Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Efficiency, Equity, and Reality

Background: Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. Methods: We identified 15 criteria by which antiretroviral therapy could be rationed in African countries and analyzed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. Findings: Rationing can be explicit or implicit. Access to treatment can be explicitly targeted to priority subpopulations such as mothers of newborns, skilled workers, students, or poor people. Explicit conditions can also be set that cause differential access, such as residence in a designated geographic area, co-payment, access to testing, or a demonstrated commitment to adhere to therapy. Implicit rationing on the basis of first-come, first-served or queuing will arise when no explicit system is enforced; implicit systems almost always allow a high degree of queue-jumping by the elite. There is a direct tradeoff between economic efficiency and social equity. Interpretation: Rationing is inevitable in most countries for some period of time. Without deliberate social policy decisions, implicit rationing systems that are neither efficient nor equitable will prevail. Governments that make deliberate choices, and then explain and defend those choices to their constituencies, are more likely to achieve a socially desirable outcome from the large investments now being made than are those that allow queuing and queue-jumping to dominate.

Automated Placement of Cameras in a Floorplan to Satisfy Task-Specific Constraints

In many multi-camera vision systems the effect of camera locations on the task-specific quality of service is ignored. Researchers in Computational Geometry have proposed elegant solutions for some sensor location problem classes. Unfortunately, these solutions utilize unrealistic assumptions about the cameras' capabilities that make these algorithms unsuitable for many real-world computer vision applications: unlimited field of view, infinite depth of field, and/or infinite servo precision and speed. In this paper, the general camera placement problem is first defined with assumptions that are more consistent with the capabilities of real-world cameras. The region to be observed by cameras may be volumetric, static or dynamic, and may include holes that are caused, for instance, by columns or furniture in a room that can occlude potential camera views. A subclass of this general problem can be formulated in terms of planar regions that are typical of building floorplans. Given a floorplan to be observed, the problem is then to efficiently compute a camera layout such that certain task-specific constraints are met. A solution to this problem is obtained via binary optimization over a discrete problem space. In preliminary experiments the performance of the resulting system is demonstrated with different real floorplans.

Boosting Nearest Neighbor Classifiers for Multiclass Recognition

This paper introduces an algorithm that uses boosting to learn a distance measure for multiclass k-nearest neighbor classification. Given a family of distance measures as input, AdaBoost is used to learn a weighted distance measure, that is a linear combination of the input measures. The proposed method can be seen both as a novel way to learn a distance measure from data, and as a novel way to apply boosting to multiclass recognition problems, that does not require output codes. In our approach, multiclass recognition of objects is reduced into a single binary recognition task, defined on triples of objects. Preliminary experiments with eight UCI datasets yield no clear winner among our method, boosting using output codes, and k-nn classification using an unoptimized distance measure. Our algorithm did achieve lower error rates in some of the datasets, which indicates that, in some domains, it may lead to better results than existing methods.

Automated Camera Layout to Satisfy Task-Specific and Floorplan-Specific Coverage Requirements

In many multi-camera vision systems the effect of camera locations on the task-specific quality of service is ignored. Researchers in Computational Geometry have proposed elegant solutions for some sensor location problem classes. Unfortunately, these solutions utilize unrealistic assumptions about the cameras' capabilities that make these algorithms unsuitable for many real-world computer vision applications: unlimited field of view, infinite depth of field, and/or infinite servo precision and speed. In this paper, the general camera placement problem is first defined with assumptions that are more consistent with the capabilities of real-world cameras. The region to be observed by cameras may be volumetric, static or dynamic, and may include holes that are caused, for instance, by columns or furniture in a room that can occlude potential camera views. A subclass of this general problem can be formulated in terms of planar regions that are typical of building floorplans. Given a floorplan to be observed, the problem is then to efficiently compute a camera layout such that certain task-specific constraints are met. A solution to this problem is obtained via binary optimization over a discrete problem space. In experiments the performance of the resulting system is demonstrated with different real floorplans.

Task Assignment in a Distributed System: Improving Performance by Unbalancing Load

We consider the problem of task assignment in a distributed system (such as a distributed Web server) in which task sizes are drawn from a heavy-tailed distribution. Many task assignment algorithms are based on the heuristic that balancing the load at the server hosts will result in optimal performance. We show this conventional wisdom is less true when the task size distribution is heavy-tailed (as is the case for Web file sizes). We introduce a new task assignment policy, called Size Interval Task Assignment with Variable Load (SITA-V). SITA-V purposely operates the server hosts at different loads, and directs smaller tasks to the lighter-loaded hosts. The result is that SITA-V provably decreases the mean task slowdown by significant factors (up to 1000 or more) where the more heavy-tailed the workload, the greater the improvement factor. We evaluate the tradeoff between improvement in slowdown and increase in waiting time in a system using SITA-V, and show conditions under which SITA-V represents a particularly appealing policy. We conclude with a discussion of the use of SITA-V in a distributed Web server, and show that it is attractive because it has a simple implementation which requires no communication from the server hosts back to the task router.

