The growth of Africaâs towns and cities has outpaced local authority capacity in terms of management, infrastructure, and financing. Many African towns and cities are now facing a governance crisis. Accordingly, the capability and capacity of urban local government to provide basic services to a growing population have entered the core of the development debate. In particular, fiscal decentralization â the devolution of revenue mobilization and spending powers to lower levels of government â has become a main theme of urban governance in recent years.\nThis paper explores the opportunities and constraints facing local revenue mobilization in urban settings in Africa. The study examines various revenue instruments available, including property taxes, business licences, and user fees, and their effect on economic efficiency and income distribution. Moreover, political and administrative constraints facing various revenue instruments and factors impacting on citizensâ compliance behaviour are discussed. The analysis is exemplified by cases from across Africa and other regions. Local governments need to be given access to adequate resources to do the job with which they are entrusted. However, a general conclusion emerging from this study is that local revenues mobilized in most urban authorities in Africa are necessary but not sufficient to develop and supply adequate services for the fast-growing urban population.
This Article explores, and ultimately embraces, a new exception to the complete diversity rule in removal cases: the doctrine of procedural misjoinder. We argue that the doctrine offers federal courts a vital tool with which to police joinder gamesmanship. Absent this power, plaintiffs may preclude defendant access to federal courts by the relatively simple expedient of joining in state court largely unrelated claims against or on behalf of non-diverse parties. The resulting lawsuit thus fails the complete diversity test, rendering such cases removal-proof. Like fraudulent joinder, the long-standing practice of ignoring non-diverse parties against whom no valid claim may be asserted, the doctrine of procedural misjoinder would permit federal courts to disregard any diversity-destroying parties who have been improperly added to the state lawsuit. Because access to federal courts is at stake, we believe federal courts should adopt this new doctrine, applying federal joinder standards to test the legitimacy of plaintiffsâ party alignments before denying removal jurisdiction.
R. v. Oakes is widely regarded as one of the most important judgments interpreting Canadaâs Charter of Rights and Freedoms. In addition to laying down its famous proportionality test to assess the reasonableness of limits on Charter rights, it clarified the Supreme Court of Canadaâs Courtâs interpretive methodology for Charter cases, perhaps most centrally that rights are of presumptive importance, and limitations the exception that are only acceptable if governments meet a demanding test of justification. The citation of Oakes by courts in Antigua and Barbuda, Australia, Fiji, Hong Kong, Ireland, Israel, Jamaica, Namibia, South Africa, the United Kingdom, Vanuatu and Zimbabwe has made Oakes one of the central models for rights-based constitutional adjudication. So the almost immediate retreat from Oakes is of broader constitutional significance, both domestically and abroad. There is a dominant narrative on what the true legacy of Oakes and the retreat from Oakes are. The argument is that Oakes set out a uniform approach for assessing justifiable limitations on Charter rights irrespective of differences in context, but that in the decade following Oakes, the Court searched for criteria of deference, to reliably and predictably categorize cases where deference was warranted and those where it was not. These categories were not applied consistently by the Court, and, indeed, produced disagreement within the Court over how they should be applied in specific cases. Underlying both trends were concerns regarding the cogency of the distinctions employed by the Court to delineate the boundaries of these categories. Although the dominant narrative captures much of Oakesâ legacy, it misses much of what is at stake in many recent s. 1 cases, and by implication, what the true legacy of Oakes and the retreat from Oakes are. Oakes created an enormous institutional dilemma for the Court, by setting up a conflict between the demand for definitive proof to support each stage of proportionality analysis, and the reality of policy making under conditions of factual uncertainty. The legacy of Oakes is that the central question of s. 1 is how the Court should allocate the risk of factual uncertainty when governments legislate under conditions of imperfect information. If Oakes is a comparative model for proportionality analysis under other rights-protecting constitutions, then these kinds of problems are not particular to Canada. Foreign courts would be wise to grapple with these difficulties with the benefit of two decades of reflection by Canadian courts instead of simply applying the Oakestest in its original and undeveloped form.
A key challenge for software engineering is to learn how to reconcile the formal world of the machine and its software with the non-formal real world. In this paper, we describe Problem Oriented Software Engineering (POSE), an approach that brings both non-formal and formal aspects of software development together within a single theoretical framework for software engineering design. We show how POSE captures development as the recordable and re-playable design theoretic transformation of software problems. Their representation and transformation allows for the identification and clarification of system requirements, the understanding and structuring of the problem world, the structuring and specification of a hard-ware/software machine that can ensure satisfaction of the requirements in the problem world, and the construction of adequacy arguments, convincing both to developers and to customers, users and other interested stake-holders, that the system will provide what is needed. Designs are recordable and re-playable through our adaptation of tactics, a (now standard) form of programming language used in transformational proof theoretic presentations. This brings to our system many other benefits of such approaches, including the ability to abstract from a captured design, and to combine programmatically captured designs. This paper provides an example-driven presentation of our framework for software engineering design.
Narendra Kunapareddy, Parsa Mirhaji, David Richards, S. Ward Casscells
Although the decentralized and autonomous implementation of health information systems has made it possible to extend the reach of surveillance systems to a variety of contextually disparate domains, public health use of data from these systems is not primarily anticipated. The Semantic Web has been proposed to address both representational and semantic heterogeneity in distributed and collaborative environments. We introduce a semantic approach for the integration of health data using the Resource Definition Framework (RDF) and the Simple Knowledge Organization System (SKOS) developed by the Semantic Web community.
Only for the recipients of foreign aid is something akin to central planning seen as a way to achieve prosperity. The end of poverty is achieved with free markets and democracyâwhere decentralized âsearchersâ look for ways to meet individual needsânot Poverty Reduction Strategy Papers (PRSPs) to achieve Millennium Development Goals (MDGs). The PRSPs and MDGs create lots of bureaucracy but hold no one specific agency in foreign aid accountable for any one specific task. Planners in foreign aid use the old failed models of the pastâthe âFinancing Gapâ, the âpoverty trapâ, the government-to-government aid model; and the âexpenditures = outcomesâ mentality. Searchers in foreign aid would imitate the feedback and accountability of markets and democracy to provide goods and services to individuals until homegrown markets and democracy end poverty in the society as a whole. An example of the more promising âsearchersâ approach in foreign aid is 2006 Nobel Peace Laureate Mohammad Yunus and Grameen Bank.
There is increasing interest in fiscal decentralization in Peru as a mechanism to generate more involved decision-making at the subnational level. This is tempered with a continuing emphasis on overall fiscal stability. However, considerable work needs to be undertaken to define more clearly expenditure responsibilities and financing mechanisms that increase local accountability. In addition, a more transparent fiscal transfer system is needed, together with clarity in expenditure management at all levels of government. The paper suggests that a substantial work agenda is needed to extend the decentralization process with greater transparency.
