Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy.

Objective To understand how national and provincial tuberculosis programme managers in Pakistan perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. National and provincial tuberculosis programme managers play an important role in effective implementation of the Stop TB strategy. Design A qualitative interview study was conducted with 10 national and provincial tuberculosis programme managers to understand how they perceive and engage with the Stop TB strategy, its strengths, weaknesses and their experience in its implementation. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). Participants National and provincial tuberculosis programme managers in Pakistan. Managers were selected purposively; 10 managers were interviewed (six national staff and four from provincial level). Setting National and provincial tuberculosis programmes in Pakistan Main outcome measures 1. Knowledge and perceptions of national and provincial tuberculosis programme managers about the Stop TB strategy 2. Progress in implementing the strategy in Pakistan 3. Significant success factors 4. Significant implementation challenges 5. Lessons learnt to scale up successful implementation. Results The managers reported that most progress had been made in extending DOTS, health systems strengthening, public -private mixed interventions, MDR-TB care and TB/HIV care. The four factors that contributed significantly to progress were the availability of DOTS services, the public-private partnership approach, comprehensive guidance for TB control and government and donor commitment to TB control. Conclusion This study identified three main challenges as perceived by national and provincial tuberculosis programme managers in terms of implementing the Stop TB strategy: 1. Inadequate political commitment, 2. Issue pertaining to prioritisation of certain components in the TB strategy over others due to external influences and 3. Limitations in the overall health system. To improve the tuberculosis control programme in the country political commitment needs to be enhanced and public -private partnerships increased. This can be done through government prioritisation of TB control at both national and provincial levels; donor-funded components should not receive undue attention; and partnerships with the private health sector, health institutions not yet covered by DOTS services, non-governmental organisations and patient coalitions should be increased

Sequentializing Parameterized Programs

We exhibit assertion-preserving (reachability preserving) transformations from parameterized concurrent shared-memory programs, under a k-round scheduling of processes, to sequential programs. The salient feature of the sequential program is that it tracks the local variables of only one thread at any point, and uses only O(k) copies of shared variables (it does not use extra counters, not even one counter to keep track of the number of threads). Sequentialization is achieved using the concept of a linear interface that captures the effect an unbounded block of processes have on the shared state in a k-round schedule. Our transformation utilizes linear interfaces to sequentialize the program, and to ensure the sequential program explores only reachable states and preserves local invariants.Comment: In Proceedings FIT 2012, arXiv:1207.348

Faster Algorithms for Weighted Recursive State Machines

Pushdown systems (PDSs) and recursive state machines (RSMs), which are linearly equivalent, are standard models for interprocedural analysis. Yet RSMs are more convenient as they (a) explicitly model function calls and returns, and (b) specify many natural parameters for algorithmic analysis, e.g., the number of entries and exits. We consider a general framework where RSM transitions are labeled from a semiring and path properties are algebraic with semiring operations, which can model, e.g., interprocedural reachability and dataflow analysis problems. Our main contributions are new algorithms for several fundamental problems. As compared to a direct translation of RSMs to PDSs and the best-known existing bounds of PDSs, our analysis algorithm improves the complexity for finite-height semirings (that subsumes reachability and standard dataflow properties). We further consider the problem of extracting distance values from the representation structures computed by our algorithm, and give efficient algorithms that distinguish the complexity of a one-time preprocessing from the complexity of each individual query. Another advantage of our algorithm is that our improvements carry over to the concurrent setting, where we improve the best-known complexity for the context-bounded analysis of concurrent RSMs. Finally, we provide a prototype implementation that gives a significant speed-up on several benchmarks from the SLAM/SDV project

The performance gap in energy-efficient office buildings: how the occupants can help?

Rising demand and limited production of electricity are instrumental in spreading the awareness of cautious energy use, leading to the global demand for energy-efficient buildings. This compels the construction industry to smartly design and effectively construct these buildings to ensure energy performance as per design expectations. However, the research tells a different tale: energy-efficient buildings have performance issues. Among several reasons behind the energy performance gap, occupant behavior is critical. The occupant behavior is dynamic and changes over time under formal and informal influences, but the traditional energy simulation programs assume it as static throughout the occupancy. Effective behavioral interventions can lead to optimized energy use. To find out the energy-saving potential based on simulated modified behavior, this study gathers primary building and occupant data from three energy-efficient office buildings in major cities of Pakistan and categorizes the occupants into high, medium, and low energy consumers. Additionally, agent-based modeling simulates the change in occupant behavior under the direct and indirect interventions over a three-year period. Finally, energy savings are quantified to highlight a 25.4% potential over the simulation period. This is a unique attempt at quantifying the potential impact on energy usage due to behavior modification which will help facility managers to plan and execute necessary interventions and software experts to develop effective tools to model the dynamic usage behavior. This will also help policymakers in devising subtle but effective behavior training strategies to reduce energy usage. Such behavioral retrofitting comes at a much lower cost than the physical or technological retrofit options to achieve the same purpose and this study establishes the foundation for it

