Demand for Public Health Care in Pakistan

A health care demand model is estimated for each province in Pakistan to explain the outpatient visits to government hospitals over the period 1989–2006. The explanatory variables include the number of government hospitals per capita, doctors’ fee per visit at a private clinic, income per capita, the average price of medicine and the number of outpatient visits per capita in the previous period. All variables are significant determinants of the demand for health care in at least one province but their signs, magnitudes and the levels of significance vary. These variations may be attributed to cultural, social and religious factors that vary across provinces. Variations in health care quality offered at public hospitals may also be a factor. These factors and improved accessibility of health care facilities should be the focus of public policy aimed at increasing the usage of public sector health care facilities in Pakistan.Health Care, Hospitals, Human Resources, Policy, Public Health

Design of multi-homing architecture for mobile hosts

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis proposes a new multi-homing mobile architecture for future heterogeneous network environment. First, a new multi-homed mobile architecture called Multi Network Switching enabled Mobile IPv6 (MNS-MIP6) is proposed which enables a Mobile Node (MN) having multiple communication paths between itself and its Correspondent Node (CN) to take full advantage of being multi-homed. Multiple communication paths exist because MN, CN, or both are simultaneously attached to multiple access networks. A new sub layer is introduced within IP layer of the host’s protocol stack. A context is established between the MN and the CN. Through this context, additional IP addresses are exchanged between the two. Our MNS-MIP6 architecture allows one communication to smoothly switch from one interface/communication path to another. This switch remains transparent to other layers above IP. Second, to make communication more reliable in multi-homed mobile environments, a new failure detection and recovery mechanism called Mobile Reach ability Protocol (M-REAP) is designed within the proposed MNS-MIP6 architecture. The analysis shows that our new mechanism makes communication more reliable than the existing failure detection and recovery procedures in multi-homed mobile environments. Third, a new network selection mechanism is introduced in the proposed architecture which enables a multi-homed MN to choose the network best suited for particular application traffic. A Policy Engine is defined which takes parameters from iv the available networks, compares them according to application profiles and user preferences, and chooses the best network. The results show that in multi-homed mobile environment, load can be shared among different networks/interfaces through our proposed load sharing mechanism. Fourth, a seamless handover procedure is introduced in the system which enables multi-homed MN to seamlessly roam in a heterogeneous network environment. Layer 2 triggers are defined which assist in handover process. When Signal to Noise Ratio (SNR) on a currently used active interface becomes low, a switch is made to a different active interface. We show through mathematical and simulation analysis that our proposed scheme outperforms the existing popular handover management enhancement scheme in MIPv6 networks namely Fast Handover for MIPv6 (FMIPv6). Finally, a mechanism is introduced to allow legacy hosts to communicate with MNS-MIP6 MNs and gain the benefits of reliability, load sharing and seamless handover. The mechanism involves introducing middle boxes in CN’s network. These boxes are called Proxy-MNS boxes. Context is established between the middle boxes and a multi-homed MN

The comparison of Iron and Ferritin serum level in Rheumatoid Arthritis patients and healthy individuals

Background and aims: The rheumatoid arthritis is a chronic autoimmune disease and a stable progressive inflammatory disorder in synovial tissue. It seems that both cell-mediate immune responses and humoral immunity play roles in causing this disease. Oxidative stress and changes in the amount of trace elements play an important role in the progress of the disease. The aim of the current study was to compare the Iron and Ferritin serum levels in Rheumatoid Arthritis patients and healthy individuals. Methods: This study was a case-control research in which 44 patients suffered from rheumatoid arthritis and 44 healthy individuals were investigated that they were all homogenous in terms of age and gender. The iron was estimated by photometric measurement and the development of ferrous-ferroin colored complex. The amount of ferritin in the serum was measured by architect autoanalyzer. The data were analyzed through covariance and Mann-Whitney tests using SPSS software at the significant level lower than P<0.5. Results: The results showed that the levels of iron and ferritin evaluated in patients (mean ± SD) were 59.97±6.65, 99.20±11.69, respectively, and in control group are 69.77±4.52, 44.79±7.14. This difference was not significant in iron (P>0.05), but it was not significant in serum ferritin (P<0.001). Also, There were significant differences between the proportion of iron to ferritin in both case and control groups (P<0.001). Conclusion: It seems that there is a correlation between the amounts of ferritin with rheumatoid arthritis. Iron is suspicious to be an effective factor in rheumatoid arthritis

Association between vitamin d deficiencies in sarcoidosis with disease activity, course of disease and stages of lung involvements