Since the endorsement of a socialist market economy in 1992 in the 14th National Congress of the Chinese Communist Party, self-financing and fee-charging principles have been widely adopted, and finally legitimized in China's higher education system. However, refonns in China's post secondary education, mainly privatization and tuition fee hikes, have produced some serious controversies and concerns among students, parents, and international education researchers. This article delves into the issues of post secondary education refonn in China and brings into attention problems that occur when policies are institutionalized in a centralized decentralization setting. Depuis l'adhesion a une economie de marche socialiste au 14e Congres national du Parti communiste chinois, les principes d'autofmance et de privatisation ont ete adoptes partout, et finalement legitime dans le systeme d'education tertiaire en Chine. Neanmoins, les refonnes dans le systeme d'etude post-secondaire chinois, surtout dans la privatisation et dans la hausse des frais de scolarite, ont provoque de serieuses controverses et des soucis chez les etudiants, parents, et chercheurs intemationaux sur l'enseignement. Cet article etudie les problemes de reforme au niveau post-secondaire en Chine et attire l'attention sur les problemes qui surviennent lorsque les politiques se font institutionnalisees dans un milieu de decentralisation centralisee.
Background theories in science are used both to prove and to disprove that theory choice is underdetermined by data. The alleged proof appeals to the fact that experiments to decide between theories typically require auxiliary assumptions from other theories. If this generates a kind of underdetermination, it shows that standards of scientific inference are fallible and must be appropriately contextualized. The alleged disproof appeals to the possibility of suitable background theories to show that no theory choice can be timelessly or noncontextually underdetermined: Foreground theories might be distinguished against different backgrounds. Philosophers have often replied to such a disproof by focussing their attention not on theories but on Total Sciences. If empirically equivalent Total Sciences were at stake, then there would be no background against which they could be differentiated. I offer several reasons to think that Total Science is a philosophersâ fiction. No respectable underdetermination can be based on it.
In recent years, formation flying has been recognized as an enabling technology for a variety of mission concepts in both the scientific and defense arenas. Examples of developing missions at NASA include magnetospheric multiscale (MMS), solar imaging radio array (SIRA), and terrestrial planet finder (TPF). For each of these missions, a multiple satellite approach is required in order to accomplish the large-scale geometries imposed by the science objectives. In addition, the paradigm shift of using a multiple satellite cluster rather than a large, monolithic spacecraft has also been motivated by the expected benefits of increased robustness, greater flexibility, and reduced cost. However, the operational costs of monitoring and commanding a fleet of close-orbiting satellites is likely to be unreasonable unless the onboard software is sufficiently autonomous, robust, and scalable to large clusters. This paper presents the prototype of a system that addresses these objectives-a decentralized guidance and control system that is distributed across spacecraft using a multiple team framework. The objective is to divide large clusters into teams of "manageable" size, so that the communication and computation demands driven by N decentralized units are related to the number of satellites in a team rather than the entire cluster. The system is designed to provide a high level of autonomy, to support clusters with large numbers of satellites, to enable the number of spacecraft in the cluster to change post-launch, and to provide for on-orbit software modification. The distributed guidance and control system will be implemented in an object-oriented style using a messaging architecture for networking and threaded applications (MANTA). In this architecture, tasks may be remotely added, removed, or replaced post launch to increase mission flexibility and robustness. This built-in adaptability will allow software modifications to be made on-orbit in a robust manner. The prototype system, which is implemented in Matlab, emulates the object-oriented and message-passing features of the MANTA software. In this paper, the multiple team organization of the cluster is described, and the modular software architecture is presented. The relative dynamics in eccentric reference orbits is reviewed, and families of periodic, relative trajectories are identified, expressed as sets of static geometric parameters. The guidance law design is presented, and an example reconfiguration scenario is used to illustrate the distributed process of assigning geometric goals to the cluster. Next, a decentralized maneuver planning approach is presented that utilizes linear-programming methods to enact reconfiguration and coarse formation keeping maneuvers. Finally, a method for performing online collision avoidance is discussed, and an example is provided to gauge its performance.
At first thought, there would appear to be little or no obvious connection between Landmarks in Hepatology and the essay recently published in the New England Journal of Medicine by 1986 Nobel Peace Prize Laureate Elie Wiesel.1 In 40 articles published over the past 4 years, the Landmarks series has not only documented the background of numerous discoveries in hepatology that have resulted from observation and experimentation, but it has also celebrated the physicians and investigators who brought us these new hepatological insights, investigations, and therapies. The Landmarks essays have been embellished with play on words and other attempts at humor, biography, history, politics, and the arts, and have presented for the readership abstruse facts and historical trivia to enhance the appreciation and enjoyment of the science and clinical innovation of hepatology. In contrast, Professor Wiesel's essay reminded us of one of the saddest eras in medical experimentation that serves as an archetype for inhumanity perpetrated by physicians, often but not always in the name of science, on hapless human subjects who had no choice but to participate in the most cruel and brutal experiments. It goes without saying that there was no semblance of informed consent. Wiesel refers, of course, to the medical experiments carried out by Nazi physicians and their henchmen and lackeys during the Dark Age known as the Third Reich. Out of this sordid experience, portrayed in the accounts of survivors and eyewitnesses, historical documents, and in the testimonies of those physicians who faced the Nuremberg Tribunal, ethical rules for experimentation on patients and volunteers were codified2 (Fig. 1). Surely, however, there is no connection between the celebration of hepatological discovery and the perversion of Nazi medical brutalityâbut there is. And because there is we have the opportunity, justification, and, in fact, the duty to confront the memory of these events so as to reinforce our vigilance and determination to uphold the highest ethical standards in hepatology and, indeed, in all of medicine, be it experimental science or routine clinical practice. This connection between discovery in hepatology and cruel experimentation was personified by one of the most prestigious and prodigious investigators in liver disease in the 1920s and 1930s; namely, Hans Eppinger. Observant and perceptive readers of Landmarks in Hepatology will surely have noticed that until now there has been no mention of Hans Eppinger nor any reference to his many contributions in the field. This purposeful exclusion came about, rightly or wrongly, because I felt unable to honor this physician-scientist for his early discoveries, knowing full well about his later utterly ethically unacceptable activities as a medical leader, physician-scientist, and human being. This month's article will therefore redress the balance with respect to both components of that man's extraordinary career, which ended ignominiously in self-destruction. My decision to revisit those tragic events was not taken lightly; it is also in full keeping with the commitment expressed in the first paragraph of the very first article in this series,3 which promised enlightenment in order to avoid repetition of past mistakes. Whereas it is hard to believe that anything as terrible as occurred under the auspices of Nazi medicine could happen