Blockchain Papers

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The decentralization system impacts the change of the local tax regulation. Based on the Law No 34 of 2000 on local tax and retribution, local government may determine new kind of taxes besides what has established in this Law, but they must refer to the available criteria. Tax as one of the important local incomes to finance either the government operation or local development and to support the accountable, real, and extant decentralization . After the Law No 34 of 2000 has been replaced by the law No 28 of 2009 on local tax and retribution, local government is not allowed to pick up tax other than what the law has determined. The basis of the tax and the discretion is extended. To improve the tax accountability; this law stipulates that some parts of tax income should be allocated to finance activities relevant to such tax.<br /><br />Keywords : Local Tax

Federico Revelli

This paper models the local tax mix determination process in the presence of statewide fiscal limitations—the decentralized government finance archetype—and shows how excess sensitivity of local public spending to grants (the conventionally and somewhat misleadingly termed “flypaper effect”) arises in the constrained tax mix irrespective of whether lower or upper limits bind and how it cannot, in general, be taken as a symptom of local government overspending. An empirical application to Italian province panel data provides consistent evidence of the role of corner solutions produced by two-sided tax limits in explaining the sensitivity of local public expenditures to grants.

James F. Childress

Who shall live when not all can live? Although this question has been urgently forced upon us by the dramatic use of artificial internal organs and organ transplantations, it is hardly new. George Bernard Shaw dealt with it in “The Doctor's Dilemma”: Sir Patrick.Well, Mr. Savior of Lives: which is it to be? That honest decent man Blenkinsop, or that rotten blackguard of an artist, eh?Ridgeon.It's not an easy case to judge, is it? Blenkinsop's an honest decent man; but is he any use? Dubedat's a rotten blackguard; but he's a genuine source of pretty and pleasant and good things.Sir Patrick.What will he be a source of for that poor innocent wife of his, when she finds him out?Ridgeon.That's true. Her life will be a hell.Sir Patrick.And tell me this. Suppose you had this choice put before you: either to go through life and find all the pictures bad but all the men and women good, or go through life and find all the pictures good and all the men and women rotten. Which would you choose?1 A significant example of the distribution of scarce medical resources is seen in the use of penicillin shortly after its discovery. Military officers had to determine which soldiers would be treated—those with venereal disease or those wounded in combat.2 In many respects such decisions have become routine in medical circles. Day after day physicians and others make judgments and decisions “about allocations of medical care to various segments of our population, to various types of hospitalized patients, and to specific individuals,”3 for example, whether mental illness or cancer will receive the higher proportion of available funds. Nevertheless, the dramatic forms of “Scarce Life-Saving Medical Resources” (hereafter abbreviated as SLMR) such as hemodialysis and kidney and heart transplants have compelled us to examine the moral questions that have been concealed in many routine decisions. I do not attempt in this paper to show how a resolution of SLMR cases can help us in the more routine ones which do not involve a conflict of life with life. Rather I develop an argument for a particular method of determining who shall live when not all can live. No conclusions are implied about criteria and procedures for determining who shall receive medical resources that are not directly related to the preservation of life (e.g. corneal transplants) or about standards for allocating money and time for studying and treating certain diseases.Just as current SLMR decisions are not totally discontinuous with other medical decisions, so we must ask whether some other cases might, at least by analogy, help us develop the needed criteria and procedures. Some have looked at the principles at work in our responses to abortion, euthanasia, and artificial insemination.4 Usually they have concluded that these cases do not cast light on the selection of patients for artificial and transplanted organs. The reason is evident: in abortion, euthanasia, and artificial insemination, there is no conflict of life with life for limited but indispensable resources (with the possible exception of therapeutic abortion). In current SLMR decisions, such a conflict is inescapable, and it makes them so morally perplexing and fascinating. If analogous cases are to be found, I think that we shall locate them in moral conflict situations.An especially interesting and pertinent one is U.S. v. Holmes.5 In 1841 an American ship, the William Brown, which was near Newfoundland on a trip from Liverpool to Philadelphia, struck an iceberg. The crew and half the passengers were able to escape in the two available vessels. One of these, a longboat, carrying too many passengers and leaking seriously, began to founder in the turbulent sea after about twenty-four hours. In a desperate attempt to keep it from sinking, the crew threw over board fourteen men. Two sisters of one of the men either jumped overboard to join their brother in death or instructed the crew to throw them over. The criteria for determining who should live were “not to part man and wife, and not to throw over any women.” Several hours later the others were rescued. Returning to Philadelphia, most of the crew disappeared, but one, Holmes, who had acted upon orders from the mate, was indicted, tried, and convicted on the charge of “unlawful homicide.”We are interested in this case from a moral rather than a legal standpoint, and there are several possible responses to and judgments about it. Without attempting to be exhaustive I shall sketch a few of these. The judge contended that lots should have been cast, for in such conflict situations, there is no other procedure “so consonant both to humanity and to justice.” Counsel for Holmes, on the other hand, maintained that the “sailors adopted the only principle of selection which was possible in an emergency like theirs,—a principle more humane than lots.”Another version of selection might extend and systematize the maxims of the sailors in the direction of “utility”; those are saved who will contribute to the greatest good for the greatest number. Yet another possible option is defended by Edmond Cahn in The Moral Decision. He argues that in this case we encounter the “morals of the last days.” By this phrase he indicates that an apocalyptic crisis renders totally irrelevant the normal differences between individuals. He continues, In a strait of this extremity, all men are reduced—or raised, as one may choose to denominate it—to members of the genus, mere congeners and nothing else. Truly and literally, all were “in the same boat,” and thus none could be saved separately from the others. I am driven to conclude that otherwise—that is, if none sacrifice themselves of free will to spare the others—they must all wait and die together. For where all have become congeners, pure and simple, no one can save himself by killing another.6 Cahn's answer to the question “who shall live when not all can live” is “none” unless the voluntary sacrifice by some persons permits it.Few would deny the importance of Cahn's approach although many, including this writer, would suggest that it is relevant mainly as an affirmation of an elevated and, indeed, heroic or saintly morality which one hopes would find expression in the voluntary actions of many persons trapped in “borderline” situations involving a conflict of life with life. It is a maximal demand which some moral principles impose on the individual in the recognition that self-preservation is not a good which is to be defended at all costs. The absence of this saintly or heroic morality should not mean, however, that everyone perishes. Without making survival an absolute value and without justifying all means to achieve it, we can maintain that simply letting everyone die is irresponsible. This charge can be supported from several different standpoints, including society at large as well as the individuals involved. Among a group of self-interested individuals, none of whom volunteers to relinquish his life, there may be better and worse ways of determining who shall survive. One task of social ethics, whether religious or philosophical, is to propose relatively just institutional arrangements—which criteria and procedures of selection is most satisfactory in view of the human condition (man's limited altruism and inclination to seek his own good) and the conflicting values that are to be realized?There are several significant differences between the Holmes and SLMR cases, a major one being that the former involves direct killing of another person, while the latter involve only permitting a person to die when it is not possible to save all. Furthermore, in extreme situations such as Holmes, the restraints of civilization have been stripped away, and something approximating a state of nature prevails, in which life is “solitary, poor, nasty, brutish and short.” The state of nature does not mean that moral standards are irrelevant and that might should prevail, but it does suggest that much of the matrix which normally supports morality has been removed. Also the necessary but unfortunate decisions about who shall live and die are made by men who are existentially and personally involved in the outcome. Their survival too is at stake. Even though the institutional role of sailors seems to require greater sacrificial actions, there is obviously no assurance that they will adequately assess the number of sailors required to man the vessel or that they will impartially and objectively weigh the common good at stake. As the judge insisted in his defense of casting lots in the Holmes case: “In no other than this [casting lots] or some like way are those having equal rights put upon an equal footing, and in no other way is it possible to guard against partiality and oppression, violence, and conflict.” This difference should not be exaggerated since self-interest, professional pride, and the like obviously affect the outcome of many medical decisions. Nor do the remaining differences cancel Holmes' instructiveness.Which set of arrangements should be adopted for SLMR? Two questions are involved: Which standards and criteria should be used? And, Who should make the decision? The first question is basic, since the debate about implementation, e.g. whether by a lay committee or physician, makes little progress until the criteria are determined.We need two sets of criteria which will be applied at two different stages in the selection of recipients of SLMR. First, medical criteria should be used to exclude those who are not “medically acceptable.” Second, from this group of “medically acceptable” applicants, the final selection can be made. Occasionally in current American medical practice, the first stage is omitted, but such an omission is unwarranted. Ethical and social responsibility would seem to require distributing these SLMR only to those who have some reasonable prospect of responding to the treatment. Furthermore, in transplants such medical tests as tissue and blood typing are necessary, although they are hardly fully developed.