The Changing Profile of Regional Inequality

There is a growing concern in developing and transition economies that spatial and regional inequality, of economic activity, incomes, and social indicators, is on the increase. Regional inequality is a dimension of overall inequality, but it has added significance when spatial and regional divisions align with political and ethnic tensions to undermine social and political stability. Despite these important popular and policy concerns, surprisingly there is little systematic and coherent documentation of the facts of what has happened to spatial and regional inequality over the past twenty years. This paper is an attempt to meet this gap. It provides changing scenarios of multi-dimensional inter-temporal spatial inequality and level of development in Pakistan during early 1980s and late 1990s

Competitive Structure and Bank Loan Rate in Pakistan’s Banking Industry

This paper estimates the relationship between loan price and the number of banks in the corporate loan markets of Pakistan. An original data set is constructed that includes loan price (interest rate) and market structure (number of banks) in more than 300 geographical markets across Pakistan. Variation in market structure (number of banks) along with variation in borrower and lender characteristics is employed to identify the factors that affect interest rates in loan markets. The findings based on regression result show that a competitive structure influences market price as loan rates decline when the number of banks increase in a market. Although the statistical evidence goes in favour of the structure conduct hypothesis, the findings are not robust across various functional forms. The detailed analysis of the Credit Information Bureau data and institutional details documented in this paper will be a useful reference for further research on the Industrial Organisation of Banking in Pakistan. JEL Classifications: L10, L11 Keywords: Price-concentration, Loan Price, Industrial Organisation, Bankin

Mapping the Spatial Deprivation of Pakistan

Geographical targeting may be a viable way to allocate resources for poverty alleviation in developing countries. Efficiency can be increased, and leakages to the nonpoor reduced substantially, by targeting needy areas. A national and regional database of substantial poverty maps or deprivation indices are not readily available in Pakistan. Further, existing activities of poverty alleviation are carried out on ad hoc basis in the absence of identified pockets of poverty. This paper presents indices of multiple deprivations based on the 1998 Population and Housing Census data. Possible applications of this exercise include identifying areas of need, making decisions on regional and sectoral priorities, facilitating targeted public interventions through special poverty alleviation programmes, understanding the relationship between poverty and its causes, and helping federal and provincial governments in determining financial awards.

Regulation, quality reporting and third-party certification of healthcare providers

The newly established provincial healthcare commissions in Pakistan have started certification of healthcare providers. The policy-makers perceive that without third-party certification or licencing the healthcare quality will be suboptimal in the country. This paper reviews the current literature on third-party certification and studies objectives and progress of the largest healthcare commission in Pakistan. It analyses the certification role of the Punjab Healthcare Commission and draw lessons for future regulation and strengthening of the quality reporting process. It also documents the short-term and long-term trade-off resulting from the enforcement of quality certification in the absence of appropriate alternative investment in medical training and care provisions in the country for uncertified providers. The paper concludes with a roadmap for future research to improve healthcare regulation in Pakistan

Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers’ Well-Being:Retrospective Population-Based Database Study With Embedded User Survey

Background:The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England.Objective:This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers’ support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery.Methods:This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses.Results:The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers’ well-being assessments, support needs checks, and peer support groups.Conclusions:Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers’ access to, and engagement with, such services

Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR): study protocol for a randomised controlled trial and economic evaluation

Introduction: Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy. This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. Delayed participation in CR exercise training promotes muscle atrophy, reduces cardiovascular fitness and prolongs recovery. Limited data suggest no detrimental effect of beginning CR exercise training as early as 2 weeks post-surgery, but randomised controlled trials are yet to confirm this. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy. Methods and analysis: In this assessor-blind randomised controlled trial, 140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2–3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme. Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness. Ethics and dissemination: Recruitment commenced on July 2017 and will complete by December 2019. Results will be disseminated via national governing bodies, scientific meetings and peer-reviewed journals. Trial registration number: NCT03223558; Pre-results

Effects of Low Molecular Weight and Unfractionated Heparin on Lipoprotein Lipase and Lipid Profile in haemodialysis patients

Introduction: In haemodialysis patients, mortality from cardiovascular disease is much greater than in the general population. The current study aimed to evaluate the effects of two different types of heparin, low molecular weight heparins (LMWH) and high molecular weight heparin (HMWH), on lipid profile in patients undergoing haemodialysis. Material & Methods: A total of 60 patients on haemodialysis were selected from two main hospitals of Lahore, Pakistan and were divided into two major groups based on the type of heparin used. A 5 ml blood sample was taken from the dialysis machine to get the serum and was kept frozen at -20ºC for analysis of total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein. Comparison of lipoprotein lipase activity between groups were evaluated by using the student t-test. A P-value of ? 0.05 was considered statistically significant. Results: Gender wise distribution of study population (n=60) was 67% (n=40) males and 33% (n=20) females. The age distribution of individuals varied from 39-43 years. Moreover, use of HMWH was high in males (73%) as compared to female (27%) with an average age of 39 ± 12 years where duration of haemodialysis was 4.44 ± 2.83. A significant difference in LPL activity related to different times in all patients was observed. A clearer difference observed in case of LDL where LPL activity was markedly different in both groups. Our data showed that individuals using LMWH had less chances of dyslipidaemia as compared to those using HMWH. Conclusion: LMWH is a useful and safe anticoagulant during haemodialysis as compared to HMWH

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Essays on the electricity and banking industries in Pakistan

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