now or in the future, we can never be reminded too often of the needs for obtaining true informed consent, for full disclosure in explaining the likely outcome of our actions as physicians, and of partnering with rather than patronizing our patients and study volunteers. Physicians have an abiding responsibility toward their patients and experimental subjects, whose rights must be protected and championed even when the good of the community, of the state, and of humankind appears to be at stake. It is timely to address this issue now in the closing days of the year that simultaneously commemorated the 60th anniversary of the liberation of the Nazi extermination camps at the end of the Second World War and saw the wide distribution and acclaim of the movie Hotel Rwanda, which poignantly and painfully chronicled a recent modern genocide so graphically. We have yet to learn the full extent of physician participation and complicity in the abuse and torture of detainees at Abu Ghraib.4, 5 To paraphrase Elie Wiesel in his interview with Professor Georg Klein6 on December 10, 2004, in connection with the Nobel Peace Prize that he was awarded for his work on genocide and for his message of peace, atonement, and human dignity, "It was not hatred that perished at AuschwitzâŠ.only the victims died." Hans Eppinger was born in Prague in 1879 supposedly into a part-Jewish family of so-called "Privileged Jews"7-10 who, thus entitled by the Emperor, enjoyed social, civil, and professional liberties that were out of reach to their less favored co-religionists. It may appear paradoxical that Eppinger was also apparently accredited years later as an "Official Aryan" by the National Socialist authorities, a designation that was clearly linked to his joining the Nationalsozialistische Deutsche Arbeiter-Partei (NSDAP); i.e., the National Socialist German Workers' Party, nicknamed the Nazi Party. Yet it was not uncommon that exemptions to the 1935 Nuremberg Racial Laws were granted to certain Mischlinge; i.e., Jewish half-breeds, and incongruously many DeutschblĂŒtigkeitserklĂ€rĂŒngen (Certificates of German Blood) were actually signed by Adolf Hitler himself, thereby officially classifying the recipients as Aryans when such outright hypocrisy suited the FĂŒhrer and his kind.11 An astounding number of these Mischlinge were promoted to high rank in the German Armed Forces, and some even prospered politically.11 It should be noted, however, that the truth about Eppinger's ethnicity is still not known, and more discovery about it is needed. In 1902, more than 30 years before these grotesque events transpired, Eppinger was awarded his Doctorate in Medicine in Graz, where 20 years earlier his father, Hans Eppinger senior, had been appointed Professor of Pathological Anatomy. After staying for a few years, Eppinger moved to the famed Allgemeine Krankenhaus (General Hospital) in Vienna, where he rose to become First Assistant in the First Medical Clinic, which was headed by the internationally acclaimed cardiologist Karel Frederik Wenckebach. Later, when he was a full Professor of Medicine, Eppinger accepted the position of Chair of Medicine in Freiburg im Breisgau, after turning down offers from Strassburg, Halle, Königsberg, Leipzig, Frankfurt, and even Berlin. He left for Cologne in 1930, but it was there that in April 1933âironically, probably because of his part-Jewish heritageâhe fell foul of the Brown Shirts, Hitler's Sturmabteilung (SA or Storm Division). He hurriedly returned to Vienna to head the First Clinic but, importantly, because of his tussle with the German Reich, this appointment was permitted only after the intervention of Kurt von Schuschnigg, the Austrian Education Minister, who was to succeed Engelbert Dollfuss as Chancellor when the latter was assassinated in July 1934. Eppinger's professional interests and expertise ran the gamut of internal medicine and pathology, and he published extensively on topics as diverse as bundle branch block, diaphragmatic defects, cardiac asthma, circulatory dysfunction, nephrosis, hemolytic anemia, the inflammatory reaction, parathyroid disease, and many more besides.7 He was a fanatical and overzealous experimenter and at the same time a much sought-after clinical consultant for monarchs, heads of state, and other notables, including Josef Stalin and the Dowager Queen Marie of Rumania. It was rumored that he had also attended Adolf Hitler, but this possibility was dismissed by the late Fritz Redlich (1910-2004) in his biography of the German dictator,12 on the grounds that Hitler did not like famous and overbearing academic physicians and was pathologically as secretive about his health as he was over other details of his personal life and history. By coincidence, Redlich, who was Chair of Psychiatry (1950-1967) and Dean of the Medial School (1967-1972) at Yale University, had been a medical student and resident in Vienna when Eppinger was Chair of Medicine, before he emigrated to the United States in 1938. There are several associations between Eppinger and modern hepatology. First, of course, was his fascination with liver disease, in which he undertook many studies. Arguably his most importantâone could say "Landmark"âcontribution was in helping to dispel the myth that jaundice in hepatitis, so-called "catarrhal jaundice," is due to biliary obstruction caused by ascending duodenal inflammation, swelling of the ostium of the bile duct, and mucus biliary plugging, as Gabriel Andral and his many followers maintained.13, 14 Eppinger reasoned instead that toxins absorbed from the intestines injured the endothelium in the liver ("capillaritis"), causing intralobular edema and allowing serum to escape from the blood and deposit in the space of Disse.15 Eppinger's monograph on liver pathology and therapy, in which this hypothesis of "serous hepatitis" is also discussed,16 was, in its time, the handbook or bible for anyone interested in liver disease. The second link between Eppinger and modern hepatology was his mentorship of and complex relationship with the late Hans Popper (1903-1988), the undisputed father of hepatology in the latter part of the 20th Century.8-10, 17 Hans Popper worked in Eppinger's laboratory both in Vienna as a medical student and later in Freiburg in 1928.9, 10 When Eppinger returned to Vienna in 1933, he persuaded Popper to transfer from the Institute of Pathology to the First Medical Clinic as an Assistant Physician. Next, Eppinger appointed Popper and Hans Kaunitz (who, like Popper, was Jewish) to supervise a new ward that he opened. During all of his activities, Eppinger's brilliance and achievements were indelibly stained by defects of personality and character, which were well recognized by all who knew him and of him. Notwithstanding Popper's admiration for him as a scientist and his profound debt to him as a mentor and supporter, these flaws alone were grave enough to mar Eppinger as a role model for young scientists and physicians. As John Cornwell points out in the opening of his book on Hitler's scientists,18 quoting François Rabelais,19 "Science without conscience is the ruin of the soul" â Science sans conscience n'est que ruine de l'Ăąme â a warning that might have been written with Eppinger in mind. Eppinger had no scruples10; he stole case histories from other physicians and had to be supervised while watching operations in case he stole instruments as well. He was banned from the University library after being caught cutting pages out of books and bound journals. He stole gallbladders from Wenckebach's laboratory and later, using these specimens without due acknowledgment, he published the phenomenon of gallbladder edema in patients who died of beriberi. Eppinger's callous handling of his patients was no less dishonorable or overt. In his autobiography, the esteemed German theologian Helmut Thielicke described the cruel, dangerous, and demeaning treatment he received from Eppinger, whose advice he had sought for severe tetany following inadvertent parathyroid injury.20 Otto Fleming, who had been a medical student in the 1930s in Vienna and who later was a general practitioner in south Yorkshire, UK, recalled how he and all his fellow students were shocked by Eppinger's brutality when he reduced a patient to tears by explaining to those present in the lecture theater that this man with nephritis was in the "final act of the tragedy" of his disease.21 Apparently even those in NSDAP circles in Vienna complained about, among other criticisms, Eppinger's brutality to his patients and his reckless driving.22 Werner Creutzfeldt, Professor Emeritus and former Chair of Medicine at the University of Göttingen for 28 years, recalled Hans Popper inferring that