terrorism on defense spending (tax revenue) in Pakistan. These findings suggest that there is a need to take appropriate steps for strengthening institutional setup to control the fallouts of terrorism on fiscal behavior of the government of Pakistan. Keywords: Terrorism; Tax Revenue; Institutional Quality; ARDL JEL Classification: E62; H2; E02; H5; F3

Comparative effects of Alpha Tocopherol and Ascorbic Acid on Chronic Stress Induced Neuropeptide Y Derangements

Background: Chronic stress decreases resilience of the body mainly due to hormonal imbalance. Neuropeptide Y-ergic system is abnormally regulated in chronic stress due to reduction-oxidation imbalance. The antioxidants such as alpha-tocopherol and ascorbic acid reduce this imbalance with positive effect on neuropeptide Y synthesis and release. This study was aimed to compare the protective effects of alpha-tocopherol and ascorbic acid on plasma neuropeptide Y levels in chronic stress.Material and Methods: This quasi-experimental study was done at Al-Nafees Medical College in collaboration with National Institute of Health Islamabad from January 2015 to January 2016 after taking institutional approval. Sixty male Sprague Dawley rats were obtained and divided equally into four groups; group I (control), group II (restraint stress group - chronic restraint stress six hours daily for 28 days), group III (restraint stress + alpha-tocopherol 50mg/kg body weight /day), and group IV (restraint stress + ascorbic acid 100mg /kg body weight /day). Cardiac puncture was done to obtain blood for biochemical analysis.Results: A significant decrease in plasma neuropeptide Y levels was seen in group II compared to group I, group III and group IV. However, alpha-tocopherol administration in group III showed positive effects on maintenance of plasma neuropeptide Y concentration with better p trend than that of ascorbic acid supplementation in group IV.Conclusions: Alpha-tocopherol supplementation has more potent effect than that of ascorbic acid on chronic restraint stress induced derangements in neuropeptide Y levels. It leads to less imbalance in neuropeptide Y levels during chronic stress.Key words: Ascorbic Acid, Alpha-Tocopherol, Chronic Stress, Neuropeptide

The Traditional Vocabulary Changes and Realization of Identity Levels in Contemporary Architectural Products

Every age has privacy in dealing with the architecture as a product investigator of identity within a certain level, Identity is a system of thought involved in its mechanisms utilization of the [Heritage] as an active force about the architects creations, that reflect on the architects deal with heritage to create a creation product have local embodied through engagement with the traditional vocabulary according to subject these traditional items to the mechanics of change [diversification mechanism, cultural borrowing mechanism, invention mechanism, the experimentation mechanism]. It was found that all of these mechanisms coincide with a certain level of identity within the four stages of identity transformation levels, namely, [the level of sensory individual identity, sensory collective level identity, the level of moral individual identity and finally "the level of moral collective identity] from here ... the problem research had arisen of [the absence of an objective perception of the identity level that investigate the creation product and what the relationship with the change mechanism adopted on the traditional vocabulary]. The objective of this research is [reach to the objective perception of the identity level that investigate the creation product and determine its relationship with the change mechanism that subject vocabulary heritage]. The hypothesis of research represented by [the various relationship between the changeable traditional vocabulary and the verification of identity levels involved with levels of identity that achieve creative products]. The research gets to various conclusions witch has been summarized in to two items: first deals with traditional vocabulary and its mechanical changes. And the second one involved with identity and its verification

Role of Phenylalanine and Its Metabolites in Health and Neurological Disorders

Phenylalanine, an amino acid, is a “building block” of protein. Phenylalanine is a component of food sources and also derived through supplementation. In current treatment, phenylalanine is prescribed as anti-depressant agent. The present study reviewed the possible antidepressant potential of phenylalanine. We reviewed data using the major databases, namely, Web of Science, SciFinder, Google Scholar, and PubMed. This manuscript provides a brief overview of the role of phenylalanine in depressive disorders. Phenylalanine possesses anti-depressant potential. Significant anti-depressant activities have been studied both in-vitro and in-vivo models. Based on current data, phenylalanine could be recommended as a potential candidate for clinical anti-depressant trials. Phenylalanine hydroxylase (PAH) deficiency results in intolerance to the dietetic consumption of the phenylalanine and a variety of syndromes such as deep and permanent logical disability, impaired cognitive development

Blockchain Adaptability in Internet of Thing (IoT) Environments

Blockchain is a considered to be a disruptive technology as like an Internet. The features of blockchain are giving more expectations in their applications. Internet of Things is emerging day by day with millions of connecting devices. Even though Internet of Things is evolving, the security of the internet of things is questionable with its architecture