“Medical is not as as many since there is debate in medical about the relevant and Although can contribute little or nothing to this two may be in First, should be used only to determine the group from which the final selection will be and the attempt to of to should be Medical would exclude some but would not as a of between those who the first For example, if two for were the physicians would not choose the one with the better medical selection would be made on other Second, and should be to an absolute and should be only when they are without related to medical the to with the of which might to most significant moral questions when we to the final the of has been and the number is than the other criteria should be used? should the final selection be First, I shall examine some of the that from to make the final selection in of social these about the and of the I shall the possible for selection or criteria of social on but most they are The and to the society is although this obviously be from his of and the of his to society an is in of these social and has been to suggest the of that affect social value or we encounter the first major of this do we determine the relevant criteria of social of various social are only too does one and the of the life, that day we may how to or or the value in in the same and way that has I am not that we can or that we should attempt to do if the various social and human in could be how do we determine how much we will to Which will have in case of more in the light of which values and principles do we social possible way of determining the values which should be in selection has been by He that our medical decisions about allocating resources are on an of values by there is no way of we should be and about it. should we He that we the values that most in our society and use them as criteria for distributing SLMR. values can be by or if in this put a greater on than men would have a greater on our SLMR than of is significant and the who was SLMR in might be in as the greatest American since George is criteria that could be applied but at the and as well as individual the criteria of social value that are used in is this more than in the and decisions of the selection committee of the where such as and have been significant for determining who shall As two conclude after these criteria and they who the the way but who have so much to the making of The is no for a with bad to this first of determining social values is a only is it if not to on social but it is easy to our will be in a few and the of actions will it is to which persons will their in in and the of of For these as has might be a but we simply the to the which we must is more than when we think in make us that such an approach to SLMR is the of but this should not be The on another the approach would in the person to his social and it and the of the his as a person which be to his or to It is not at all that we are to live with these of who the artificial has we to the principle that social should determine we patients to be with only when they are go to have have a a good and to the that any for for selection is a to the of view which The is not to all but to that SLMR cases are which involve The however, can have and for from by and can go and seek for criteria for the question of life or death in the of the artificial these criteria to the of human the to which they can be little more than that at by casting The he will be to those in American medical is most to a certain or in of which when is this of the and where it only as a and It only us how all selection criteria and procedures the to us in the of the human condition and its This approach is with his view of the task of us how to and ethics, I would can help us the and in light judgments can be made. Even if all actions in SLMR should involve some may human to a greater than others. that a on any criteria is more than that at by casting selection by would the to the moral and values that we are to maintain a of is that we use some of or such as first or such as a to determine who shall be as a to when and judgments can and must be made. Edmond Cahn who the casting of lots as Cahn it, crisis involves too for and too for other as a to which human these values are with the of it is to have persons rather than determining who shall they are with the outcome of the the such as and of being which make human life it is are to be and in the the it must be that the use of seems and the of criteria in SLMR to make their as and as possible so that does not determine who shall however, the moral and values which might be supported by selection by or A more is that the procedure that I develop the relevant moral too That so the argument might the society and its and not the individual with his illness and upon SLMR. is that the values and principles at work in the may well over those in the both of their and and of the of selection in of social As “The more is the to be made of an and the more the life and the more the for human as a moral principle I is in certain conflict situations, it a significant of by of it be as a and procedure without an the including human which might it. this about the Holmes case: of our upon as the all the and the in our should think rather of of as the of the of those individuals to one another that might have been and by casting The and which on the approach would be in his social role and can be and to by a recognition of his equal to be a is by procedures which of selection by more the by human than does It is not but it is to the of letting all die or only those who have the greatest social and argument can be by values other than individual and of value in the medical is the of between and Which selection criteria are most in with this of Which will and it? is that selection by or is from this which is to for human is an of about It is not simply the that another will a particular but more that another will him in certain will him as a As Although has to do with on a of another person, it is on a of a the to to with or live to and so to another is first of all to him to the principle of morality in his with to as a person, This be in situations when a person decisions about him to be made in of his social for such decisions his as a on of in social value or would have reason for that his had been the that one is being not as an in himself but as a means in medical progress or the of a greater social good is with and of this in the which was after the after the first heart The of between the and is not only an value in the of being an in the treatment. It is to be of its as a the related values of individual and are maintained in selection by other the argument for this Which criteria and procedures would men have to a in which several men are to determine for themselves and their the criteria and procedures by which they would to be to and from SLMR if the need need to two and ask which set of criteria and procedures would be as the most and, indeed, the The are The men are are interested in their own that of members of their and of they are not by Furthermore, they are of their own and to the social do not how they would in a the for SLMR in of social these which would be all or the use of Which would seem the most The By which set of criteria would they to be in or from the of those who will be The choice in this and of would be selection or since this of A possible is that one would to a and choose the I think especially since I that the in this are for their as well as for selection or could be more to the It would make more for men who are self-interested but about their to society to a set of criteria which would in of would selection by as relatively just and for or The and those who are would be greater if the is on social than if it is on and be in these situations, but they would be by the of being relatively by makes this A to would make for the and those who have a specific in It would be for them to his by relatively of criteria in is involved. the of life have us to the of and to the of or human life is an after has an absolute to most of us would that we have as much to it as in Although it is as selection by is in in I am not of any which some of its patients from kidney in to make for later who are better in of social Furthermore, few would it. few would a person from a kidney on the that a person better had just In a of the of by at the of from to patients but were not the had its of in and is at least certain is that we extend this principle first to determine who the patients shall live or that we artificial such as a or first would be more than a since the make their over a of time rather than as a group at one This procedure would be in with at least one principle in our and with our of individual and in to these values can be by how the can be to the one easy way of this task is to maintain the of which to a patients are not that they are being for SLMR in to the treatment. whether is or not is not the significant it is rather for would be most to the is that can be more if of and are and that they are by selection by or has another since it would the need for a committee to examine in of their social This responsibility can be there is a possible of use of selection which is interesting to although I do not it as a good reason for It can be as of the of has that SLMR cases would if these scarce resources were rather than on social would no be a the of and would make certain that they would not be by a selection they would help to or so that medical would be and the that I have are the of to be without If we would we not just after we had in it The direction of argument has been against any and I would this as the way to me one possible way of while at the same time them so that they would be of the approach is that which make it necessary to that one man is indispensable for a society in view of a particular set of it the when the is a for the argument to this has that the of would on those who think that the social in this is so that they simply by the outcome of a or a first first the reason must be rather than that is, we from in this not we to of this to the of our but his would be the in a social value the should be used as a of exception in for example, only if it would a reason to another person from a kidney if all were this to the has been made to we would be to put this of another for a only if we would be in which all are being to a by from it. would make an exception I do not this procedure of I think that one can it while about selection by or If it is a lay committee would be upon to with the since the or others would in be the outcome of or This lay committee would determine whether this was so indispensable at this time and that he had to be saved by the values by It would make it that exception is if at only as the of two a defense would be only if and so many moral and values in SLMR

