Stephen P. Cohen

The Indian army : its contribution to the development of a nation

This book explores the origins of the Indian army from its early exploitative role, to its performance in World War II when it confronted extreme political and military challenges. Cohen examines the doctrine of civilian control in India and the evolution of the theory of so-called martial races. The book serves as an interpretation of the history of the Indian Army in the light of contemporary approaches to nation-building and development theory.

What low back pain is and why we need to pay attention

Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.

The Nation and the State of Pakistan

The Pakistani state has been failing for many years, but even the very idea of Pakistan is contested. The tension between these two concepts is what makes Pakistan an especially important case. Which Pakistan is likely to emerge? What should the United States do?

Prevention and treatment of low back pain: evidence, challenges, and promising directions

Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.

Renal Carbuncle: The Use of Ultrasound in its Diagnosis and Treatment

The use of ultrasound in the diagnostic and therapeutic management of 5 patients with renal abscesses is described. A spectrum of ultrasonic findings was noted, with the majority of the lesions being anechoic (3 cases). However, a few lesions showed a mixed pattern (2 cases). Ultrasonic aspiration of abscess fluid for culture and sensitivity obviated an operation in 1 case. For the first time, ultrasonically guided, percutaneous, indwelling catheter drainage of a renal carbuncle is reported. Since the patient had failed to respond to systemic antibiotic therapy this technique saved the patient from undergoing an operation. The clinical and ultrasonic findings in the 6 previous case reports of abscesses are reviewed.

Low back pain: a call for action

Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain.

The Jihadist threat to Pakistan

The dangers of Islamic radicalism in the short run have been exaggerated. However, unless steps are taken now to rebuild a moderate Pakistan, it could truly become one of the worlds most dangerous states within a decade.

Is India Ending its Strategic Restraint Doctrine

One of the most remarkable attributes of India as an independent state has been its reticence to use force as an instrument of policy. From the delay in sending troops to defend Kashmir in 1947 to the 24-year hiatus in testing nuclear weapons before 1998, Indian decisions on military force have come as an unwelcome last resort, and with rare exception, have been counterproductive, solidifying the wisdom of restraint. India’s rapid economic growth, ambitious military modernization particularly the 1998 nuclear tests and rapprochement with the United States have raised the prospect of India’s rise to great-power status, including an end to the country’s enduring strategic restraint. With more options available, will India finally abandon its long-standing international political— military posture? The consequences of an end to restraint could be revolutionary, but the doctrine’s strong roots and its survival despite failures, including against China and Pakistan suggest that it will endure.

Perception, politics, and security in South Asia : the compound crisis of 1990

Introduction 1. The Strategic Context 2. A Region in Turmoil on the Eve of Crisis 3. Kashmir: From Simla to Chaos 4. From Domestic Insurgency to International Concern 5. Americas Deepening Engagement 6. 1990 as a Nuclear Crisis 7. Lessons for the Real War?

Spontaneous expulsion of intravesical bullet.

The first reported case of spontaneous expulsion per urethra of an intravesical bullet which initially entered through the left flank is presented. Recognition of the truc location of the millile might have been facilitated had lateral and/or oblique films have been obtained under emergency conditions as advocated by the authors.