Eppinger had a hole in his brain where other people have a conscience. Creutzfeldt also related to me that even almost a score of years after Eppinger's departure from Freiburg, senior nurses still in practice there vividly remembered Eppinger's heartless attitude towards his patients, a contrast to the warmth of their nostalgia for Siegfried Thannhauser, who succeeded him briefly. There is no doubt that Eppinger was an ardent Nazi, as Redlich described him,12 and played a key role in the dastardly Sea Water Experiments in the Dachau concentration camp.22-24 However, these signature activities in his curriculum vitae are either glossed over euphemistically or omitted completely from the many available, albeit brief, biographical accounts of Eppinger's life.7-10, 25, 26 Eppinger was dismissed from his position in the University of Vienna after the war, in June 1945, because he had been a member of the then-illegal Nazi Party in Austria before the Anschluss; i.e., the annexation of Austria by Germany.27 He had also been a clandestine member of the nationalistic Deutschen Klub, to which he had paid dues since November 1937.22 He stood idly by when 153 of the 197 medical faculty in Vienna were sacked within weeks of the Anschluss, mostly for being Jewish.28 Eppinger may not have been driven by extreme racist views per seâafter all, he had appointed several Jews like Popper and Kaunitz to high positions in his Clinic. Rather, Eppinger fervently believed that the goals of the Third Reich offered the best future for Germans everywhere. Whether this was the main philosophy of so many other physicians, who it must be remembered represented the highest enrollment (45%) in the NSDAP of any professional group,29 is far from clear. Also, by joining forces with the NSDAP he sought to further his own megalomania for research opportunities and material support. Whatever his motivation, Eppinger did abet the militantly prejudiced, recently appointed Dean, Eduard Pernkopf, in ruthlessly promoting the Nazi medical ethos in the Vienna school. Hans Eppinger even celebrated the first anniversary of the "cleansing" of the faculty by authoring an upbeat newspaper article in the Neues Wiener Tagblatt, in which he declared, "Now that all disease (my italics) has been eradicated, the Viennese School of Medicine can in future dedicate itself to its great task without inhibition."28 Pernkopf, incidentally, rose to become the Rector of the University in 1943; after spending 2 years imprisoned by the Allies after the war, he was free to complete his notorious "Atlas of Topographical and Applied Human Anatomy," for which the bodies of almost 1,400 people executed by the Gestapo, mostly for "political" reasons, served as artists' models.30 To Eppinger, who threw in his lot wholeheartedly with the philosophy, doctrines, policies, and hierarchy of the Third Reich, it was but a small step to invest his medical research expertise in the planning and conduct of human studies for the benefit of the German military effort. Although Eppinger's other activities have not yet been exhaustively researched, there has been no evidence presented thus far that he also participated medically in the sickening racial hygiene work that aimed to perfect techniques of mass extermination and sterilization, nor in studies that sought to document and preserve the anatomical characteristics of inferior racial groups, those people referred to as Untermenschen, or "subhumans," considered to have Lebensunwertes Leben, i.e., lives unworthy to be lived, and other individuals, such as the enfeebled, retarded, and those with neurological or physical defects. Neither did he seem to engage in futile sadistic experiments, such as excruciatingly painful attempts at muscle, bone, and even whole limb transplantation. In this context, it is chilling to point out that numerous German physicians had already played key practical roles in forcible sterilizations (some 300,000 to 400,000 victims) and in legalized killings, mostly by gassing and cremation, of individuals with mental or physical handicaps. Therein was the prototype for the extermination process of the Final Solution of the Jews, which physicians not an of the German physicians to the Nazi the and the or and were of using their medical such as the early of the so-called of and have been The of how to and and in the for of time the and military The to in and studies were to this end on both of the military To a at the German over the of the of with an so-called which some already was true with an Eppinger and from that a be to the of and with that of or complete for to to the best of health and even may be by the Eppinger also that his recently promoted in Vienna, conduct the which had to be at the Dachau concentration because the of volunteers at the medical were so late in the The experiments were in the of but the of including the of a liver without not to mention that the experimental subjects of would and other in attempts to some The of and including between the of the Medical of the and Reich of the and Reich of the it that Eppinger was no but was instead a key the offered on was the that there was no of during the of the the that the physicians were only following the of their or the of the the that the Allies and other had experiments the that the victims were to and the that there were no or for human experimentation that could The also that to as would the of medical and it that their among some of the and on the Although it is true that human experiments have been in almost even after the Nuremberg was have the and human of the Third Reich. act of not Also, or not the no with or or the this responsibility has been expressed in all over the Also, the was recognized in where for human experimentation also had been before During his to with his was and his that there had been any of the that had and Eppinger's to that on his was to years of the other physicians and in the were of were to by 5 to life 2 to for years, and to 10 were Eppinger was not but he was to appear before the However, on the of 25, one before the of the was he and it not for the extraordinary events that occurred almost 40 years later, the of Hans Eppinger may well have with him. However, in the late the and of the that he in Freiburg in and the of many and in liver research that and to a for and in liver studies. he to his Hans Popper, the father of hepatology of the for advice on a for the and Popper the name of Eppinger. Werner Creutzfeldt, for was at the in the of Eppinger's and from other than Hans Popper himself, and so he Popper the Popper was on of his for Eppinger as a liver scientist and his to After all, when Popper Vienna in under the of the Gestapo, among the he with him were his his his and a signed of that he later to that of his own the it must be that it was and that Popper knew of Eppinger's role in and did as he his for The must be however, that Popper's was At the very he should have his mentor more knowing well of his and the that he had on in Vienna in the medical even when its faculty had been by The Eppinger which Popper to a Nobel Prize of was awarded first to in but he nor recipients were likely to have had any as to Eppinger's name In the early Professor of Medicine at Yale University and of the for in Medicine at the Yale University School of Medicine, of the and it with the Eppinger whose he had as a medical student and about he had later in the of The case was taken by the and Eppinger's name was from the but only after the on the of the New on November The New article caused great to who were the of the for the of in that very Armed with few facts at that time, were and between those who of the and those who were and that was The the years of Hans Popper's as he was of his earlier of but he no over the of the As he me while on a to he knew that when he to work for Eppinger in he had a with the years later, the for for the same to the name of Eppinger from a that had received its designation by the in on the anniversary of its latter and, we the between Hans Eppinger and modern us full to the at the of this namely, how to with the flaws of the when these are related to the conduct of the science itself and human and life are In this can be considered under the of which often to from studies that were or like the at who recently published that no from experiments should be by in the that experiments by such are likely to be as well as being there was evidence that even in Dachau the were this is not a since some and investigations, like the Nazi and for the link between and were even were on the same racial hygiene that to and have that the benefit of the research is of such that it more lives than were the and the could not or would not have been in any other without such human we should and the and at the same time the highest and to the time the are This the however, of on the and by our we their To between these is too a to As might be by such the to medicine would be for This was to the in the when the of the New England Journal of Medicine to the of Nazi studies that were to be in In the case of Eppinger, the decision is an of his earlier work is clearly it can be to have been and ethically yet at the same time and at one should him and for the he did and one should never his name to be as an for or as a role The more by however, and one that is both more and more to is so many physicians the and in so many have the their of and a commitment to Yet for all Wiesel still in us as a I in that medicine is still a he the highest ethical the still for And for us all, We to him. in of this the was of Professor that there was no evidence that Eppinger had any Jewish It was a that Eppinger's was of from the on both of Jewish of of the of The with and by and with and and with Werner Creutzfeldt and Elie Wiesel The also the for his and in the of this essay in Whereas the and of these the his a of and documents, the are his
OBJECTIVE: To summarize the expectations held by World Health Organization programme personnel about how the introduction of the Integrated Management of Childhood Illness (IMCI) strategy would lead to improvements in child health and nutrition, to compare these expectations with what was learned from the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE-IMCI), and to discuss the implications of these findings for child survival policies and programmes. DESIGN: The MCE-IMCI study designs were based on an impact model developed in 1999-2000 to define how IMCI would be implemented at country level and below, and the outcomes and impact it would have on child health and survival. MCE-IMCI studies included: feasibility assessments documenting IMCI implementation in 12 countries (1999-2001); in-depth studies using compatible designs in Bangladesh, Brazil, Peru, Tanzania and Uganda; and cross-site analyses addressing the effectiveness of specific subsets of IMCI activities. RESULTS: The IMCI strategy was successfully introduced in the great majority of countries with moderate to high levels of child mortality in the period from 1996 to 2001. Seven years of country-based evaluation, however, indicates that some of the basic expectations underlying the development of IMCI were not met. Four of the five countries (the exception is Tanzania) had difficulties in expanding the strategy at national level while maintaining adequate intervention quality. Technical guidelines on delivering interventions at family and community levels were slow to appear, and in their absence countries stalled in their efforts to increase population coverage with essential interventions related to care-seeking, nutrition, and correct care of the sick child at home. The full weight of health system limitations on IMCI implementation was not appreciated at the outset, and only now is it clear that solutions to larger problems in political commitment, human resources, financing, integrated or at least coordinated programme management, and effective decentralization are essential underpinnings of successful efforts to reduce child mortality. CONCLUSIONS: This analysis highlights the need for a shift if child survival efforts are to be successful. Delivery systems that rely solely on government health facilities must be expanded to include the full range of potential channels in a setting and strong community-based approaches. The focus on process within child health programmes must change to include greater accountability for intervention coverage at population level. Global strategies that expect countries to make massive adaptations must be complemented by country-level implementation guidelines that begin with local epidemiology and rely on tools developed for specific epidemiological profiles.
This paper proves that several interactive proof systems are zero-knowledge against general quantum attacks. This includes the well-known GoldreichâMicaliâWigderson classical zero-knowledge protocols for graph isomorphism and graph 3-coloring (assuming the existence of quantum computationally concealing commitment schemes in the second case). Also included is a quantum interactive proof system for a complete problem for the complexity class of problems having honest verifier quantum statistical zero-knowledge proofs, which therefore establishes that honest verifier and general quantum statistical zero-knowledge are equal: $\mathrm{QSZK}= \mathrm{QSZK}_{\mathrm{HV}}$. Previously no nontrivial interactive proof systems were known to be zero-knowledge against quantum attacks, except in restricted settings such as the honest verifier and common reference string models. This paper therefore establishes for the first time that true zero-knowledge is indeed possible in the presence of quantum information and computation.
This paper describes a new protocol for authentication in ad-hoc networks. The protocol has been designed to meet specialized requirements of ad-hoc networks, such as lack of direct communication between nodes or requirements for revocable anonymity. At the same time, a ad-hoc authentication protocol must be resistant to spoofing, eavesdropping and playback, and man-in-the-middle attacks. The article analyzes existing authentication methods based on the Public Key Infrastructure, and finds that they have several drawbacks in ad-hoc networks. Therefore, a new authentication protocol, basing on established cryptographic primitives (Merkle's puzzles and zero-knowledge proofs) is proposed. The protocol is studied for a model ad-hoc chat application that provides private conversations.
Rifat Atun, Martin McKee, Francis Drobniewski, Richard Coker
OBJECTIVE: To develop a methodology and an instrument that allow the simultaneous rapid and systematic examination of the broad public health context, the health care systems, and the features of disease-specific programmes. METHODS: Drawing on methodologies used for rapid situational assessments of vertical programmes for tackling communicable disease, we analysed programmes for the control human of immunodeficiency virus (HIV) and their health systems context in three regions in the Russian Federation. The analysis was conducted in three phases: first, analysis of published literature, documents and routine data from the regions; second, interviews with key informants, and third, further data collection and analysis. Synthesis of findings through exploration of emergent themes, with iteration, resulted in the identification of the key systems issues that influenced programme delivery. FINDINGS: We observed a complex political economy within which efforts to control HIV sit, an intricate legal environment, and a high degree of decentralization of financing and operational responsibility. Although each region displays some commonalities arising from the Soviet traditions of public health control, there are considerable variations in the epidemiological trajectories, cultural responses, the political environment, financing, organization and service delivery, and the extent of multisectoral work in response to HIV epidemics. CONCLUSION: Within a centralized, post-Soviet health system, centrally directed measures to enhance HIV control may have varying degrees of impact at the regional level. Although the central tenets of effective vertical HIV programmes may be present, local imperatives substantially influence their interpretation, operationalization and effectiveness. Systematic analysis of the context within which vertical programmes are embedded is necessary to enhance understanding of how the relevant policies are prioritized and translated to action.
Esoteric protocols, such as electronic cash, electronic voting and selective disclosure protocols, use special message constructors that are not widely used in other types of protocols (for example, in authentication protocols). These message constructors include blind signatures, commitments and zero-knowledge proofs. Furthermore, a standard formalization of the Dolev-Yao intruder [6] does not take into account these message constructors, nor does it consider some types of attacks (such as privacy attacks, brute-force dictionary attacks and known-plaintext attacks) that esoteric as well as other types of protocols are designed to protect against. This paper aims to present an extension of typed MSR [3, 4] in order to formally specify the needed message constructors, as well as the capabilities of a Dolev-Yao intruder designed to attack esoteric protocols.
I consider it important to begin this article by making an essential observation: research on distance education in Mexico is still in the embryonic stage, in spite of its long history. One indication is that among the lines of research defined by the Mexican Council on Educational Research, the leading organization in the field in Mexico, distance education does not even appear. Only recently, in the last few years, has an effort been made by educational institutions and professionals interested in doing research in this field, to set up working associations, such as the Distance education Researchersâ Network and Technologies for Learning.Since research on distance education is just beginning, it should come as no surprise that the definition of its field of inquiry and its conceptualization are imprecise as yet. As a result, the theory and methodology of research into its history are in their infancy, and studies must resort to methodological tools taken from other fields or use information technology and tele-communications as partial reference points. The limitations of these approaches make it difficult to offer in-depth explanations of the current status of distance education, not to mention justifiable proposals for its further development.It is the intention of this article to look for criteria that take the historical character of education as a starting point. In its origins, education was open and ongoing, a process that is innate in the human condition. In its process of institutionalization, it took on the form of school systems, with a structure and a legitimizing function that excluded those who could not, or would not, adapt to schoolsâ schedules, spaces, and learning methods. This situation created a need for educational programs that were not bound by such rigid conditions. On the basis of these considerations, I undertake this study with the following premises as my starting point: (a) education is a sociocultural product that had a beginning, has evolved, and will one day disappear; (b) distance education develops just as school-based education does, but with an inversely proportional growth curve, because as schools make their admissions and operating processes more closed and rigid, alternative educational options arise; and (c) research into the history of distance education needs its own theoretical and methodological approach, because it is a field that is still in the process of formation. It is hoped that this article will contribute to the development of the field.To begin, it is important to take a look at the concepts of open and distance education. Depending on the context, they are sometimes taken as synonyms, and other times their uses can be confused.Unlike in other places, where open refers to unrestricted access to educational institutions with no need to demonstrate previous studies, in Mexico the concept refers to the fact that traditional school processes are made more flexible; for example, class attendance, the school calendar, and examination periods for certifying learning. The documentation of previous studies, however, is still a prerequisite.Distance education refers more often to the methodological and technological strategies that make it possible to deliver educational contents and provide communication among participants in an educational process even though they do not coincide in space and time. As paradoxical as it may sound, the driving force behind distance education is the desire to do away with distance.In view of the ambiguities in the use of the term, and not wishing to enter into a debate about its concept or use, I will consider distance education not in its literal meaning, but as the intention to overcome the distances that deny many people access to educational services. In short, and from a social standpoint, we should conceive of distance education as more than a way to overcome distance in space and time, for which a number of methodological and technological resources are available. Our biggest challenge is to overcome the tremendous social, cultural, and economic distances reflected in unequal access to educational services.The purpose of this article is to establish a perspective for the historical analysis of distance education by proposing categories that coincide with the premises that underlie this mode of education: (a) greater and more equitable coverage; (b) self-reliance and independent learning; and (c) flexibility in adapting to participantsâ living conditions. From this perspective, there are many approaches for looking at the changes that have taken place in distance education, such as educational policies and their social orientation, distance education models that have been implemented, and the most typical approach, the technological supports on which they are based.Among the factors that have had an impact on the origin and development of distance education, there are three that I consider crucial: (a) the development of traditional classroom education, which limited the times, places, and modes available for learning, and thus led inexorably to the creation of new modes for those who could not go to school; (b) the development of different media and modes of communication that allowed for contact among people from different locales who were participating in the same educational process; and (c) the educational policies that were implemented in each stage of the history, and the role played by distance education. These considerations will give structure to my analysis within the historical framework outlined below, which does not so much mark boundaries between periods as indicate educational policy shifts that led to new perspectives for distance education.Itinerant distance education was characterized by the distribution of educational materials designed for independent study and subsequent visits by educators to studentsâ places of residence, as in the cultural missions created in 1923 to provide service to rural professors in their own community. This model was formalized in 1945 with the Federal Teachersâ Training Institute, which provided an array of support services, combining long-distance communication like radio and mail service with face-to-face individual and group advisory sessions, as well as different learning situations such as correspondence courses, complementary oral courses, individual study, local study and advisory centers, and group classes. The institute was phased out in 1971, but its methods have survived in teacher training institutions.Correspondence courses date back to the nineteenth century, when regular postal service was institutionalized, and continue up to the present day. In fact, educational programs that limit their activities to distributing courses, giving online educational support, and evaluating by Internet, are in essence offering correspondence courses.The creation of telesecundarias in the 1960s ushered in large-scale use of educational television that now reaches over 30,000 locations. The coverage and student-support strategies used in this experience give it a massbased, standardized quality, which allows it, on the one hand, to reach large numbers of students, while on the other hand running the risk of offering inadequate support to each student in his or her regional and personal circumstances. Face-to-face instructors are an attempt to remedy this situation. Television has also been used for educational purposes in higher education, but not on a systematic, massbased, and exclusive basis.The 1960s witnessed the influx of the universities into distance education, a new era marked by the opening of the great European universities that worked within these educational frameworks, such as the Open University in Great Britain and the Universidad Nacional de EducaciĂłn a Distancia (UNED) in Spain. Along these same lines, the National Autonomous University of Mexico created the Open University System, aimed mainly at people who for one reason or another could not study within the traditional system. The Open Teaching System of the National Polytechnic Institute, while not distance education per se, did represent a milestone in the creation of nonclassroom formats of higher education. When the National Pedagogical University (UPN, in its initials in Spanish) created the Distance Education System in 1979, it became the first public institution of higher learning in Mexico to offer this type of education on a nationwide basis, by setting up distance education units in every state. The UPN to this day has continued to give priority to the use of printed materials for independent study, while maintaining the Saturday advisory sessions that require professors and students to meet face-to-face. In this sense, the itinerant model of the last century is still in use.In the 1990s, the e-learning rush began in earnest, owing to the development of the Internet, which made communication access easy and readily available, thereby providing distance education with an excellent platform for educational communication, access to information, and more reliable learning processes. The momentum continues to grow as technological innovations open avenues for new educational possibilities.We must not lose sight of the uneven Development of these processes. Many institutions remain faithful to the structures and practices of the time of their founding, and new proposals are often overlaid on traditional processes. Socioeducational practices tend to encompass processes that are simultaneous and disparate, even recurrent and regressive. It is not at all uncommon to find the most traditional teaching methods presented with the latest technology, or trend-setting pedagogical innovations supported by traditional technologies. We can therefore conclude that the new media are not about to displace the old ones; instead, they serve to diversify the menu of possibilities, in an ongoing search for the best options for distance education.In general, it can be stated that distance education in Mexico is a mixture of the traditional and the modern, forever caught in a tugof-war between the inertia of routine on the one hand, and rupture and progress on the other. Some aspects of the educational system become more flexible, such as classroom time, curricular options, and so forth, while other control mechanisms typical of school systems remain firmly entrenched, such as the centralization of teacher-training processes and an overall school-bound vision of educational situations.The following