A. Shiva Kama Sundari, Rahayu Sulistiowati

This article aims to describe and analyze an idea of decentralization of education based on local excellence through the implementation of school-based management in SMK N 1 Pesisir Tengah. The results of this research showed that the implementation of school-based management in SMK N 1 Pesisir Tengah has not been going well. This can be seen from yet successful implementation of decentralization functions by the Ministry of National Education to the school. Such as planning and program evaluation, management of curriculum, the management of equipment and supplies, Management of curriculum, teaching process management functions, management of financial, the school and community relations. From several functions that have not run optimally which mentioned above, SMK N 1 Pesisir Tengah is good enough in carrying out the functions workforce management, student services and the management of school climate. Meanwhile, community participation in the educational practices at SMK N 1 Pesisir Tengah only visible on the financing of honorary staff. Keywords : School-Based Management, School Autonomy, Public Participation

Erika Tanhua-Piiroinen, Johanna Sommers-Piiroinen

Working life requires employees to continuously update their competences, making lifelong learning an important but challenging part of professional development. This study aims to look for solutions to uncover the tacit and implicit knowledge within the enterprise by the means of social media. Our interest is specially focused on challenges on informal learning and refining and sharing of the tacit knowledge among these expert companies. We have so far collected data from two enterprises about their current knowledge sharing habits and procedures and found out the pitfalls they have experienced in their working culture concerning finding and sharing knowledge. The main challenges (apart from lack of time, which is quite obvious result today) are defects in storing information in a way that enables its easy rediscovery and the huge amount of information from which to filter the relevant pieces of knowledge. Particularly the centralized experts in an insurance company find the lack of regular vertical interaction between the decentralized claim handlers a drawback. There exists a lot of overlapping effort as they need to tell the same issues many times to various claim handlers. Taking these challenges into account new working models will be put into practice utilizing collaborative tools, like wikis and chat forums.

Beat Weber

The virtual currency and payment project Bitcoin intends to challenge the current monetary and payment system that finds itself in a legitimacy crisis in the aftermath of the financial market turmoil of 2008. In examining the governance of the Bitcoin system, I try to assess its potential to create input and output legitimacy as a payment system and as a monetary system in comparison with current practice.

Hui Cui, Yi Mu, Man Ho Au

Consider a practical scenario: an untrusted gate-way is required to verify all the incoming information en-crypted via an encryption scheme, while the sender does not want to reveal any information about the plaintext and the privileged user to the gateway. That is, the gateway distributes the information to a predefined group of users and only the privileged user can open the message. To solve this problem, we need an access control mechanism to allow certain specification of the access control policies while protecting the users' privacy. With this scenario in mind, we propose the notion of verifiable and anonymous encryption where a verification function is added to the ciphertext, which captures the security requirements of the confidentiality of the plaintext and the anonymity of the privileged user. We present two specific constructions of our framework under the setting of asymmetric bilinear pairings in this paper. Our first scheme is proven confidential and anonymous under a weaker security model in the random oracle model, and our second one is built on the basis of a zero knowledge proof of knowledge under a strong security game.

Ching Yuen Luk

Since the mid-1980s, both Shanghai and Hong Kong have implemented health insurance reform to contain healthcare costs. But the reform result in these two places represents polar extremes. While Shanghai witnessed a revolution in healthcare financing in 2000, Hong Kong remains status quo on healthcare financing. Using the theory of historical institutionalism, this study examines how the complex interplay of forces affects health insurance reform implementation in these two places. It finds that Shanghai succeeded in implementing health insurance reform because of contextual influences, ideological shift, policy feedback, the authoritative political institutions, the dominance of key bureaucratic stakeholders in health insurance reform process, the endorsement of new ideas, and the decentralization power given to local governments. On the other hand, it finds that Hong Kong failed to implement any health insurance reforms in 1993 because of a more democratic political system, policy feedback, the persistence of old ideas, and a robust economy. Besides, it finds that the government failed to implement healthcare financing reforms in 1999 and 2000 because of a disjointed political system, difficult economic circumstances, the new idea lacking public acceptance, policy feedback, and the institutionalization of old ideas.

