Writing is an important skill for language production. However, it is considered a difficult skill, particularly in English as a second language (ESL) contexts where students face many challenges in writing. Therefore, the present study was conducted with an aim to investigate problems in Pakistani undergraduate ESL learners' writing and factors that hinder their writing skills. It also aimed at obtaining suggestions on how to improve Pakistani ESL learners' writing skills. For this purpose, focus groups of Pakistani English language teachers'and undergraduate ESL learners were conducted. Writing samples were also collected from 30 ESL undergraduate learners to find the major problems in their writing. The interviews and essays were analyzed using thematic content analysis. The findings reveal that the major problems in Pakistani undergraduate ESL learners' writing are insufficient linguistic proficiency (including command over grammar, syntax and vocabulary), writing anxiety, lack of ideas, reliance on L1 and weak structure organization. These challenges are influenced by various factors including untrained teachers, ineffective teaching methods and examination system, lack of reading and writing practice, large classrooms, low motivation and lack of ideas. The study also sheds light on the remedial measures such as increased reading, conscious and incidental vocabulary teaching, writing practice, trained teachers, reforms in the examination system, and writing competitions.

IntroductionThe jugular foramen is a canal between the occipital bone and the inferior and medial portion of the petrous pyramid of the temporal bone. It is an important route for arterial, venous, and nervous structures through the base of the skull. The dura mater at the inner aperture of the foramen forms a distinct compartment for housing the various venous structures and cranial nerves (CNs). These dural relationships are of potential interest in surgical treatment of various intrinsic and extrinsic lesions including paragangliomas, nerve sheath tumors, meningiomas, chordomas, chondrosarcomas, and other rare pathologic processes at the level of this foramen.Preserving lower CN function when operating on jugular foramen schwannomas is very difficult. At the entrance into the pars nervosa of the jugular foramen, the lower CNs penetrate a thin periosteal layer where they are wrapped with perineurium, making their identification difficult even Keywords ► skull base ► posterior fossa ► cranial anatomy ► meninges ► jugular foramen ► anatomy AbstractIntroduction Preserving cranial nerve (CN) function during tumor removal at the jugular foramen is challenging. No anatomical study has better defined the relevant dural septations on the inner surface of the jugular foramen. This study was undertaken to elucidate this anatomy. Methods Fourteen cadaveric heads (28 sides) were dissected, and relationships of the meningeal coverings of the jugular foramen and adjacent CNs documented. A classification scheme was created to better describe the dural septations of the inner surface of the jugular foramen. Results Four types of dural septations were noted. Type I: 10 sides (36%) where a dural septation was seen between CNs IX anteriorly and X and XI posteriorly. Of these, the septum was ossified in 20%. Type II (32%) was defined as a jugular foramen with no dural septation. Type III (7%) was defined as septation between CNs IX and X anteriorly and XI posteriorly. Type IV (7 sides, 25%) or the chaotic form was defined as multiple septations within the jugular foramen that housed and divided CN rootlets. Conclusions The dural septations defined here can be used in future studies to help correlate operative strategy to meningeal morphology within the jugular foramen.

Education in Pakistan is no longer a matter of indifference to the rest of the world. Typically, concern is focused on the role played by the madrasah (Islamic religious school; plural madaaris) as the dominant provider of education. The rise in the number of English-medium education institutions countrywide does not enter such accounts. This ethnographic study relates this topic to the pedagogic aspirations of Pakistanis asking, What is the role of English-medium schools in Pakistan and is it even the case that the majority of Pakistanis are markedly in favor of a predominantly religious education for their children? The study suggests that formal English-medium education is most parents’ real-world priority, fluency in English being a prerequisite for higher paying jobs in Pakistan.

The dual citizenship has been the subject of intense political debate in Pakistan barring the elected representatives, in parliament, the provincial assemblies and the presidency, from holding dual nationality. The perceptions that holding a foreign citizenship challenges the undiluted loyalty to country further engender question mark over their political participation in country’s affairs. A qualitative study has been carried out in the city of Rawalpindi to explore the stance of Pakistani nationals on such exclusion of Pakistani dual citizens from mainstream politics of Pakistan asking should the individual’s association to the state be an exclusive one? In this paper, in‐depth interviews were conducted with a sample of 40 male and female respondents (22 Pakistani citizens, 18 Pakistani dual citizens) and 6 constitutional experts. The results indicate distrust among Pakistani citizens when considering dual citizens’ right of representation in general elections of Pakistan, stemming from a mistrust of their “split loyalties”.

Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.