Galvanic Vestibular Stimulation Induces a Spatial Bias in Whole-body Position Estimates

This is an accepted manuscript of an article published by Elsevier in Brain Stimulation on 23/07/2015, available online: https://doi.org/10.1016/j.brs.2015.07.030 The accepted version of the publication may differ from the final published version.Peripheral galvanic vestibular stimulation (GVS) has been shown to temporarily ameliorate left spatial neglect [ 1 ]. Specifically, anodal (facilitatory) stimulation over the left mastoid bone coupled with cathodal (inhibitory) over the right mastoid reduces visuospatial-neglect scores in line cancellation [ 2 ] and line bisection tasks [ 3 , 4 ]. This montage increases activity in the left vestibular nerve and suppresses activity in the right [ 5 ], which has been shown to focally activate vestibular networks that occupy visuospatial attention mechanisms, primarily in the non-dominant hemisphere [ 5 ]. Thus, it appears that electrical stimulation of the peripheral vestibular system can shift visuospatial attention to the left side of space [ 4 ]. However, whether such a shift of spatial attention in normal subjects can influence perception of spatial position during whole-body spatial translations is unknown. We hypothesized that shifting attention to the left would result in participants underestimating spatial position estimates during rightward whole-body translations and overestimating spatial position estimates during leftward whole-body translations

'I once wore an angry bird t-shirt and went to read Qur’an': asymmetrical institutional complexity and emerging consumption practices in Pakistan

This article brings together theories of institutional logics and the exploration of the lives of tweens in Pakistan to understand how emerging consumption practices fit within Pakistani children’s daily lives, and how institutional complexity that includes the dominance of religion under Pakistani Islamization is negotiated to separate and maintain the differences between them. We identify resolutions to asymmetrical institutional complexity in the consumption of character T-shirts: spatial–temporal practices, visual practices, symbolic substitution practices and single logic practices. We contribute to an understanding of how consumption happens in an Eastern Muslim culture, and how multiple institutional logics shape the consumption practices of children, by articulating how halal consumption practices, far from being essentialist, or presented as market segmentation, form from negotiations and reflections at the boundaries where Islam and Market logics meet

Lazy-CSeq-SP: Boosting Sequentialization-Based Verification of Multi-threaded C Programs via Symbolic Pruning of Redundant Schedules

Abstract. Sequentialization has been shown to be an effective symbolic verification technique for concurrent C programs using POSIX threads. Lazy-CSeq, a tool that applies a lazy sequentialization scheme, has won the Concurrency division of the last two editions of the Competition on Software Verification. The tool encodes all thread schedules up to a given bound into a single non-deterministic sequential C program and then invokes a C model checker. This paper presents a novel optimized imple-mentation of lazy sequentialization, which integrates symbolic pruning of redundant schedules into the encoding. Experimental evaluation shows that our tool outperforms Lazy-CSeq significantly on many benchmarks

High use of private providers for first healthcare seeking by drug-resistant tuberculosis patients: a cross-sectional study in Yangon, Myanmar.

BACKGROUND: Drug resistance is a growing challenge to tuberculosis (TB) control worldwide, but particularly salient to countries such as Myanmar, where the health system is fragmented across the public and private sector. A recent systematic review has identified a critical lack of evidence for local policymaking, particularly in relation to drivers of drug-resistance that could be the target of preventative efforts. To address this gap from a health systems perspective, our study investigates the healthcare-seeking behavior and preferences of recently diagnosed patients with drug-resistant tuberculosis (DR-TB), focusing on the use of private versus public healthcare providers. METHODS: The study was conducted in ten townships across Yangon with high DR-TB burden. Patients newly-diagnosed with DR-TB by GeneXpert were enrolled, and data on healthcare-seeking behavior and socio-economic characteristics were collected from patient records and interviews. A descriptive analysis of healthcare-seeking behavior was followed by the investigation of relationships between socio-economic factors and type of provider visited upon first feeling unwell, through univariate logistic regressions. RESULTS: Of 202 participants, only 8% reported first seeking care at public facilities, while 88% reported seeking care at private facilities upon first feeling unwell. Participants aged 25-34 (Odds Ratio = 0.33 [0.12-0.95]) and males (Odds Ratio = 0.39 [0.20-0.75]) were less likely to visit a private clinic or hospital than those aged 18-24 and females, respectively. In contrast, participants with higher income were more likely to utilize private providers. Prior to DR-TB diagnosis, 86% of participants took medications from private providers. After DR-TB diagnosis, only 7% of participants continued to take medications from private providers. CONCLUSION: In urban Myanmar, most patients shifted to being managed exclusively in the public sector after being formally diagnosed with DR-TB. However, since the vast majority of DR-TB patients first visited private providers in the period leading to diagnosis, related issues such as unregulated quality of care, potential delays to diagnosis, and lack of care continuity may greatly influence the emergence of drug-resistance. A greater understanding of the health system and these healthcare-seeking behaviors may simultaneously strengthen TB control programmes and reduce government and out-of-pocket expenditures on the management of DR-TB