David M. Gaba

The healthcare industry may be the largest and most expensive endeavor of the developed world, with the United States at the top of the list of per capita expenditure. Clearly, as indicated by the intense (and continuing) debate over the Affordable Care Act, the issues of the healthcare industry are of extreme interest to the public and policy makers.The biggest problems in the healthcare industry are about how to achieve its fundamental goals—how to provide adequate and equitable care to the entire populace; how to guarantee equitable access to all; how to achieve optimal population health; how to ensure efficacy, quality, and safety of patient care; how to provide choice of provider and hospital; and, most importantly, how to pay for all of these goals and how to obtain political agreement of the populace to make it happen.Fortunately, this monograph will address primarily issues of quality and safety, and will largely ignore these other very large and thorny issues. Some of the ideas in this chapter have been addressed in part by the author in prior journal publications.12From a safety standpoint, it is now well recognized that there is a significant incidence of harming patients in the course of trying to diagnose and treat them.3Many such events are known to be preventable. The incidence of minor problems is very high, but even serious events have been found in approximately 1% of all hospitalizations. It is often said that many of these adverse events are irrelevant because the patients they occur in are already very ill, and hence might well have suffered negative outcomes anyway. However, I contend that no patient “signs up for bad care,” so we should still be very concerned about such events even when they do not, in the final analysis, actually affect the final outcome. The next time, maybe they will.In addition, it is likely that many errors that occur, even serious errors, are hidden. Some are not apparent because the patient is very ill, so only detailed investigation or analysis can disclose an error. In other cases, errors can be hidden simply by failing to inform anyone of them and waiting to see what happens. Moreover, healthcare does not have the robust incident or accident investigation processes that are routine in transportation (e.g., National Transportation Safety Board). Most investigations—in the infrequent occasions that they occur—are conducted only at the local level and with varying degrees of sophistication and alacrity.Parts of healthcare (such as anesthesia and surgery) and nuclear power production are but two examples of activities of “high intrinsic hazard” (aviation is a well-known third). The hazard in these activities is inherent—it can be managed and controlled—but the hazard cannot be eliminated. Yet, the management of hazard in nuclear power and aviation has become so good that it is accepted that adverse events are not “normal.”Nuclear reactors should not unexpectedly interrupt power production, and they should never harm workers or the public, melt down, or explode. Airplanes are not supposed to crash—ever. In these arenas when one of these things happens, we know that something went horribly wrong. Yet, human beings are inherently prone to catastrophic internal failures that result in serious disability or death. Thus, adverse outcomes—not necessarily due to errors or poor care—are very common in healthcare. All of us are going to die, and most of us will die in close proximity to healthcare. It is difficult to sort out which events are the ordinary “natural history” of disease and which are due to suboptimal care. This makes efforts at measuring safety outcomes particularly difficult in healthcare.All of the high intrinsic hazard industries share the fact that they are so critical to human welfare that we cannot just shut them all down while we solve all of their problems. Certainly, we can't stop performing healthcare activities just because they are imperfect—the ravages of disease are worse. While a single nuclear reactor can be shut down whenever necessary, and a flight can be cancelled or delayed, it is sometimes impossible (and possibly unethical) to refrain from or abort an emergency medical procedure due to a significant safety risk when the patient's underlying disease processes will otherwise quickly cause serious harm or death.Decisions on a larger scale are more complicated. While it is in principle possible to abandon the use of nuclear power in some countries, this can only be done temporarily or it must be phased out over a very long period of time. Access to abundant electrical power is the lifeblood of modern societies. Similarly, the dislocations caused by even short stoppages of air travel by the 9/11 terrorist event or the Icelandic volcano's ash cloud demonstrated that air travel also cannot be stopped for long. On the other hand, in healthcare, the introduction of new, potentially lifesaving drugs and devices can be delayed pending proof that they are safe and effective.The calculus of such decisions may vary from country to country, although many aspects of healthcare (and nuclear power production) are similar everywhere. In healthcare, the practices of physicians stem originally from the roots of the “autonomous healer” who used individual, often idiosyncratic, knowledge and “skill” to diagnose and treat ailments. There were few curative or invasive therapies. While administering potions to, cupping, and bleeding patients didn't usually help them very much, and might have hastened their demise, they were not generally powerful enough to directly cause serious harm or death. Hospitals were originally organized more as “guild workshops” 4 wherein the members of the physician's guild could independently ply their trade.Now, in the early 21st century, some things have changed drastically while others have not. We have many more diagnostic and treatment interventions that can often cure. Many are very powerful and can themselves directly, and quite quickly, cause serious harm or death. I like to say that there is a high potential lethality per square meter in settings like the operating room, intensive care unit, emergency room, or chemotherapy administration unit. Wielding such interventions requires very complex care coordinated across many individuals and many work units.Since the latter half of the 20th century, it has become possible to compare many patient outcomes in response to diagnosis or treatment, a process that is still unfinished. Despite all of this change, the structure of the hospital, for example, has not changed much in hundreds of years, retaining many elements of the guild workshop. Even where an institution is the employer of physicians, the amount of autonomy of practice given to physicians is enormous, despite the grumblings of how medicine is dictated by the rules and regulations of payers and other bodies. The system also is structured around assumptions that the individual skill of the professionals will be uniform, solid, and unvarying over time, which of course is impossible to guarantee.Even the division of labor is old. I conjecture that if healthcare were to be developed now, from scratch, we would not have job types of “doctor,” “nurse,” “pharmacist,” and “respiratory therapist,” to name only a few. We would have many other job types and a vastly different organizational and work structure—hopefully based on a more rational assessment of how best, and how safely, to achieve the goals of the work in the first place.A fundamental difference in healthcare versus other industries is that “we” do not design or construct the units we work on: human beings—nor are we given an instruction manual for them. We do not understand a great deal of how the human body works, how it fails, or why and how it gets sick or recovers from illness. Yes, great strides have been made and more discoveries are happening every day, but we are mostly working empirically by trial and error.In my own field of anesthesia, we do not know many of the fundamental mechanisms by which our drugs can render patients unconscious, unaware, resistant to pain, immobile, and (fortunately) unable to recall what has transpired during surgery. Yet, by trial and error, we have worked out the methods to do these things—which clearly evolution never really intended for human beings—on a regular basis with low, but not low enough, rates of serious problems.In healthcare, the public is very concerned with personal and intimate aspects of the work, and such individual, societal, and ethical issues are commonplace. They also care very deeply about choosing and seeing “their” doctor. This is not the case for other industries where the public doesn't care specifically who exactly is doing the work (pilots and nuclear power plant operators interact with the public minimally, if at all). However, for nuclear power, the public has great concerns over the long-term impact of accidents, and also a hard to grasp “dread” factor of radiation that does not come into play in healthcare.56Organizationally, the nuclear power industry and healthcare are very different. There are just over 100 nuclear power reactors in the United States, owned and operated by 30–40 firms and under significant scrutiny by the federal regulator, the U.S. Nuclear Regulatory Commission (NRC).Healthcare is a vastly more decentralized and massive undertaking. There are 4,000– 6,000 hospitals, owned by 1,000–2,000 firms. There are roughly the same number of stand-alone surgicenters. There are more than 200,000 physician offices. More than 20 million surgical operations with anesthesia are performed, just under one billion doctor visits occur, and about three billion prescriptions are written every year in the United States. Yet, there is no federal regulatory agency of the practice of healthcare. That comes under the jurisdictions of the 50 states and the federal health systems (e.g., Department of Defense, Department of Veterans Affairs, and the Indian Health Service).The federal U.S. Food and Drug Administration regulates the approval and sale of drugs and devices. The federal Centers for Medicare &amp; Medicaid Services (CMS) controls the criteria for federal payment for medical services. CMS may act as an indirect regulator of practice—if you won't get paid for it, you probably won't do it—and there are other indirect regulators by accreditation (e.g., The Joint Commission) or by voluntary participation (e.g., Institute for Healthcare Improvement and the Leapfrog Group). However, indirect regulation is generally not comparable to direct regulation, as in the NRC's direct oversight of nuclear power, or the Federal Aviation Administration's direct oversight of aviation.Of note, in aviation and nuclear power, the firms themselves (individual airlines or individual power utility companies) impose strong safety control over the day-to-day work of personnel, often over and above the requirements of the regulator. This is only partially true for healthcare. The work of nurses, pharmacists, and allied health personnel comes under the direct purview of the employing institution, although the degree to which actual practices at the front line reflect the stated goals or policies of the institution varies greatly.The practices of physicians have less direct oversight by the firm; the majority of physicians are independent (fee-for-service, not salaried) members of the hospital's medical staff. As such, though not under direct line authority of the hospital, they must apply for clinical privileges and their actions can be scrutinized by the institution. Other influences on physician practices come from specialty board certification and professional society practice guidelines.However, when guidelines are well articulated, strongly evidence based, and widely agreed upon by the medical community, it typically takes a decade until these practices are consistently adopted and executed. Regardless of whether physicians are actual employees of the hospital or are independent medical staff members, in practice they have nearly unlimited discretion as to how they manage individual patients. Local standardized operating procedures are occasionally imposed, but even then their authority and compliance may be minimal, especially without specific incentives for compliance or disincentives for noncompliance.In fact, all of the hazardous industries suffer from a phenomenon in which what is articulated for safety on paper does not always correspond to the reality at the front line or even to a plausible reality that could be implemented at the front line. One aspect of this has been described by the sociologist Lee Clarke as “fantasy documents,” such as policies, procedures, or plans that are created to satisfy a regulatory, internal, or public relations need, but are known by most participants to be infeasible. They “sound good” and make people feel better, but it is widely known—at least by frontline staff—that they cannot really work as described.78One factor about the aftermath of accidents that affects other industries in a profound way that doesn't happen in healthcare is that a severe accident in nuclear power, in oil refining, or even in aviation, can seriously harm the “means of production.” That is, not only may the accident hurt workers or the public, it also takes out of service the facilities (power plants, refineries, or airplanes) that are used to do the work. Even ignoring cleanup or repair costs (if relevant), this means that there is a huge financial and operational loss from the lost means of production.As indicated above, for nuclear power, this can expand all of the way to long-term plans to abandon this method of generating electricity. None of these effects is seen in healthcare. If we harm a patient in the operating room, that may be very sad, may generate litigation, and may (rarely) garner bad publicity for the hospital, but we just “send for the next patient.”I cynically suggest that if the aftermath of medical errors or preventably suboptimal care events in an OR, ICU room, or emergency department bay would be to take that room out of service for days or months, that would generate a much more aggressive response for improvement by the healthcare institution than we currently see.It is true that healthcare cannot strive for the same level of standardization within a facility, or especially between facilities having the same basic technology, as is achieved in nuclear power or the aviation industry. Human beings are not reactors or airplanes and diseases are not understood at fundamental levels, hence healthcare personnel need more flexibility to respond to unanticipated situations. However, as for many things in healthcare, the pendulum is currently too far to the side of insufficient standardization.On the equipment and procurement side, the decentralization and huge number of sites of care raise all sorts of issues. Unlike the 106 nuclear power plants of perhaps a few dozen designs, the hundreds of thousands of patient rooms, ORs, ICU bays, etc., in the 8,000 institutions each needs outfitting with various devices such as monitors and infusion pumps.Rather than being purchased as large, integrated, preconfigured units, such devices are often purchased one at a time, or, at best, in periodic bundles of hundreds. The combinatorics of all of the devices makes it impossible for vendors to test them in use all together. And, until fairly recently, there was little demand on vendors—either from regulators or the marketplace—for serious human factors testing of either prototypes or actual devices.The decision to purchase equipment is often made by small committees or single influential individuals based on idiosyncratic assessments of features. Purchase decisions are strongly affected by the purchase cost of the equipment and disposable supplies, and only rarely by total life cycle or systems cost. One area where both nuclear power and healthcare can benefit is to achieve and maintain a high degree of user-centered human factors testing of concepts, prototypes, and actual equipment during the design, premarketing, marketing, and postmarketing phases of product life.Issues of design are compounded in healthcare by the current variability in the preparation and training of personnel on the use of the equipment, even that which is life critical. Nursing and allied health disciplines generally have more structured mechanisms for providing training to personnel before they use advanced equipment via “in-services” and checkoffs of competency.Even so, experience suggests that such checkoffs can be “fantasy activities”—showing that immediately after training, and in a quiet environment, a clinician can demonstrate performance of specific tasks doesn't necessarily correlate with skill with the device during actual use in challenging real-life conditions. Fortunately, most of the time, personnel do rapidly learn to use the essential aspects of equipment in their routine bedside activities.However, problems may arise especially for devices that are used only rarely (e.g., defibrillators), in situations requiring the use of advanced and complex device features, or when it is necessary to deal with unexpected glitches or faults (e.g., when something isn't hooked up quite right or the wrong button is accidentally pressed) in a stressful in physicians have been more resistant to to training, which is rarely made Thus, it is not for a physician to a device a anesthesia in patient having never or seen or used the healthcare, there is like the in aviation, of how much experience has as an they cannot an they have been specifically and as on that of In nuclear power, each plant has a of the control room on so it is that plant operators would be to control the reactor and systems if they are not with the this suggests that perhaps healthcare nuclear power have the optimal structure for In healthcare, it is and with little devices and systems are In nuclear power, there is strong control and little risk of by but at the cost of extreme and to especially in safety critical in so many there may be a in the Clearly, to its and physician autonomy and control by firms or but has to up to its for very high Nuclear power has an safety at least in the United States, but is, to a in its not of and other the two in many there are many of where of and may each industry to a that is more and at cost to the

