Gray Zone Constitutionalism and the Dilemma of Judicial Independence in Pakistan

Many countries exist in a gray zone between authoritarianism and democracy. For countries in this conceptual space--which is particularly relevant today given the halting path of change in the Arab world--scholars, judges, and rule of law activists conventionally urge an abstract notion of\u27 judicial independence as a prerequisite for successful democratic transition. Only recently, for example, Pakistan\u27s judiciary was widely lauded for its independence in challenging the military regime. However, judicial independence is neither an all-or-nothing concept nor an end in itself. With the return of civilian rule in Pakistan, a series of clashes between Parliament and the Supreme Court has raised concern that the same judiciary celebrated for challenging the military regime--while invoking exactly the same abstract notion of judicial independence--might now be asserting autonomy from weak civilian institutions in a manner that undermines Pakistan\u27s fragile efforts to consolidate democracy and constitutionalism. In this Article, I challenge the conventional view by examining these recent developments in Pakistan, which are instructive for other countries in this gray zone. Over many decades, as Pakistan has cycled between military and weak civilian rule, the military and its affiliated interests have entrenched their power, and the judiciary has played a central role in facilitating that process. The result has been an enduring institutional imbalance that has undermined Pakistan\u27s weak representative institutions. This process of entrenchment has never gone entirely unchallenged, and Pakistan\u27s current shift to civilian rule offers genuine potential for the long-term consolidation of democracy and constitutionalism. But this persistent institutional imbalance and continued military dominance remains a significant obstacle to fully realizing that potential. Accordingly, I urge an understanding of judicial independence that goes beyond abstract, unqualified notions of judicial autonomy and instead contemplates an appropriate balance between autonomy and constraint--one that not only enables representative institutions to strengthen their governance capacities and power to rein in the military, but also enhances mechanisms of judicial accountability to reinforce the democratic legitimacy of the judiciary\u27s role. Pakistan\u27s experience also has broader significance, suggesting lessons--or at least notes of caution--about the relationship between entrenched status quo interests and an independent judiciary in other countries, such as Egypt, that risk languishing in the gray zone between authoritarianism and democracy but seek a more complete shift to democracy

TOpic: rare and special cases, the real "Strange cases"

Introduction: The bladder hernia represents approximately 1-3% of all inguinal hernias, where patients aged more than 50 years have a higher incidence (10%). Many factors contribute to the development of a bladder hernia, including the presence of a urinary outlet obstruction causing chronic bladder distention, the loss of bladder tone, pericystitis, the perivesical bladder fat protrusion and the obesity

Cost-effectiveness of Implementing Low-Tidal Volume Ventilation in Patients With Acute Lung Injury

Background: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. Methods: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. Results: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were$22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90$9,482. Results were robust to a wide range of economic and patient parameter assumptions. Conclusions: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.NIH F32HL090220.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84154/1/Cooke - CEA LPV.pd

Primary Ovarian Pregnancy - A Rare Case Report

We report the rare case of a 27-year-old female who presented to the emergency department with severe pain in the lower abdomen. She gave a history of a spontaneus pregnancy of 5 weeks gestation with a history of irregular spotting on and off. The total leukocyte count was 25,000/cmm and β-human chorionic gonadotropin level was 984.7 IU/mL. Ultrasound showed an adnexal mass with hemoperitoneum. An ovarian wedge resection was done. She made good postoperative recovery and was discharged on the third postoperative day. Histology confirmed a ruptured ovarian ectopic pregnancy. Ovarian ectopic pregnancy is a rare condition and is associated with the use of assisted reproductive techniques. This case is unusual as it was a spontaneous pregnancy with no history of use of any assisted reproductive techniques

A First Look at Chebyshev-Sobolev Series for Digital Ink

Considering digital ink as plane curves provides a valuable framework for various applications, including signature verification, note-taking, and mathematical handwriting recognition. These plane curves can be obtained as parameterized pairs of approximating truncated series (x(s), y(s)) determined by sampled points. Earlier work has found that representing these truncated series (polynomials) in a Legendre or Legendre-Sobolev basis has a number of desirable properties. These include compact data representation, meaningful clustering of like symbols in the vector space of polynomial coefficients, linear separability of classes in this space, and highly efficient calculation of variation between curves. In this work, we take a first step at examining the use of Chebyshev-Sobolev series for symbol recognition. The early indication is that this representation may be superior to Legendre-Sobolev representation for some purposes.Comment: Accepted at MathUI 202