Usman Khalil, Owais Ahmed Malik, Wee-Hong Ong, Mueen Uddin
The concept of smart city architecture requires a comprehensive solution that can combine real-time response applications for cyber-physical systems. However, the architecture faces challenges that can obstruct the operations in terms of systems, processes, and data flow as far as the breach risk is concerned. Though the field has been researched with the existence of centralized and distributed architectures to support smart cities. Research gaps regarding security concerns, platform assistance, and resource management continue to persist. This research article presents a novel blockchain-based architecture that proposes expansion in the non-fungible tokens (NFTs) to cater to the expansion of IoT-enabled smart assets. It enables NFTs to employ fog computing for all users and smart devices connected to a fog node in a cyber-physical system. The proposed expansion suggested in Non-Fungible Tokens (NFTs) for IoT assets representation in a cyber-physical system, provides devices and user identification and authentication functionality. The proposed NFT architecture has been designed to provide a smart city solution for cyber-physical systems that ensures robust security features (such as CIA) by introducing new attributes and functions for Owner, User, Fog, and IoT device/s authentication. The validation and rigor of the security services, efficiency, and latency have been achieved by deployments on private and public ledgers. The efficiency, and cost-effectiveness of the suggested functions and components have been evaluated in terms of evaluation cost and time complexity which resulted in promising results, obtained and validated on a testnet. The evaluation cost for the devised mint component was approximately 81%, and devised approve() was approximately 23% more efficient than other solutions.
Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility ( 8). Thanks to this technique, it is now possible to achieve fertilization and pregnancy when the number of spermatozoa in the ejaculate is extremely low. I therefore understand the enthusiasm of clinicians such as Dr Baker, whose practice puts them in a position from which they can appreciate the benefits brought by this technique to patients affected by the most severe forms of infertility. I also appreciate the value of the efforts made by different in vitro fertilization (IVF) groups, starting with that of Professor van Steirteghem and his collaborators, who are doing their best to develop the necessary follow-up of the children born after the ICSI procedure. My major concern is with the way in which assisted reproduction techniques generally emerge, including those that may develop in the wake of ICSI. These new microassisted human fertilization procedures are: testicular sperm extraction (TESE) to alleviate male factor infertility due to obstructive azoospermia ( 2) or due to azoospermia resulting from spermatogenetic maturation arrest ( 3; 5; 9); elongating and elongated spermatid injection (ELSI; 14) when spermatozoa are absent;␣round spermatid injection (ROSI; 13; 14) and round spermatid nuclei injection (ROSNI; 6; Sofikitis et al., 1995), when late spermatids are missing; and, very recently, secondary spermatocyte injection (SESI; 11) when spermatids are not available. These new techniques bypass the sperm selection processes that have evolved to regulate vertebrate fertilization (ICSI; 1), various steps of spermiogenesis (ROSI and ROSNI), the complete spermiogenetic process and the equatorial stage of division of meiotic cells (SESI). The first aspect that is deeply disturbing is that the development and use of these techniques were not originally published in the form of true scientific papers, i.e. papers that are peer-reviewed, that contain proof the assertions made (figures, pictures), and that provide all the information required for verification (detailed protocols). Instead, the first information on these revolutionary technologies was published in the form of press releases and short `letters to the Editor' of the Lancet (ELSI; 5; ICSI; 8) or of the New England Journal ofMedicine (ROSI; 13) or in the form of conference reports (ROSNI, SESI; 10, 11). These major distortions of the accepted method of scientific communication, concerning an issue as important as assisted reproduction which always receives tremendous media attention, raises the␣question of the responsibility of some of the clinicians in␣the IVF field. They also raise the question of the deontology of the editorial boards of some medical journals which seem to chase the scoop, rather than rigorously informing the scientific community on the conditions under which these human experiments were permitted (ethical committees?) and performed (reality, security, repeatability?) and how the outcome of these experiments is being followed up. There is another reason for disquiet. These new techniques are used to create human beings. However, in most cases they do not result from the logical extension of thorough animal experimentation designed to prepare the ground for the transfer to the clinical field, or of clearly planned and well-thought-out clinical decisions. Although I agree with Dr Baker that many important medical breakthroughs have developed fortuitously, in the field of reproduction it is striking that the fortuitousness is systematic, or almost. Instead, the emergence of the microinjection techniques has been presented as the consequence of an `accident' in the case of ICSI ( 8), or as totally opportunistic in the case of ROSI (Tesarick et al., 1995) and ELSI ( 5). SESI ( 11) was presented as the extrapolation of animal studies. In fact, these studies had only been performed using fertile animals, not animals affected by spermatogenic arrest, and were performed shortly before experimentation with human subjects, and by a single laboratory. There was therefore no opportunity for validation by the scientific community. As a consequence, not only do the practitioners of these techniques lack the minimum biological background that is always required before experimenting on human beings but, in most cases, no ethical approval was sought and therefore granted to develop these extremely audacious techniques. A further consequence is that the practitioners were and