Muhammad Asim Tufail, Abu Hassan Abu Bakar, Wiwied Virgiyanti, Faisal Manzoor Arain

Technological development in the information and communication technologies (ICT) sector is essential to attain sustainability in today’s era. Cities have developed satellite towns at the periphery with hi-fidelity digital and physical infrastructure which converts a single cantered city into a multi cantered one. In case of Kuala Lumpur Metropolitan Area (KLMA) the shift of civic services to Putrajaya and development of Multimedia Super Corridor (MSC) which offers incentives to local and foreign companies to develop a super block of research and development based economic sector. This development spearheaded the Malaysian Vision 2020 of knowledge based economy and society and has become an attraction to the business community across Malaysia. The purpose of this paper is to discuss the key factors that have attracted the companies to physically move from KLMA to MSC. To achieve the study objectives, a questionnaire survey and interviews were carried out to collect pertinent information from companies focusing on businesses in finance, insurance and real-estate. The data collected was analyzed to identify the ranking of variables of Bill of Guarantees offered in MSC policy. The study findings suggest that in addition to good infrastructure and good working environment, the tax exemption offered by the government has been the driving force for companies to decentralize towards MSC. The results suggest that the better infrastructure, connectivity, low taxes, low telecommunication tariffs, and land cost were considered as the most important factors for decentralization of ICT companies in Malaysia. The other factors that were highlighted in this study include low cost of doing business, and competitive conditions for attracting companies to avail MSC status. The study also presents the initial hindrances faced by the ICT companies i.e., accessibility issue for city clients and workers, high rental rates of the property and slow development of supportive public amenities in MSC