Specialized Mappings Architecture with Applications to Vision-based Estimation of Articulated Body Pose

A fundamental task of vision systems is to infer the state of the world given some form of visual observations. From a computational perspective, this often involves facing an ill-posed problem; e.g., information is lost via projection of the 3D world into a 2D image. Solution of an ill-posed problem requires additional information, usually provided as a model of the underlying process. It is important that the model be both computationally feasible as well as theoretically well-founded. In this thesis, a probabilistic, nonlinear supervised computational learning model is proposed: the Specialized Mappings Architecture (SMA). The SMA framework is demonstrated in a computer vision system that can estimate the articulated pose parameters of a human body or human hands, given images obtained via one or more uncalibrated cameras. The SMA consists of several specialized forward mapping functions that are estimated automatically from training data, and a possibly known feedback function. Each specialized function maps certain domains of the input space (e.g., image features) onto the output space (e.g., articulated body parameters). A probabilistic model for the architecture is first formalized. Solutions to key algorithmic problems are then derived: simultaneous learning of the specialized domains along with the mapping functions, as well as performing inference given inputs and a feedback function. The SMA employs a variant of the Expectation-Maximization algorithm and approximate inference. The approach allows the use of alternative conditional independence assumptions for learning and inference, which are derived from a forward model and a feedback model. Experimental validation of the proposed approach is conducted in the task of estimating articulated body pose from image silhouettes. Accuracy and stability of the SMA framework is tested using artificial data sets, as well as synthetic and real video sequences of human bodies and hands.

Utility-Based Decision-Making in Wireless Sensor Networks

We consider challenges associated with application domains in which a large number of distributed, networked sensors must perform a sensing task repeatedly over time. For the tasks we consider, there are three significant challenges to address. First, nodes have resource constraints imposed by their finite power supply, which motivates computations that are energy-conserving. Second, for the applications we describe, the utility derived from a sensing task may vary depending on the placement and size of the set of nodes who participate, which often involves complex objective functions for nodes to target. Finally, nodes must attempt to realize these global objectives with only local information. We present a model for such applications, in which we define appropriate global objectives based on utility functions and specify a cost model for energy consumption. Then, for an important class of utility functions, we present distributed algorithms which attempt to maximize the utility derived from the sensor network over its lifetime. The algorithms and experimental results we present enable nodes to adaptively change their roles over time and use dynamic reconfiguration of routes to load balance energy consumption in the network.

A Customizable Camera-based Human Computer Interaction System Allowing People With Disabilities Autonomous Hands Free Navigation of Multiple Computing Task

Many people suffer from conditions that lead to deterioration of motor control and makes access to the computer using traditional input devices difficult. In particular, they may loose control of hand movement to the extent that the standard mouse cannot be used as a pointing device. Most current alternatives use markers or specialized hardware to track and translate a user's movement to pointer movement. These approaches may be perceived as intrusive, for example, wearable devices. Camera-based assistive systems that use visual tracking of features on the user's body often require cumbersome manual adjustment. This paper introduces an enhanced computer vision based strategy where features, for example on a user's face, viewed through an inexpensive USB camera, are tracked and translated to pointer movement. The main contributions of this paper are (1) enhancing a video based interface with a mechanism for mapping feature movement to pointer movement, which allows users to navigate to all areas of the screen even with very limited physical movement, and (2) providing a customizable, hierarchical navigation framework for human computer interaction (HCI). This framework provides effective use of the vision-based interface system for accessing multiple applications in an autonomous setting. Experiments with several users show the effectiveness of the mapping strategy and its usage within the application framework as a practical tool for desktop users with disabilities.

Task-Irrelevant Perceptual Learning Specific to the Contrast Polarity of Motion Stimuli

Studies of perceptual learning have focused on aspects of learning that are related to early stages of sensory processing. However, conclusions that perceptual learning results in low-level sensory plasticity are of great controversy, largely because such learning can often be attributed to plasticity in later stages of sensory processing or in the decision processes. To address this controversy, we developed a novel random dot motion (RDM) stimulus to target motion cells selective to contrast polarity, by ensuring the motion direction information arises only from signal dot onsets and not their offsets, and used these stimuli in conjunction with the paradigm of task-irrelevant perceptual learning (TIPL). In TIPL, learning is achieved in response to a stimulus by subliminally pairing that stimulus with the targets of an unrelated training task. In this manner, we are able to probe learning for an aspect of motion processing thought to be a function of directional V1 simple cells with a learning procedure that dissociates the learned stimulus from the decision processes relevant to the training task. Our results show learning for the exposed contrast polarity and that this learning does not transfer to the unexposed contrast polarity. These results suggest that TIPL for motion stimuli may occur at the stage of directional V1 simple cells.