categorization shows different organizational models for defining the relationship between educational modes and institutions.The National Pedagogical University in its beginnings could be considered emblematic of this category, when its Distance Education System controlled more than 70 centers all over the country and concentrated academic, administrative, and educational processes. This model, with its mass production of materials, permits greater coverage and exclusive, specialized personnel, but at a cost: standardization, lack of regional variation, and obsolescence of materials due precisely to their mass production. This model eventually came under the fire of teachersâ unions and decentralization policies and gradually lost ground. Now the academic oversight of curricula remains centralized, but the administration has been delegated to the state governments, and the professors themselves are in charge of evaluating the studentsâ learning processes.An illustrative case is the National Autonomous University of Mexico, which organizes its Open University System on the basis of its existing structure, by simply adding to each department a division that takes care of open education, with a separate faculty, but the same programs, curricula, and calendars as the classroom-based system. It has the advantage of making use of resources that are already in place, and offers the possibility of introducing flexibility into the classroom-based system, but runs the risk of imposing school-bound structures on distance education.With this model, nonclassroom education can have its own curriculum, with specially developed spaces, materials, and personnel. This obviously implies an extra investment, but allows for an organizational model that is designed expressly for this kind of education. An example is the National Polytechnic Institute, which in 1974 started up its own program of nonconventional educationâthe Open Teaching Systemâwith its own curriculum, personnel, study materials, and administration. More recently, in 2005, the Virtual University System of the University of Guadalajara was created, with its own administration and its own academic offerings.With these models, the members negotiate their academic, administrative and technological responsibilities. This format also allows for optimal use of resources, manageable production scales, and regional and institutional adaptations. Problems can arise, however, if collaboration and cooperation policies are not renewed and the results of joint work are not distributed evenly. Of the examples of this type of collaboration in Mexico, the EDUSAT Network deserves special mention. It provides a technological platform that covers a significant portion of the population of Latin America, and serves educational institutions using all modes of learning, at all levels.Outside influences are undeniable in our educational culture in general, and in distance education in particular. This influence is evident in a number of aspects, including: (a) the way institutions from countries with preponderant economic power have gained easy entry into our educational systems by taking advantage of their technological advances, their excess academic production, and the need for flexible versions of higher education to meet the demand of Latin American institutions; (b) the tendency to imitate foreign models, either conventional universities that incorporate distance education in different ways, or universities that engage exclusively in distance education; or c) alliances among institutions from different countries, alliances that are not always balanced or beneficial to our needs and purposes.The history of distance education in Mexico is highly complex, and reflects the multiple causes to which it owes its origin, as well as the outside influences that have shaped the programs and institutions that work in this educational mode. The origin and subsequent trends are characterized by the following features:There is a certain amount of confusion and ambiguity in the definitions given to the concepts of open and distance education, and even more in the uses to which these concepts are put, which makes it difficult to delineate the field and object of study with any kind of precision.Distance education systems tend to preserve their original format; they are unwilling to abandon the strategies, methods, type of material, and media they used when they first started up. It is thus common for programs to include a hodgepodge of learning and teaching strategies, resources, and media from all the stages of distance education.Distance education has been used primarily for compensatory purposes, intended for people who do not have access to traditional education, rather than as a strategy for diversifying and strengthening learning processes.Depending on the role that we wish to assume in the global knowledge society, we can aim at a whole range of goals: from being knowledge generators, to being knowledge disseminators, or merely consumers. Here is where key decisions must be made that will allow us to move up from our status as technology and information consumers, which relegates us to a position of dependence, and aspire to full participation in the globalization process by means of our own home-grown proposals, rooted in our particular identities and social projects.In terms of organization, the trend seems to point to institutions that engage exclusively in distance education, or that combine it with face-to-face education, which is the tendency that is gaining momentum and moving toward proposals involving formats without borders.Depending on the coverage strategies, we have, on the one hand, large-scale, standardized systems for the majority population groups that demand education and, on the other hand, personalized systems with greater academic and technological support for the privileged few. An alternative proposal for distance education should offer quality education for all. If distance education is to continue promising a ticket to better living conditions in Mexico, it needs to open up more and overcome distances in time and space, but above all, social, economic, and cultural distances.The problems affecting distance education are serious, numerous, and hard to overcome: dependence on imported projects, standardization, a bureaucracy that leads back to traditional school-bound formats, traditionalism, a lack of adequate policies, and isolation. However, we must not overlook its strengths, such as the existing infrastructure, the wide range of valuable proposals that have already been made and, above all, the spirit of collaboration that characterizes us, and that only needs greater organizational efforts to become a consolidated force.
Blockchain technology has been gaining great interest from a variety of sectors including healthcare, supply chain, and cryptocurrencies. However, Blockchain suffers from a limited ability to scale (i.e., low throughput and high latency). Several solutions have been proposed to tackle this. In particular, sharding has proved to be one of the most promising solutions to Blockchain's scalability issue. Sharding can be divided into two major categories: (1) Sharding-based Proof-of-Work (PoW) Blockchain protocols, and (2) Sharding-based Proof-of-Stake (PoS) Blockchain protocols. The two categories achieve good performances (i.e., good throughput with a reasonable latency), but raise security issues. This article focuses on the second category. In this paper, we start by introducing the key components of sharding-based PoS Blockchain protocols. We then briefly introduce two consensus mechanisms, namely PoS and practical Byzantine Fault Tolerance (pBFT), and discuss their use and limitations in the context of sharding-based Blockchain protocols. Next, we provide a probabilistic model to analyze the security of these protocols. More specifically, we compute the probability of committing a faulty block and measure the security by computing the number of years to fail. We achieve a number of years to fail of approximately 4000 in a network of 4000 nodes, 10 shards, and a shard resiliency of 33%.
Martin Thomas Ivers, George F. Timson, Hans von Blankensee, Gary Whitfield · 6 authors
The United States Veterans Administration provides a medical care delivery system comprising more than 170 hospitals, clinics and domicilliaries. Historically, these institutions have been relatively autonomous in their day-to-day operations and consequently efforts at computerization have been difficult to adequately coordinate. A recent undertaking of the VA has been to establish decentralized coordination of planning and implementation for hospital computer systems. This presents a unique opportunity to promote standard, portable and well-designed solutions to meet the widely variable needs of a large and diverse health care delivery organization. Although computer systems for each hospital will vary with the needs of the hospital, functional program packages can be delivered and maintained in a cost-effective and manpower-efficient manner. Additionally, because all systems will be based on a common data dictionary it will be possible to gracefully expand systems as needed and to study clinical care and delivery methodologies across many institutions.
As enterprises became increasingly information based, making improvements in their information activities is a top priority to assure their continuing competitiveness. A key to achieving these improvements is developing an enterprise information architecture (EIA). An EIA can be viewed as a structured set of multidimensional interrelated elements that support all information processes. The current ad hoc EIA in place within many enterprises cannot meet an organization's future needs because it has an incoherent framework, incompatibilities, missing elements, few and poorly understood standards, uneven quality and unnecessary duplications. This paper discusses the EIA developed at Lawrence Livermore National Laboratory as a case study, for other information based enterprises, particularly those with decentralized and autonomous organization structures and cultures. While the technical architecture is important the organization and processes by which it is developed and sustained over time are equally important. This paper outlines the motivation for an EIA and discusses each of the interacting elements identified. It also presents an organization structure and processes for building a sustainable EIA activity.
B. Walter, Marjorie Sadlo, J. KĂŒpfer, V. Niemeier · 8 authors
To the Editor: Itch is a well-known dermatological symptom whose reactions in the brain have been studied very less. In a study with functional magnetic resonance imaging (MRI) response to histamine iontophoresis, McGlone et al (2001) showed that the forebrain regions activated by brief itch (3â4 min) are different from those activated by pain. These findings provide insights into separate motivational and behavioral consequences of itch and pain. In previous studies, Darsow et al (2000) and Hsieh et al (1994) could also identify functional covariates of the itch sensation in the central nervous system by positron emission tomography (PET) analysis. A co-activation of the anterior cingulate cortex, supplementary motor area, premotor area, and inferior parietal lobe was found. Somatosensory areas were significantly activated only in one study (Darsow et al, 2000). All the studies reported above either used stimulation evoking short-lasting itch or recorded brain activation in a short time frame (e.g., 50 s). To our knowledge, there are no studies examining brain activations during the course of longer-lasting skin reactions usually seen after histamine prick. Therefore, we tested brain responses to longer-lasting histamine reaction in healthy participants. Effects of pain due to the prick were controlled by an additional prick condition using saline. Flare, wheal, and itch Following histamine prick, a substantial local reaction was observed. The mean diameter of flares reached 24 mm and showed a maximum about 5 min after prick. Mean wheal diameters increased continuously up to 6 mm at the end of the session. After saline prick, the flare was considerably smaller and a wheal was never detected. Accordingly, ratings of itch intensity and unpleasantness were much higher after histamine than after the saline prick (see Fig 1). Itch intensity/unpleasantness. Time course of itch intensity and unpleasantness (mean curves and standard errors of ratings, possible range: 0â100). Brain activation corresponding to itch was found in eight clusters located mainly in frontal regions. Medial frontal activation took place in the superior frontal gyrus and the gyrus rectus in both hemispheres as well as in a small area of the left anterior cingulate gyrus. Right hemispheric clusters were found in the inferior frontal gyrus and in orbital and dorsolateral parts of the superior frontal gyrus. Further activation was located in the left temporal pole and some parts of the left cerebellum (see Table I and Fig 2). Brain areas of activation. Brain areas of activation (pooled over six subjects) related to itch sensation. Remarks: The numbers correspond to the cluster descriptions in Table I. In comparison, brain reactivity in connection with tonic itch sensations is much more difficult to investigate in functional magnetic resonance imaging (fMRI) analysis than brain reactivity with regard to pain sensations, where short-term reactions can be evaluated. In this study, we demonstrated the brain activation under the histamine-itch condition in eight different areas of the brain in comparison with salineâplacebo control. Brain activation was shown mostly in the superior frontal gyrus, in the temporal pole, in the cerebellum, and the inferior frontal gyrus. No activation differing from the placebo control was found in the postcentral gyrus where activation of body sensations was usually found. The gyrus frontalis medius and gyrus frontalis inferior are known to stimulate the motoric activities of the body, in which sensory input is necessary. In the gyrus frontalis inferior, the secondary sensoric cortex is represented and may be activated during itch reactions. In the cingulate areas emotional components of the itch reaction may exist, because the cingulate cortex is known as being highly correlated to emotions. In the temporal pole medial, there is the interpretative cortex that represents experiences and remembrance. Perhaps there the present itch is compared with former itch experiences. But all of these interpretations are still hypothetical with regard to the few studies in this area that looked for activation of the brain. Our results seem to be similar to the finding of McGlone et al (2001), who also showed activation in the forebrain (Brodman's area BA10), an area related to perception (Faw, 2003). Further activations that they found in BA21, BA22, and BA40 could not be confirmed by our results. In the PET analyses of previous studies, Darsow et al (2000), Drzezga et al (2001), Hsieh et al (1994), and Mochizuki et al (2003) identified partly different areas of activation in the anterior cingulated cortex, supplementary motor area, premotor area, and inferior parietal lobe. Hsieh et al (1994) demonstrated the coactivation of the anterior cingulate cortex, supplementary motor area, premotor area, and inferior parietal lobule and underpinned the posterior sector of the anterior cingulate cortex as being related to the sensory/affective aspect of the event. The divergent results may be due to a different method of stimulation with histamine used in this study. We decided to investigate the tonic histamine reaction by prick that produces an itch sensation without producing a substantial pain sensation in a quick and easy way. The PET analyses used in the studies mentioned above have only a very short time frame for revealing activation, whereas fMRI analysis is able to take a longer time period into account. For instance, Darsow et al (2000) described activation for 50 s beginning 2 min after stimulation in the PET analysis. Further studies should evaluate the time course of brain activation during itch. The âpain matrixâ (Derbyshire, 2000; Peyron et al, 2000) also comprises very different regions from those identified in our study. Therefore, we assume that brain processes during itch differ substantially from those during pain. But data based on a small sample like ours cannot be take as proof for missing activation. Further studies with larger samples are needed to explore the âitch matrixâ. Subjects Six of eight right-handed healthy non-smoking males (mean age: 25.6 y; ranging from 20 to 30 y) were selected for the study. All of them had no history of allergy, no atopic diseases in the family, no current diseases, and no current intake of drugs that could influence the study. The remaining two subjects had to be excluded from further analyses because they reported only a slight itch sensation during the experiment (see below). The study was approved by the ethics committee of the medical faculty of the University Giessen, Germany, and performed according to Declaration of Helsinki principles. Design Subjects participated in the fMRI examinations in separate sessions for each of four experimental conditions: subjects received one prick per session with either histamine or saline to the left forearm. The sessions were conducted in partly permuted order with an interval of at least 1 wk. No information about the substance used in the current session was given to the subjects. Measures and procedure After informed consent for the experimental procedure and for the fMRI examination, the participants learned how to use a visual analog scale (VAS) on a standard PC with a keypad. Then, the subjects were placed into the scanner and instructed on how to use the keypad with their right hand. The VAS were presented on a screen that was placed behind the MR scanner and could be observed by means of a mirror. VAS ratings were performed every minute starting 28 s after the onset of the experiment. The ratings could range from zero to hundred. The extremes of the scale for itch intensity were labeled âno itchâ (=0) and âthe most intense itch imaginableâ (=100). A second VAS was used for the unpleasantness of itch. It was labeled âno itchâ (=0) and âthe most unpleasant itch imaginableâ (=100) (Yosipovitch, 2003). The prick was applied 2 min after the start of the experimental session by using plastic needles (Stallergenes, Anthony-Cedex, France). Wheal and flare diameters were taken every 2 min starting 30 s after the prick. The experimental session lasted 17 min. Analysis of itch ratings Subjects who always rated their itch intensity during the histamine condition always lower than 15 were excluded from analyses. This was the case for two subjects. Due to this loss, data only of six subjects are reported here. Image acquisition and analysis fMRI uses the blood-oxygen-level-dependent (BOLD) response (Logothetis and Wandell, 2004), which is basically an increase of oxygenated blood in areas where neural activation takes place. Fast echo-planar imaging sensitive to BOLD signal was applied to acquire every an image of almost the whole brain 4 s. A fixed-effect general linear model for the fMRI time series at each volume element (voxel) was used in order to compare activation between the two conditions (histamine vs saline prick). The mean time course of itch sensation reported by the six subjects during the histamine sessions served as a regressor for both sessions. The comparison of regression coefficients obtained in histamine and saline sessions gives the activation correlated with itch intensity pooled over subjects. The rating procedure, the prick itself, and head motion parameters were considered as additional covariates for controlling their possibly confounding effects. The significance level was set to α=0.05 after controlling for multiple comparisons due to the analysis of the whole brain volume using the random field theory. This study was supported by the âInstitut fĂŒr Grenzgebiete der Psychologie und Psychohygiene.â