Norfariza Mohd Radzi, Muhammad Faizal A. Ghani, Saedah Siraj, Mojgan Afshari

This article presents findings on the essential strategies required at the school site and the relevant people responsible for the effective implementation of school-based financial management in Malaysia. Many lessons have been learned since more than a decade of the school-based financial management reform in Malaysia through the establishment of school as Responsibility Centre or Pusat Tanggungjawab (PTj). The government of Malaysia has allocated an enormous amount of money for the education sector during last the few decades to ensure the highest quality of education for Malaysian society. Therefore school finance has to be managed strategically to confirm the best educational outcome through effective resource allocation. This study employed the qualitative approach using the interview method with ten selected principals heading schools with financial autonomy in Malaysia. The findings revealed a few essential strategies that need to be focused by schools both at individual level and school level in order to successfully manage school finances. The collaboration and mutual effort from all stakeholders are expected to bring transformation toward effective school based financial management in Malaysia.. Keywords: school-based, financial management, effective,

Jansen, Mark A.

This paper concerns the open source software project Bitcoin, which is often described as virtual cash. The paper investigates what ‘virtual’ signifies when applied to ‘cash’ and in turn what ‘virtual cash’ says about Bitcoin. Bitcoin is the latest cryptographic effort to create digital cash-like tokens, where Bitcoin’s designer Nakamoto argues that users now no longer have to trust a third party, traditionally the bank. Paradoxically, for Bitcoin it is key that nodes in the network agree on the status of the shared block chain database. Trust remains to be established, albeit in a different manner. Power is not destroyed, but transferred from banks to Bitcoin’s protocol. The paper concludes that ‘virtual’ refers to Bitcoin’s model of how cash appears to function in everyday exchange, allowing user privacy. Bitcoin does not model another aspect of cash, its function as a credential referring to debt. Bitcoin discontinues the concept of debt.

Hubert Lacoin, François Simenhaus, Fabio Lucio Toninelli

Let be a bounded, smooth enough domain of ℝ 2 . For L &gt; 0 consider the continuous‐time, zero‐temperature heat bath stochastic dynamics for the nearest‐neighbor Ising model on (ℤ/ L ) 2 (the square lattice with lattice spacing 1/ L ) with initial condition such that σ x =−1 if x ∊ and σ x = + 1 otherwise. We prove the following classical conjecture due to H. Spohn: In the diffusive limit where time is rescaled by L 2 and L → ∞, the boundary of the droplet of “‐” spins follows a deterministic anisotropic curve‐shortening flow such that the normal velocity is given by the local curvature times an explicit function of the local slope. Locally, in a suitable reference frame, the evolution of the droplet boundary follows the one‐dimensional heat equation. To our knowledge, this is the first proof of mean‐curvature‐type droplet shrinking for a lattice model with genuine microscopic dynamics. An important ingredient is in our forthcoming work, where the case of convex was solved. The other crucial point in the proof is obtaining precise regularity estimates on the deterministic curve‐shortening flow. This builds on geometric and analytic ideas of Grayson, Gage and Hamilton, Gage and Li, Chou and Zhu, and others.© 2015 Wiley Periodicals, Inc.

Mortéza Mahmoudian

Although academic and practical interest in non-fungible tokens (NFTs) has continuously increased over the last few years, there is still a need to better understand their social acceptability. The aim of the study was to explore the double edge of NFT legitimacy for NFTs by unveiling the role of sustainability and by adopting technology legitimacy and the field of sustainability transition studies as a theoretical lens. Specifically, this research investigates the role of sustainability in securing and maintaining technology legitimacy within NFT projects. We interviewed 12 experts through exploratory qualitative research. The findings highlight three main ways in which sustainability participates in the legitimation of NFT projects. While sustainability can be inherent in the NFT project itself, this legitimation can also be derived from the perceived sustainability of the NFT technology or be part of innovative business models. Theoretical contributions and managerial implications are then discussed. JEL CODES: O33, O35, O50

Yang Liu, Yuan Cao, Marcos Curty, Sheng‐Kai Liao · 16 authors

Bit commitment is a fundamental cryptographic task that guarantees a secure commitment between two mutually mistrustful parties and is a building block for many cryptographic primitives, including coin tossing, zero-knowledge proofs, oblivious transfer and secure two-party computation. Unconditionally secure bit commitment was thought to be impossible until recent theoretical protocols that combine quantum mechanics and relativity were shown to elude previous impossibility proofs. Here we implement such a bit commitment protocol. In the experiment, the committer performs quantum measurements using two quantum key distribution systems and the results are transmitted via free-space optical communication to two agents separated with more than 20 km. The security of the protocol relies on the properties of quantum information and relativity theory. We show that, in each run of the experiment, a bit is successfully committed with less than 5.68*10^-2 cheating probability. Our result demonstrates unconditionally secure bit commitment and the experimental feasibility of relativistic quantum communication.

Sylvain Auroux

Although academic and practical interest in non-fungible tokens (NFTs) has continuously increased over the last few years, there is still a need to better understand their social acceptability. The aim of the study was to explore the double edge of NFT legitimacy for NFTs by unveiling the role of sustainability and by adopting technology legitimacy and the field of sustainability transition studies as a theoretical lens. Specifically, this research investigates the role of sustainability in securing and maintaining technology legitimacy within NFT projects. We interviewed 12 experts through exploratory qualitative research. The findings highlight three main ways in which sustainability participates in the legitimation of NFT projects. While sustainability can be inherent in the NFT project itself, this legitimation can also be derived from the perceived sustainability of the NFT technology or be part of innovative business models. Theoretical contributions and managerial implications are then discussed. JEL CODES: O33, O35, O50

Charmaine Henriques

Distributed by Third World Newsreel, 545 Eighth Avenue, 10th Floor, New York, NY 10018; 212-947-9277Produced by Tracy AssingDirected by Tracy Assing2010, DVD, color, 40 min. “Our ancestors were written out of history. Finding out what our story is continues to be a work in progress. It is true that a few more books have been written, but Caribbean history remains largely under researched. In some ways the damage has already been done, because most people believe there are no true Caribs, because an only true Carib is a dead Carib.” Tracy Assing, The Amerindians. The Amerindians is a documentary that details the history and the current day concerns of one of the few remaining indigenous communities in the Caribbean. Tracy Assing, the director and narrator of the film, is a member of the Santa Rosa Carib Community located in Arima, Trinidad. Ms. Assing learned in school that there were 2 tribes in the Caribbean: the Arawaks and the Caribs. The Arawaks were peace loving farmers and the Caribs, warlike cannibals. Both groups were eventually decimated by the Spanish. Assing understood she was Carib, but the Caribs were annihilated; these revelations made her begin to ask her family who were they and lead her on a journey to discover the truth about her identity. Assing knew what the history books alleged, but wanted to speak to respected educators to find out if research discovered any new information. She found Dr. Basil Reid (Lecturer in Archaeology) and Dr. Bridget Brereton (Professor of History) both of the University of the West Indies, St. Augustine. Dr. Reid thinks there needs to be a way to redefine history. History in the Caribbean starts with the beginning of the arrival of Columbus. However the Amerindians were there long before Columbus’ arrival, with a history of their own. Dr. Reid also states that researches use the terms Arawak and Carib as a function of convenience, but these terms don’t mean much in relations to Caribbean archaeology since it is not possible to go back in time and ask these individuals how they referred to themselves. Dr. Brereton further explains that the inhabitants present at the time of European contact were divided into several ethnic communities, but they or their ancestors came from the northern area of South America and spoke a language from the Arawakan Language Group. Traditionally, historians had written Amerindians out of the national history. They have followed the narrative that the pure-blooded Amerindians disappeared, and that evidence was accepted as proof that Amerindians as Amerindians had no part to play in the modern history of Trinidad or Tobago. In reality, by the end of the 15th century there were as many as 40,000 Indians living on the island. Based on early writings of French, Spanish, Dutch and English explorers it is known that some of their tribal names were Taino, Guarani, Yaio and Warao. However, in the late 1780’s the last Spanish governor Jose Maria Chacon gathered together the remaining Christianized Amerindian people and relocated them to Arima. Since then, Arima has been seen as the main center of Amerindian settlement and civilization for the remaining indigenous population in Trinidad. Only converted Indians were allowed onto the mission in Arima because priests and bishops felt that segregation was the only way in which the Christianized Indios would not be tempted by the pagan practices of the uninitiated. The residents of the mission were first referred to as Indios and within time then Carib. Later migration of Indios were integrated onto the mission where they mixed with the converted Indios (their descendants are now the current population of Arima). In 1974, the Santa Rosa Carib Community was formed. Its main mandate was the up keep of the Santa Rosa Festival. The President/Chief of the organization Ricardo Bharath-Hernandez realized there was more at stake and invited descendants of other indigenous groups from Guyana, Suriname and St. Vincent for a community exchange. Thus began the Amerindian Day of Recognition, celebrated on October 14th of every year. Not everybody is satisfied with the Amerindian Day of Recognition. Cristo Adonis (Santa Rosa Carib Community’s Medicine Man) views the celebration as a show. He thinks the additional land requested by the Carib Community should be given to them so there could be a better celebration, not only for song and dance but in a more educational way with young people being more involved and along these lines the different parties that come to Trinidad for the for the Amerindian Day of Recognition can stay for longer than a few days and participate in workshops. The Santa Rosa Festival, which celebrates the Feast of Santa Rosa de Lima (the first canonized Roman Catholic Saint from the Americas) still takes place each year during the last weekend of August and has become a uniting and dividing factor among the members of this society. Assing admits that she stopped taking part in Festival when she was 8 years old because she felt the legend of Santa Rosa had more in common with the fantasy stories written by Edith Blyton that she was reading at the time. Also, by then she had developed an awareness that being indigenous had less to do with being a good Catholic and more to do with the sense of belonging to the land. Cristo Adonis is in agreement with Assing. Adonis respects the elders that take part in the Festival and would not want it to end but his opinion is the myth is a made-up story. Meanwhile, Parish Priest Monsignor Christian Pereira confirms that the validity of the story may be questionable, but understanding the meaning of the myth is more important than whether it was true or false. There are also other issues of contention within the Santa Rosa Carib Community. Assing and her cousins grew up hunting, fishing, harvesting fruit, herbs and flowers and learning how to plant corn and cassava. Now her cousins’ children will not fish in the river due to the pollution and houses take up spaces where gardens would have been made. When the Spanish arrived they found bones within dwellings and it was assumed this was confirmation of cannibalism, but what was going on was a form of ancestral worship. When individuals died, the bones of the deceased remained with their relatives. The bones were used to communicate with those who had passed on by making offerings to them and using them in smoke ceremonies; it was like the member of the family was still alive. Today when someone dies, they go to the Catholic Church where there is a mass, procession and funeral and the deceased is put into the ground. No indigenous aspect to the funeral rite remains. Assing sees this as a loss of connection with her ancestors, a loss of tradition and a loss of an important avenue of communication. During the “Consultation” on: Indigenous People Rediscovering and Preserving a Way of Life (held December 13, 2009 at the Arima Town Hall) Assing retold a story where she had a frank discussion with the President of the Santa Rosa Carib Community Ricardo Bharath-Hernandez (who declined to be interviewed for the documentary). She asked him what he wanted his legacy to be and later put forth a proposal to have the community center become an operational research center. She describes as a child how she visited the community center where she saw artifacts, woven baskets and mats, and photographs. Now as an adult she walks into the community center and sees the same things, even though many researchers have come to interview members of the community and as a consequence there is video. Equally, there are books and papers being written, therefore the question remains how can and why don’t the youth of the Carib Community have access to this information. Assing felt this is something that needs to be addressed because there is more to the Santa Rosa Carib Community than the Catholic festival. Between these two entities the core of the main dispute within the Carib Community is once again revealed: Assing feels that the Carib Community is more than and has more to offer than the Santa Rosa Festival, while Ricardo Bharath-Hernandez feels due to the Santa Rosa Festival the remnants of the indigenous population in Arima has survived. Nonetheless, during the 2010 Amerindian Day of Recognition celebration, the Minister of Arts and Multiculturalism, Winston Peters gave assurances that he would ensure indigenous people would receive land they deserved and through the Amerindian Project Communities in collaboration with the Santa Rosa Carib Community, the government is working on several proposals for long-term development of the indigenous community. The pacing of the documentary is slow and it does not pick up until after the 15 minute mark. The first half of the film is basically dedicated to giving background information about the Santa Rosa Festival. While, I understand the background information was necessary to show that the concentration on the Festival is taking away from the further exploration and preservation of the Carib culture, too much time was taken up on the Festival. Also at times the film seemed disjointed. The film would have flowed better if it started with the history of indigenous peoples in the Caribbean, followed by the community issues and ending with the information about the Festival. The movie does show some interesting artifacts and illustrations and when it focuses on the land and nature, the colors and surroundings are vibrant, and the cinematography is crisp and clear. Even though the film has its problems, the second half of the movie does make up for the first half and as Tracy Assing states, there is not a lot of research being done on Caribbean history much less history of indigenous cultures in the Caribbean. Hence, I would still recommend The Amerindians.

Elena Cigu, Irina Bilan

The decentralization process was continuous in Romania starting with 1990, generating the implication of local authorities in local public finance, as a result of exclusives, shared and delegate competences and, so, the necessity of ensuring a good management of resources and expenditures. Therefore, the decentralization of competences / responsibilities from State to local governments was a major Romanian political theme and a first rank component of management of local public finance, as main driving instrument for local development. Specific legal framework of local responsibilities is established both to European and national level. Researchers based on regulation and practice have tried to quantify the responsibilities developing different models to measure local revenue and expenditures autonomy. The paper aims is to identify some models for measuring local expenditure autonomy and to apply for Romania. The study is oriented to measure local expenditure autonomy in Romania using Bell, Ebel, Kaiser and Rojchaichainthorn's model.

Amanda Talsma, Jan Sloots, Janneke van de Ouweland

Dit onderzoek is verricht voor het Lectoraat Duurzaam Financieel Management aan de Hanzehogeschool. Er wordt onderzocht welke gevolgen het gebruik van de Bitcoin heeft voor de maatschappij.

Mezgebe Weldegebrieal Gebremedhin

This study attempted to investigate the An assessment on Decentralized Service Delivery in the&#13;\nHealth Sector in Ahferom Wereda which is one of the administrative divisions of Tigray National&#13;\nRegional State. The main objectives of this study was to examine adequate human resources and&#13;\nhealth service availabilities including pharmaceutical commodities, the local level health&#13;\nservice delivery arrangements in terms of accountability, the institutional capacity of local&#13;\ngovernment in implementing and coordinating decentralized health service programs and&#13;\npolicies and identify the challenges of decentralized governance in the process of health service&#13;\nprovision. The study used a descriptive survey research design and employed both qualitative&#13;\nand quantitative data types, specifically semi -questionnaires, semi-structured interviews and&#13;\nfocus group discussion. In addition to this, study was employed both primarily and secondary&#13;\nsources of data. The sampling designs used in this study are both probability and non probability&#13;\nsampling designs. These are, purposive, clustered, lottery method, proportionate sampling and&#13;\nfinally convenience sampling was employed. For the purpose of this, the study used a sample of&#13;\n190 house hold heads. In addition to this, the study used 20 key respondents purposely. The key&#13;\nrespondents with regard to this objective were officials in health related management and health&#13;\nservice providers of the wereda .The major findings of this study reveals that though&#13;\ndecentralization is contributing better health services availability, it constrains ensuring of&#13;\nadequate human recourse, geographical accessibility and adequate pharmaceutical commodities&#13;\nfor better health service delivery to the public. Besides, there is failure of accountability in&#13;\nrelation to financial planning, reporting and implementation of activities, the availability of&#13;\nchanneling procedures for complaints, strong institutional capacity in terms of leadership,&#13;\nhuman resources management and financial management capacity. In relation to the challenges&#13;\nin health service delivery; shortage of sufficient and competence human racecourses, inadequate&#13;\npharmaceutical commodities, insufficient financial resources and weak leadership are identified&#13;\nas the major challenges. The study recommended organizing public to participate in financing&#13;\nand health service delivery, enhancing leadership and improvement, filling vacancies and&#13;\nenhancing competency of the staff, strengthening standardized auditing instrument and&#13;\nimproving and strengthening inter-organizational relations with different NGOs are more&#13;\nrelevant.

Kai-Min Chung, Daniel Dadush, Feng-Hao Liu, Chris Peikert

The smoothing parameter $η_ε(\mathcal{L})$ of a Euclidean lattice $\mathcal{L}$, introduced by Micciancio and Regev (FOCS'04; SICOMP'07), is (informally) the smallest amount of Gaussian noise that "smooths out" the discrete structure of $\mathcal{L}$ (up to error $ε$). It plays a central role in the best known worst-case/average-case reductions for lattice problems, a wealth of lattice-based cryptographic constructions, and (implicitly) the tightest known transference theorems for fundamental lattice quantities. In this work we initiate a study of the complexity of approximating the smoothing parameter to within a factor $γ$, denoted $γ$-${\rm GapSPP}$. We show that (for $ε= 1/{\rm poly}(n)$): $(2+o(1))$-${\rm GapSPP} \in {\rm AM}$, via a Gaussian analogue of the classic Goldreich-Goldwasser protocol (STOC'98); $(1+o(1))$-${\rm GapSPP} \in {\rm coAM}$, via a careful application of the Goldwasser-Sipser (STOC'86) set size lower bound protocol to thin spherical shells; $(2+o(1))$-${\rm GapSPP} \in {\rm SZK} \subseteq {\rm AM} \cap {\rm coAM}$ (where ${\rm SZK}$ is the class of problems having statistical zero-knowledge proofs), by constructing a suitable instance-dependent commitment scheme (for a slightly worse $o(1)$-term); $(1+o(1))$-${\rm GapSPP}$ can be solved in deterministic $2^{O(n)} {\rm polylog}(1/ε)$ time and $2^{O(n)}$ space. As an application, we demonstrate a tighter worst-case to average-case reduction for basing cryptography on the worst-case hardness of the ${\rm GapSPP}$ problem, with $\tilde{O}(\sqrt{n})$ smaller approximation factor than the ${\rm GapSVP}$ problem. Central to our results are two novel, and nearly tight, characterizations of the magnitude of discrete Gaussian sums.

Patrick Hayden, Kevin R. Milner, Mark M. Wilde

Suppose that a polynomial-time mixed-state quantum circuit, described as a sequence of local unitary interactions followed by a partial trace, generates a quantum state shared between two parties. One might then wonder, does this quantum circuit produce a state that is separable or entangled? Here, we give evidence that it is computationally hard to decide the answer to this question, even if one has access to the power of quantum computation. We begin by exhibiting a two-message quantum interactive proof system that can decide the answer to a promise version of the question. We then prove that the promise problem is hard for the class of promise problems with 'quantum statistical zero knowledge' (QSZK) proof systems by demonstrating a polynomial-time Karp reduction from the QSZK-complete promise problem 'quantum state distinguish ability' to our quantum separability problem. By exploiting Knill's efficient encoding of a matrix description of a state into a description of a circuit to generate the state, we can show that our promise problem is NP-hard with respect to Cook reductions. Thus, the quantum separability problem (as phrased above) constitutes the first nontrivial promise problem decidable by a two-message quantum interactive proof system while being hard for both NP and QSZK. We also consider a variant of the problem, in which a given polynomial-time mixed-state quantum circuit accepts a quantum state as input, and the question is to decide if there is an input to this circuit which makes its output separable across some bipartite cut. We prove that this problem is a complete promise problem for the class QIP of problems decidable by quantum interactive proof systems. Finally, we show that a two-message quantum interactive proof system can also decide a multipartite generalization of the quantum separability problem. © 2013 IEEE.

Morgen E. Peck

Bitcoin, the cryptocurrency powered by a decentralized peer-to-peer network of computers, has been hot this season. With the exchange rate bobbing around US $100, those involved in creating new bitcoins' and upholding the network that makes them valuable' have become locked in an arms race of sorts, seeking new, powerful machines that will enrich them but that could also destabilize the nascent virtual money.

Emmanuel Aboagye, Otuo Serebour Agyemang

This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.