Background: Despite negative association between 25-hydroxy vitamin D and incidence of many chronic respiratory diseases, this feature was not well studied in sarcoidosis. Current study investigated the association between 25-hydroxy vitamin D deficiency with sarcoidosis chronicity, disease activity, extra-pulmonary skin manifestations, urine calcium level and pulmonary function status in Iranian sarcoidosis patients. Results of this study along with future studies, will supply more effective programs for sarcoidosis treatment. Methods: Eighty sarcoidosis patients in two groups of insufficient serum level and sufficient serum level of 25-hydroxy vitamin D were studied. Course of sarcoidosis was defined as acute and chronic sarcoidosis. Pulmonary function test (PFT) was assessed by spirometry. Skin involvements were defined as biopsy proven skin sarcoidosis. 24-hour urine calcium level was used to specify the disease activity. Stages of lung involvements were obtained by CT-scan and chest X-ray. The statistical analyses were evaluated using Statistical Package for the Social Sciences. Results: A significant negative correlation was obtained between vitamin D deficiency in sarcoidosis patients and disease chronic course and stages two to four of lung involvements. Considering other parameters of the disease and vitamin D deficiency, no significant correlation was detected. Conclusions: In conclusion, results of the current study implies in the role of vitamin 25(OH)D deficiencies in predicting the course of chronic sarcoidosis. Furthermore, it was concluded that vitamin 25(OH)D deficiency can direct pulmonary sarcoidosis toward stage 2–4 of lung involvements

Mothers’ Empowerment, Children’s Inoculations and Schooling in Pakistan: Urban vs Rural Areas, Daughters vs Sons and 1998-99 vs 2007-08

Mothers’ empowerment is thought to have considerable impact on children’s health and schooling. But the evidence for developing countries of the magnitudes of such effects, how they differ between urban and rural areas, whether they differ for daughters versus sons and whether they are changing over time is limited, particularly for countries that are characterized as having relatively great gender inequality. We construct a mothers’ empowerment index from Pakistani household survey data for 1998-99 and 2007-08 and investigate the associations between mothers’ empowerment and children’s inoculations and schooling. Because mothers’ empowerment may be endogenous, we explore instrumental variable estimates using women’s ages at the time of marriage as the identifying instrument. We find that the greater mothers’ empowerment: the more likely that preschool-age children have complete inoculations and the younger is the age of starting school and the greater is the schooling progression rate. These effects are larger in absolute magnitude for urban than for rural areas (though significantly so at the 5% level only for inoculations), suggesting that the urban context facilitates the effectiveness of mothers’ empowerment on investments in children’s human capital. They also are larger in absolute magnitude for daughters than for sons (though significantly so only for the schooling progression rate), suggesting some intergenerational own-gender reinforcement. Finally, these effects are significantly larger in absolute magnitudes for 2007-08 than for 1998-99, suggesting increased impact of a given degree of mothers’ empowerment in the first decade of the 21st century

A comparative evaluation of rehydration and cuploading sample application for modified twodimensional gel electrophoresis of human serum proteins using immobilized pH gradient

Proteomics is a powerful technique to study proteomes extracted from biological sources. Proteome analysis classically is based on two-dimensional electrophoresis (2D-E) for protein separation and mass spectrometry (MS) for the protein identification. The serum protein analysis is a useful diagnosis that can be used as an indicator of the physiological or clinical status of a patient. One of the central and critical steps is sample application, therefore this method should be considered and optimized for 2-DE with immobilized pH gradient. The aim of this study was focused on comparative application of ingel (rehydration loading) and in-cup (cup loading) sample application for 2-DE of human serum analysis. The results indicate that the number of spots detected with the rehydration loading was higher than the number obtained by cup-loading sample application. Also in this work, in order to obtain the best result with high resolution, a 2-DE procedure was optimized.Key words: Proteomics, 2D-E, proteome, sample application

Integration of Direction Cues Is Invariant to the Temporal Gap between Them

Many decisions involve integration of evidence conferred by discrete cues over time. However, the neural mechanism of this integration is poorly understood. Several decision-making models suggest that integration of evidence is implemented by a dynamic system whose state evolves toward a stable point representing the decision outcome. The internal dynamics of such point attractor models render them sensitive to the temporal gaps between cues because their internal forces push the state forward once it is dislodged from the initial stable point. We asked whether human subjects are as sensitive to such temporal gaps. Subjects reported the net direction of stochastic random dot motion, which was presented in one or two brief observation windows (pulses). Pulse strength and interpulse interval varied randomly from trial to trial. We found that subjects' performance was largely invariant to the interpulse intervals up to at least 1 s. The findings question the implementation of the integration process via mechanisms that rely on autonomous changes of network state. The mechanism should be capable of freezing the state of the network at a variety of firing rate levels during temporal gaps between the cues, compatible with a line of stable attractor states