still are, de facto, unable to provide their patients with even the minimal information required for obtaining `informed consent', in particular when cells other than spermatozoa are used. Several arguments are often raised when the value of animal experimentation in assisted reproduction is discussed with IVF practitioners. The first is that several previous major advances in assisted reproduction technology were not preceded by any detailed animal studies (e.g. embryo freezing) and have not had any apparent negative consequence. This leads to the view that new technological jumps can be made in the absence of prior animal experimentation. Secondly, it is often said that, for technical reasons, it is not possible to develop animal models and/or that there is no adequate animal model. The third is that `scientists have not proved that these new techniques are dangerous'. Fourthly, animal experimentation is often presented as costly and time-consuming. This explains in turn why the few laboratories which are at the interface between the basic and clinical fields, and therefore have both the technical and intellectual skills, have not developed long-term animal experiments. The first of these arguments is akin to playing Russian roulette, and is an argument which is completely unacceptable in medical practice. It is also unclear whether enough time has elapsed or if the proper means are available to assess objectively all aspects of the possible consequences of the application of microinjection techniques on the progeny. There is no doubt that the techniques of microinjection of spermatozoa and, a fortiori, of other testicular cells, represents an increased risk to the offspring, because a significant proportion of the men requiring microinjection assistance are infertile for genetic reasons. Furthermore, because different steps of spermatogenesis are bypassed when immature germ cells are used, and because the identification of these cells cannot be accurate, additional and increasing risks are certainly taken with TESE, ELSI, ROSI, ROSNI and SESI. This should, a␣fortiori, lead to even more cautiousness (and modesty?) among IVF practitioners. Finally, the argument that no previous catastrophe has occurred in the field of assisted reproduction totally ignores the unprecedented social demand for safety in the fields of health and medicine resulting from the `contaminated blood scandal' and the other recent medical and scientific problems (e.g. contaminated pituitary extracts and the `mad cow' affairs). I remind those who pretend (or who used to pretend) that it is extremely difficult or impossible to set up animal models that this argument was raised in the past to justify, for example, 8) performing the first ICSI directly on a human being, before 7) succeeded in setting up ICSI in the mouse. This clearly shows that when a topic becomes `hot' enough, skills, time and money can be found to develop animal models. Furthermore, the assertion that `there is no adequate animal model' ignores the fact that animal experimentation is mandatory and extremely constraining for the pharmaceutical industry. Initially, when the first safety assessment guidelines were implemented for drugs, this occurred because of the catastrophic consequences of the thalidomide tragedy, and was not due to a consensus on the existence of an ideal animal model. For those who argue that the onus is on basic scientists to prove that these new technologies are dangerous, I would answer that technology should serve science, not dictate to science. Of course, when circumstances allow it one of the major roles of science is to provide the knowledge that allows understanding of how and why a given therapy works or does not work. Concerning the cost of programmes involving animal experimentation, it should be remembered that the health of human beings is at stake. Furthermore, if we consider the huge profits made by the `assisted reproduction industry', which includes the revenues of clinics, clinicians and industry (e.g. hormone manufacturers), then the absence of investment by these beneficiaries in basic and experimental research on assisted reproduction is striking. By contrast, note, for example, that the pharmaceutical industry invests an estimated 15–20% of its sales in research and development of new drugs. Finally, it is also important to note two major contradictions in the views of some of the pioneers of microinjection techniques: first, after having claimed that animal studies are not really relevant to human trials, they now want to use, or more accurately abuse, the few existing data arising from animal experimentation (e.g. SUZI and ICSI performed in normal animals, not in animals with spermatogenic arrest, and data on genomic imprinting) to justify in retrospect the experimentation performed in humans (see 4); secondly, while advocating caution in the use of microinjection procedures with immature germ cells ( 12), they themselves diffuse these techniques worldwide, including to countries where, a priori, there is very little chance that there will be follow-up studies, for example. Readers of this paper may believe that I am hostile to the development of the technology of assisted reproduction, but this is not the case. My goal is to highlight the singularity of the emergence of the most recent IVF technologies and some universal principles of science and medicine. One of these principles is that animal studies must always precede action on human subjects, and should always be verified before being applied. Being a reproductive biologist, the increasing rift between basic science and technology in the domain of assisted reproduction is a matter of great frustration and anxiety to me. As a simple citizen, I remember that 40 years ago, Hannah Arendt wrote that `if knowledge [in the modern meaning of know-how] and thought separate irretrievably, we will become the playthings and slaves, not so much of our machines, but of our practical knowledge'. I thank Professors M. C. Orgebin-Christ and G. Waites, as well as Professor Kamal Zaki for giving me the opportunity to present the ideas summarized in this article before the participants of the VIth International Congress of Andrology in Salzburg (25–29 May 1997) and the 10th Annual Congress of Andrology in Cairo (17–18 December 1997).
Open access
Sperm and Testicular Function
Reproductive Biology and Fertility
Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
The current economic problems in Southeast Asia can be attributed not to too much reliance on financial markets, but to too little . Like the U.S. economy a century ago, the emerging Asian economies do not have welldeveloped capital markets and so remain heavily dependent on their banking systems to finance growth. For all its benefits, banking is “not only basically 19th‐century technology, but disaster‐prone technology.” The extreme maturity (and, in some cases, currency) mismatch on banks' balance sheets plus the first‐come, first‐served nature of the deposit obligations mean that banks are inherently vulnerable to massive runs by depositors—and that their economies are subjected to periodic credit crunches. And, as the author says, “in the summer of 1997 a banking‐driven disaster struck in East Asia, just as it had struck so many times before in U.S. history.” In this century, In this century, the U.S. economy has steadily reduced its dependence on banks by developing “dispersed and decentralized” financial markets. In so doing, it has increased the efficiency of the U.S. capital allocation process and reduced its susceptibility to the credit crunches that have occurred throughout U.S. history. By contrast, Japan has not reduced its economy's dependence on banks, and its efforts to deal with its banking problems have served only to destabilize itself as well as its neighbors. Developing countries in Southeast Asia and elsewhere are urged not to follow the Japanese example, but to take measures aimed at developing financial markets and institutions that will either substitute for or complement bank products and services.
This dissertation starts from the presupposition that Mental Health, Primary Care and their articulations are propositions originated specific historical contexts and social conditions, implying necessarily in a translation when their assimilation occurs in Brazil and the state of São Paulo.The investigation developed along two lines: the building of the Mental Health field and its links with health and Primary Care in general and the articulation of Mental Health and Primary Care in the state of São Paulo.The study concludes that Mental Health emerges in historical conditions which favor public policies of social inclusion, through the extension of care, In this way it integrates hygiene and therapeutic propositions, and continues to exert a normative social hygiene.The integration of preventive and medical practices, taken as part of specific levels of prevention, makes possible the articulation of Mental Health to Primary Care and public health services.In the state of São Paulo, Mental Health in Primary Care emerges in the context of political redemocratization in 1982, as part of the implementation of specific forms of financing health care ("Ações Integradas de Saúde -AIS"), the decentralization of the governmental programs and the importance of Primary Care as a political banner.This implementation occurs in specific conditions in the state of São Paulo, with the inclusion of multiprofessional mental health teams in public primary health care services, as an experience of psychiatric reform.
Local governments (LGs) are seen as producers of the local public good ('the good'). An authoritarian country is one in which the government decides if the good should be produced and how much to tax to finance it, as versus a democracy in which voters decide. This paper identifies conditions under which it is more efficient for a non-democratic government to delegate to the LGs the authority to 1) decide whether or not to produce the good and2) Collect tax to finance it if the good is produced. Two conditions are identified First, when the net benefit of producing the good is sufficiently small so that, compared with the benefit, inducing LGs effort under the centralized system is too costly (a moral hazard problem). Second, when the net benefit of the is higher in a locale with a higher production cost parameters, making it difficult for the center to induce the LGs to truthfully reveal the cost parameter (an adverse selection problem). These results are consistent with the experience of China in the past several decades, where "too small to be worth bothering" and "too diversified and complicated local conditions for the center to know" have been the two most prominent official arguments made by the communist government itself for decentralization
BACKGROUND: Changing patterns of patient referral, decreasing payments for service provision, confusing network participation and reimbursement, as well as challenges to autonomous clinical decision-making jeopardize the traditional role of the oncologist in delivering cancer care. The cancer patient also may be at risk with unproven cancer delivery systems that displace the oncologist as decision-maker and care provider. The authors have constructed a model that preserves the oncologist's clinical and financial autonomy while meeting marketplace demands for improved access, decreasing costs and preserved quality of care. METHODS: During a 4-year period, a group of private practice medical oncologists initiated a formal business plan to evaluate marketplace needs, then designed and implemented a novel cancer care delivery model. The model required reconfiguring the practice into an integrated Joint Commission on Accreditation of Healthcare Organizations-certified cancer service corporation, providing medical, radiation, and gynecologic oncology. Palliative care, pain management, psychologic, and nutritional services were instituted as well as the vertical integration of home health and hospice care. Clinical pathways and treatment protocols were designed to enhance patient care and facilitate cost-of-care projections in designated populations using a cancer incidence forecasting model. Outcomes analysis are performed as part of ongoing continuous quality improvement, which continues to change this health care delivery system. RESULTS: In the 3 years since implementation of the model, the practice has increased from 16 to 24 physicians, and the number of offices has increased from 12 to 17. Patient encounters, both new and established, have doubled. Cost of services, specifically hospitalization, have been reduced by 50%. Clinical research referrals have increased 300%. Physician compensation has improved >20%. CONCLUSIONS: The model created a low cost, high value provider not burdened by allocated overhead. Decentralized care enhanced community access, which improved patient compliance, enhanced patient satisfaction, decreased hospitalization, and thereby decreased cost. The horizontal structure permited the flexibility for varied purchaser products and politically sensitive physician and hospital provider panels. Consensus-based protocol and pathway determination achieved maximum physician participation, which preserved clinical and financial autonomy, decreased variance, and facilitated clinical research.
This dissertation examines why and how jurisdictions choose to finance their roads. The systematic causes of revenue choice are explored qualitatively by examining the history of turnpikes. The question is approached analytically by employing game theory to model revenue choice on a long road. The road is covered by a series of jurisdictions seeking to maximize local welfare. Jurisdictions are responsible for building and maintaining the local network. Complexity arises because local network users may not be local residents, and local residents may use non-local networks. Key factors posited to explain the choice of revenue mechanism include the length of trips using the road, the size of the governing jurisdiction, the degree of excludability, and the transaction costs of toll collection. These factors dictate the size and scope of the free rider problem. It is hypothesized that smaller jurisdictions and lower collection costs favor tolling policies over taxes.The analytical model is operationalized by assuming jurisdictions have two decisions: the strategic decision to tax or toll, and the tactical decision of setting the rate of tax or toll. Models of user demand as a function of trip distance and monetary cost and of network costs as a function of traffic flow and the number of toll collections are specified. The values of the constants and coefficients of the model are developed from recent cost literature and the estimation of a model of collection costs from California Toll Bridge data.The model is applied to evaluate the dissertation's hypotheses. The application evaluates the welfare implications of a jurisdiction and its neighbors imposing general tax, cordon toll, odometer tax, or perfect toll policies. Sensitivity tests of the model under alternative behavioral assumptions, and with varying model coefficients are conducted. Finally, policy implications from the analysis are drawn. The general trends which bode well for road pricing (electronic toll collection (ETC), decentralization, advanced infrastructure, privatization, and federal rules) are established. Possible scenarios for three cases are presented: deploying ETC and building new toll roads, and converting free roads.
Through analyzing the softness and hardness of budgeting constraints in research and development (R&D) investment under different institutions, we develop a theory of optimal R&D financing. Our theory not only provides a clear comparison of investment efficiency between centralized economies and market economies but also extends the analysis of soft budget constraints to firms in market economy. Based on this theory, we characterize optimal choices of R&D project financing in centralized and decentralized economies. Our results explain why some projects are financed internally by a large firm but others are cofinanced externally by several firms. We also explain what makes a centralized economy inefficient in R&D.
<p>This paper presents the first efficient statistical zero-knowledge protocols to prove statements such as:<br />A committed number is a pseudo-prime.<br />A committed (or revealed) number is the product of two safe primes, i.e., primes p and q such that (p - 1)=2 and (q - 1)=2 are primes as well.<br />A given value is of large order modulo a composite number that consists of two safe prime factors.</p><p>So far, no methods other than inefficient circuit-based proofs are known for proving such properties. Proving the second property is for instance necessary in many recent cryptographic schemes that rely on both the hardness of computing discrete logarithms and of difficulty computing roots modulo a composite.<br />The main building blocks of our protocols are statistical zero-knowledge proofs that are of independent interest. Mainly, we show how to prove the correct computation of a modular addition, a modular multiplication, or a modular exponentiation, where all values including the modulus are committed but not<br />publicly known. Apart from the validity of the computation, no other information about the modulus (e.g., a generator which order equals the modulus) or any other operand is given. Our technique can be generalized to prove in zeroknowledge<br />that any multivariate polynomial equation modulo a certain modulus is satisfied, where only commitments to the variables of the polynomial and a commitment to the modulus must be known. This improves previous results,<br />where the modulus is publicly known.<br />We show how a prover can use these building blocks to convince a verifier that a committed number is prime. This finally leads to efficient protocols for proving that a committed (or revealed) number is the product of two safe primes. As a consequence, it can be shown that a given value is of large order modulo a<br />given number that is a product of two safe primes.</p><p> </p><p>Keywords. RSA-based protocols, zero-knowledge proofs of knowledge, primality tests.</p>
While industrialists are discovering the hidden costs of minimal compliance with environmental regulation, environmentalists assert that EPA regulations contain too many loopholes. Since government regulation pleases neither environmentalists nor the regulated industries, we have to think in new directions. Can financing alternative technology be superior to monitoring pollution? Can local communities play a role in creating cohesion out of decentralization? What are the best new strategies both on the level of local communities and alternative technologies?
Reconstructing Africa's war damaged economies is an urgent task. This is especially so in a group of countries - Angola, Eritrea, Ethiopia, Guinea-Bissau, and Mozambique - which must also complete their economic and political transition from state socialism. Somalia, which shares their common history, must eventually be rebuilt. All of these countries must address their deep problems of underdevelopment and poverty. The challenges are therefore three-fold: to overcome underdevelopment, to make the transition from state socialism, and to reconstruct economies and societies. Socialism was influential across post-independence Africa. But UTR countries drew more explicitly on Marxism-Leninism and the Soviet development model. With the aim of accelerating growth, enterprises and property were nationalized and controls were established. But the result was a fatal over-centralization of political and economic power, and a slide into conflict exacerbated and fuelled by the politics of the cold war. Somalia collapsed into a turmoil from which it is yet to recover. Mozambique has made the most progress and, until their border war this year, Eritrea and Ethiopia were both moving forward. Angola faces urgent reconstruction problems but progress had been slow, and a return to outright war cannot be ruled out. Guinea-Bissau was knocked off course by a military revolt in 1998. Progress has therefore been tentative in the UTR group, and their future prospects depend on them finding political settlements that can secure their prospects for economic development. War, and the uncertainty associated with it, distorts economies; investments with long- term returns, mainly in production activities such as agriculture and manufacturing, are cut back, and the economy becomes dominated by activities with short-term returns, such as commerce in cities and safe areas. Natural resource sectors may continue to operate, however, when protected by their location (for example offshore oil and gas) and when combatants seek to preserve them as the 'prize' for capturing the state. Past failure to achieve broad-based growth contributed to conflict. This implies that reconstruction cannot simply entail the recreation of the pre-conflict economy. Policies, public expenditures, and institutions must be changed, often fundamentally. For this reason the agendas of reconstruction and economic reform (transition) cross over. Well- designed reforms can contribute to reconstruction and vice versa. But too often there is a mismatch between the reform and reconstruction programmes, and the ground for broad-based development is not secured. Aid is important, but success ultimately depends on the actions of three national actors: communities, entrepreneurs, and states. However, communities are impoverished, private sectors are underdeveloped, and state capacities are weak. For communities, the main challenges are to deal with the immediate post-war humanitarian and security problems and, equally important, accelerate programmes for longer-term poverty reduction. Regarding the first of these, the tasks are to resettle displaced populations, disarm and demobilize ex-combatants and assist their reintegration, reduce the level of violence (by filling the security gap and decommissioning weapons), remove land mines which disrupt community livelihoods, and protect food security while phasing out food aid and increasing targeted support. Regarding longer-term poverty reduction, the future pattern of growth is