Interactive Graphics: Exemplified with Real Data Applications

Graphics are widely used in modern applied statistics because they are easy to create, convenient to use, and they can present information effectively. Static plots do not allow interacting with graphics. User interaction, on the other hand, is crucial in exploring data. It gives flexibility and control. One can experiment with the data and the displays. One can investigate the data from different perspectives to produce views that are easily interpretable and informative. In this paper, we try to explain interactive graphics and advocate their use as a practical tool. The benefits and strengths of interactive graphics for data exploration and data quality analyses are illustrated systematically with three complex real datasets

Quarterly Bayesian DSGE Model of Pakistan Economy with Informality

In this paper we use the Bayesian methodology to estimate the structural and shocks‟ parameters of the DSGE model in Ahmad et al. (2012). This model includes formal and informal firms both at intermediate and final goods production levels. Households derive utility from leisure, real money balances and consumption. Each household is treated as a unit of labor which is a composite of formal (skilled) and informal (unskilled) labor. The formal (skilled) labor is further divided into types “r” and households have monopoly over each type “r” labor which depends upon degree of education. We go a step further by converting the existing annually calibrated model to quarterly frequency. As a result our impulse response functions have more relevant and realistic policy implications. From the results we do find the shock absorbing role of the informal sector, however, with short term existence. The model estimation diagnostics also confirm robustness and reasonability of the estimation results

Quarterly Bayesian DSGE Model of Pakistan Economy with Informality

In this paper we use the Bayesian methodology to estimate the structural and shocks‟ parameters of the DSGE model in Ahmad et al. (2012). This model includes formal and informal firms both at intermediate and final goods production levels. Households derive utility from leisure, real money balances and consumption. Each household is treated as a unit of labor which is a composite of formal (skilled) and informal (unskilled) labor. The formal (skilled) labor is further divided into types “r” and households have monopoly over each type “r” labor which depends upon degree of education. We go a step further by converting the existing annually calibrated model to quarterly frequency. As a result our impulse response functions have more relevant and realistic policy implications. From the results we do find the shock absorbing role of the informal sector, however, with short term existence. The model estimation diagnostics also confirm robustness and reasonability of the estimation results

Emergency Surgery during Lockdown: Experience at a tertiary care hospital

Introduction: COVID-19 has halted the economic and social progression of the human race. This pandemic has exposed the vulnerabilities of all walks of life. But, most of all, this crisis has jolted the health care systems around the globe. A decrease in emergency surgical interventions was observed at District headquarters Hospital, Rawalpindi. The purpose of this study was to evaluate the impact of a pandemic on acute surgical emergency presentation and referral to a tertiary care hospital. Material and Methods: It is a retrospective cohort study. We compared emergency surgical interventions requiring spinal or general anaesthesia followed by admission in a ward at DHQ hospital, Rawalpindi during a control period (15th March 2019–15th June 2019) and during the pandemic lockdown period (15th  March 2020- 15th June 2020). Results: A total of 228 cases were included in the study including both groups. About 73% (167 ) cases were performed in an emergency during Pre COVID-19 period i.e. from March 15th- June 15th, 2019.  A total of 41 exploratory laparotomies were performed in a total of which 28 (68%) were done in the control period while 13 (32%) were done during the lockdown period. Out of 13 laparotomies due to road traffic accidents, only 3 were done during the lockdown period. Civilian Violence causing penetrating trauma resulted in 21 laparotomies in total out of which 11 were before the COVID-19 crisis and 10 during the lockdown. A total of 107 appendectomies were performed. Out of which 75 (70%) were performed in the Pre COVID-19 pandemic. Less than half the number (32) of appendectomies were done during the lockdown.  A marked decrease in emergency hernia surgeries was observed. In the Pre COVID-19 time period, 13 emergency hernia surgeries were done, while only 03 surgeries were done during the lockdown. Regarding Hepatobiliary emergency surgeries, none was done during lockdown while 08 were done during three months of the Pre COVID-19 period. Conclusion: Firstly, Keeping these figures under consideration, surgical units should expect more complicated cases in the coming days and a high influx of patients should be expected once the lockdown is over. Secondly, the question that remains unanswered is that Are we doing unnecessary surgeries other than trauma in an emergency? Thirdly, there is room to consider that all appendicitis and cholecystitis don’t always need surgery. Fourthly, the private sector has the potential to share the burden on public hospitals

Scalable Screening and Treatment Response Monitoring for Perinatal Depression in Low- and Middle-Income Countries

Common perinatal mental disorders such as anxiety and depression are a public health concern in low- and middle-income countries. Several tools exist for screening and monitoring treatment responses, which have frequently been tested globally in clinical and research settings. However, these tools are relatively long and not practical for integration into routine data systems in most settings. This study aims to address this gap by considering three short tools: The Community Informant Detection Tool (CIDT) for the identification of women at risk, the 4-item Patient Health Questionnaire (PHQ-4) for screening women at high-risk, and the 4-item Hamilton Depression Rating Scale (HAMD-4) for measuring treatment responses. Studies in rural Pakistan showed that the CIDT offered a valid and reliable key-informant approach for the detection of perinatal depression by utilizing a network of peers and local health workers, yielding a sensitivity of 97.5% and specificity of 82.4%. The PHQ-4 had excellent psychometric properties to screen women with perinatal depression through trained community health workers, with a sensitivity of 93.4% and specificity of 91.70%. The HAMD-4 provided a good model fit and unidimensional construct for assessing intervention responses. These short, reliable, and valid tools are scalable and expected to reduce training, administrative and human resource costs to health systems

Technology-assisted peer therapy: a new way of delivering evidence-based psychological interventions

In low-income settings, ninety percent of individuals with clinical depression have no access to evidence-based psychological interventions. Reasons include lack of funds for specialist services, scarcity of trained mental health professionals, and the stigma attached to mental illness. In recent years there have been many studies demonstrating effective delivery of psychological interventions through a variety of non-specialists. While these interventions are cost-effective and less stigmatising, efforts to scale-up are hampered by issues of quality-control, and what has been described by implementation scientists as ‘voltage-drop’ and ‘programme-drift.’ Using principles of Human Centred Design in a rural setting in Pakistan, we worked with potential users to co-design a Tablet or Smartphone-based App that can assist a lay-person deliver the Thinking Healthy Programme, a World Health Organization-endorsed evidence-based intervention for perinatal depression. The active ingredients of this cognitive-therapy based intervention are delivered by a virtual ‘avatar’ therapist incorporated into the App which is operated by a ‘peer’ (a woman from the neighbourhood with no prior experience of healthcare delivery). Using automated cues from the App, the peer reinforces key therapeutic messages, helps with problem-solving and provides the non-specific but essential therapeutic elements of empathy and support. The peer and App therefore act as co-therapists in delivery of the intervention. The peer can deliver the intervention with good fidelity after brief automated in-built training. This approach has the potential to be applied to other areas of mental health and help bridge the treatment gap, especially in resource-poor settings. This paper describes the process of co-development with end-users and key features of the App