KERENTANAN TINGGALAN BUDAYA BAWAH AIR SITUS KARANG BUI DI PERAIRAN PANTAI UTARA JAWA BARAT

Abstract. The Vulnerability of Underwater Cultural Heritages in Karang Bui Site, Northern Coast of West Java. Underwater remains which found in Karang Bui site, Karawang-Subang waters are originated from the colonial period of Vereenigde Oostindische Compagnie (VOC) and occupation period of the Kingdom of the Netherlands in Indonesia. Research on the vulnerability of the Karang Bui site has been conducted by the Ministry of Marine Affairs and Fisheries in 2017-2018. Research methods including observation of sea area; diving activities for site documentation, seabed profiles mapping, and the use of Side Scan Sonar. Besides looting activities that occurred in the past, the threats toward Karang Bui site preservation nowadays are from human and natural factors. Karang Bui site is located in shallow water with a depth of 5-12 m, so during the maximum elevation, the waves height and current velocity which forms at that location is increasing. Sedimentation level in Karang Bui site is also high caused by many rivers estuary around the site. The site is located within the area of P.T. Pertamina petroleum refineries which is likely the spill oil will threaten the archaeological remains. Furthermore, Karang Bui site is located near Patimban, Subang port development area which also the shipping line. Planning and protection measurement needs to be carried out immediately by related institutions and local governments. Thus, due those various vulnerability factors, the lifting of Karang Bui underwater artifacts is important to be done.   Abstrak. Tinggalan bawah air yang ditemukan di Karang Bui, perairan Karawang-Subang, berasal dari masa Vereenigde Oostindische Compagnie (VOC) dan masa penjajahan Kerajaan Belanda di Indonesia. Penelitian terhadap kerentanan Situs Karang Bui telah dilakukan oleh Kementerian Kelautan dan Perikanan (KKP) pada tahun 2017-2018. Metode penelitian meliputi observasi kawasan laut, penyelaman bawah air untuk dokumentasi situs, pemetaan profil dasar laut, penggunaan side scan sonar. Selain aktivitas penjarahan pada masa lalu, ancaman terhadap kelestarian Situs Karang Bui saat ini berasal dari alam dan ulah manusia. Situs Karang Bui berada di perairan dangkal dengan kedalaman 5-12 m sehingga saat elevasi maksimal, tinggi gelombang dan kecepatan arus yang terbentuk di lokasi tersebut semakin meningkat. Tingkat sedimentasi di Situs Karang Bui juga tinggi karena banyak muara sungai di sekitar situs. Lokasi situs berada di area kilang-kilang pengeboran minyak bumi milik P.T. Pertamina, yang kemungkinan  tumpahan minyak akan mengancam tinggalan arkeologis. Selain itu, lokasi situs berada di dekat area pembangunan Pelabuhan Patimban, Subang, juga merupakan alur pelayaran. Perencanaan dan tindakan pelindungan Situs Karang Bui perlu segera dilakukan oleh institusi terkait dan pemerintah daerah. Oleh karena berbagai faktor kerentanan tersebut, pengangkatan artefak bawah air Karang Bui sangat penting untuk dilakukan

Salmonellatyphi and endocarditis: a systematic review of case reports

IntroductionSalmonella typhi, a gram-negative bacterium responsible for typhoid fever, can infect the inner lining or valves of the heart and cause endocarditis. This systematic review aimed to report cases of S. typhi-associated endocarditis and its clinical features.MethodsThis systematic review was reported as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. Only case reports and case series of endocarditis caused by S. typhi, irrespective of age, gender, and demographics, were considered eligible for inclusion. To identify relevant studies, a literature search was conducted using relevant keywords on PubMed, Google Scholar, and the Cochrane Library from inception to 31 December 2023. After selecting the studies, the relevant data were extracted and pooled in terms of frequencies and percentages. A quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.ResultsThis review included seven case reports, comprising 22.2% female and 77.8% male patients. The mean age of patients was 27.9 + 12.0 years. Regarding past medical history, 33.3% (3/9) of patients had a previous cardiac pathology. Fever remained the most common complaint, occurring in 88.9% of cases. Transthoracic and transesophageal echocardiography were used to diagnose all cases, with 33.3% identifying vegetation on the mitral, aortic, and tricuspid valves. Ceftriaxone, with or without gentamycin, remained the choice of antibiotic for 88.9% of cases, and all patients responded to the offered treatment.ConclusionS. typhi-associated endocarditis, though rare, presents unique challenges and requires timely diagnosis. This systematic review of seven cases highlights a predominantly male population affected, with a mean age in the third decade, suggesting a higher invasiveness than other causes. The findings from this study underscore the importance of early recognition and appropriate management, primarily with antibiotic therapy. Further research with larger cohorts is crucial to refine understanding and guide policymaking for this rare but life-threatening condition

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens