Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions

BACKGROUND: Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. METHODS: A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. RESULTS: HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. CONCLUSION: Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Initiation of V(D)J Recombination by Dβ-Associated Recombination Signal Sequences: A Critical Control Point in TCRβ Gene Assembly

T cell receptor (TCR) β gene assembly by V(D)J recombination proceeds via successive Dβ-to-Jβ and Vβ-to-DJβ rearrangements. This two-step process is enforced by a constraint, termed beyond (B)12/23, which prohibits direct Vβ-to-Jβ rearrangements. However the B12/23 restriction does not explain the order of TCRβ assembly for which the regulation remains an unresolved issue. The initiation of V(D)J recombination consists of the introduction of single-strand DNA nicks at recombination signal sequences (RSSs) containing a 12 base-pairs spacer. An RSS containing a 23 base-pairs spacer is then captured to form a 12/23 RSSs synapse leading to coupled DNA cleavage. Herein, we probed RSS nicks at the TCRβ locus and found that nicks were only detectable at Dβ-associated RSSs. This pattern implies that Dβ 12RSS and, unexpectedly, Dβ 23RSS initiate V(D)J recombination and capture their respective Vβ or Jβ RSS partner. Using both in vitro and in vivo assays, we further demonstrate that the Dβ1 23RSS impedes cleavage at the adjacent Dβ1 12RSS and consequently Vβ-to-Dβ1 rearrangement first requires the Dβ1 23RSS excision. Altogether, our results provide the molecular explanation to the B12/23 constraint and also uncover a ‘Dβ1 23RSS-mediated’ restriction operating beyond chromatin accessibility, which directs Dβ1 ordered rearrangements

Evolution of the Reactor Antineutrino Flux and Spectrum at Daya Bay

published_or_final_versio

A novel sequence space related to L p Lp\mathcal{L}_{p} defined by Orlicz function with application in pattern recognition

Abstract In the field of pattern recognition, clustering groups the data into different clusters on the basis of similarity among them. Many a time, the similarity level between data points is derived through a distance measure; so, a number of clustering techniques reliant on such a measure are developed. Clustering algorithms are modified by employing an appropriate distance measure due to the high versatility of a data set. The distance measure becomes appropriate in clustering algorithm if weights assigned at the components of the distance measure are in concurrence to the problem. In this paper, we propose a new sequence space M ( ϕ , p , F ) $\mathcal{{M}} ( \phi,p,\mathcal{{F}} )$ related to L p $\mathcal{L}_{p}$ using an Orlicz function. Many interesting properties of the sequence space M ( ϕ , p , F ) $\mathcal{{M}} ( \phi,p,\mathcal{{F}} )$ are established by the help of a distance measure, which is also used to modify the k-means clustering algorithm. To show the efficacy of the modified k-means clustering algorithm over the standard k-means clustering algorithm, we have implemented them for two real-world data set, viz. a two-moon data set and a path-based data set (borrowed from the UCI repository). The clustering accuracy obtained by our proposed clustering algoritm outperformes the standard k-means clustering algorithm

Sequence spaces M ( ϕ ) M(ϕ)M(\phi) and N ( ϕ ) N(ϕ)N(\phi) with application in clustering

Abstract Distance measures play a central role in evolving the clustering technique. Due to the rich mathematical background and natural implementation of l p $l_{p}$ distance measures, researchers were motivated to use them in almost every clustering process. Beside l p $l_{p}$ distance measures, there exist several distance measures. Sargent introduced a special type of distance measures m ( ϕ ) $m(\phi)$ and n ( ϕ ) $n(\phi)$ which is closely related to l p $l_{p}$ . In this paper, we generalized the Sargent sequence spaces through introduction of M ( ϕ ) $M(\phi)$ and N ( ϕ ) $N(\phi)$ sequence spaces. Moreover, it is shown that both spaces are BK-spaces, and one is a dual of another. Further, we have clustered the two-moon dataset by using an induced M ( ϕ ) $M(\phi)$ -distance measure (induced by the Sargent sequence space M ( ϕ ) $M(\phi)$ ) in the k-means clustering algorithm. The clustering result established the efficacy of replacing the Euclidean distance measure by the M ( ϕ ) $M(\phi)$ -distance measure in the k-means algorithm