determined by (i) the distribution of human and social capital, access and control over natural capital (including land tenure) and access to physical infrastructure (ii) the policy framework which determines the returns to household investments and (iii) the quality of institutions, including the legal framework. State socialism and conflict altered every aspect of the pattern of growth, and transition and reconstruction alters it again. Focusing public policy more effectively on poverty reduction, in particular on core services of most benefit to the poor, is therefore an urgent task. To support this, the relationship between donors and governments should be changed in order to focus more on monitoring social outputs and less on unworkable policy conditionalities (and to direct aid to governments committed to poverty reduction). More investment in collecting social data is needed to understand the impact of reconstruction and transition on communities. Turning to the second key actor, entrepreneurs, we can see that a new private sector is being created in UTR countries following decontrol and privatization. Overcoming investor uncertainty is a key task; this can persist and limit investment despite a fall in actual country risks. Angola and Mozambique are so far the largest recipients of foreign investment in UTR countries. But the impact of Mozambique's large investment programme is virtually unknown, while foreign investment in Angola is confined to the oil sector, which has few links to the rest of the economy. Privatization is proceeding at different speeds across UTR countries. Privatization in the financial sector is especially important; reconstruction requires a financial sector capable of mobilizing and intermediating savings into private investment. Recapitalizing the banking sector is expensive, and requires private capital, which implies privatization. Political influence can create unsound banks and better financial regulation is needed. But the phenomenon of 'straddling', in which political leaders invest in commercial enterprises, endangers the independence of financial regulation, and can distort the privatization process. Privatization in the agricultural sector has seen the non- transparent privatizations of state farms and the denial of community rights and some inconsistencies between privatization and agricultural policy reform. Encouraging more private investment in agricultural marketing is especially important for food security and rural poverty reduction. The third national actor is the state. A developmental state must be constructed. This is a set of democratically accountable institutions capable of effective policy design and implementation. If this is successful, the new state will look very different to the old state, but it is unlikely to be 'minimal'. The onus is therefore on democratic governments to prove that they provide value for money to communities and entrepreneurs. The new state agenda will remain a wish list unless it is properly financed, which it is not at present. Reconstruction expenditures are high, revenues are low (war reduced tax bases) and distorted (over dependence on trade taxes). Countries are severely indebted; almost all Africa's conflict/post-conflict countries are classified as 'Heavily Indebted Poor Countries' (HIPCs). The fiscal peace dividend is small (at least in the early years) and the high level of insecurity in Africa keeps military budgets high. Budgetary institutions are weak at mobilizing revenues and allocating them to priorities, and non-transparency and the improper use of public funds must be reduced. As a result of these problems, and the sheer scale of reconstruction expenditures, fiscal deficits before grants are very high. Nobody seriously questions the principle of fiscal prudence but the IMF's fiscal policy conditionality may be over-restrictive; certainly many other donor agencies believe that this is the case. This leaves many investments with high social returns on the shelf, implying slower growth and poverty reduction. A much longer time frame is therefore necessary to evaluate fiscal policy in an economy under reconstruction. The IMF's caution in part arises from the observation that real aid flows are in decline, and it therefore advises governments to move to a fiscal position in which any downturn in aid will not affect their recurrent, as opposed to their capital, spending. However, it is still possible for aid flows to individual countries to maintain their present levels or rise, and this is in fact the way the donor community is moving in seeking to redirect aid to countries committed to broad-based development. The IMF's fiscal policy conditionality, when it is over-restrictive, works against the new aid paradigm. Moreover, over-tight fiscal policy can lead to the use of distorting taxes that undermine reconstruction, it can work against improvements in budgeting, and it may be incompatible with democratization. The paper only touches on some of the major challenges facing the UTR group of countries. Decentralizing political and economic power, minimizing macro-economic shocks, and preventing conflict through broad-based development are all crucial. This requires hard choices over resource allocations and public policy. But these choices are a great deal easier to make than those involved in ending a conflict and initiating reconstruction. Ex ante action - good economic policy - is always better and cheaper than ex post crisis management.
This paper is one of eight case studies in the health sector conducted under the project "Population and Urbanization: Managing the Urbanization Process Under the decentralized Governance Framework" jointly undertaken by the Philippine Institute for Development Studies, National Economic and Development Authority and Development Academy of the Philippines. This paper is a case study on Cotabato City recommended by NEDA-Region XII as a model city for health. The city has come up with the Special Project on Health and Sanitation that won a silver Award in the 1997 Health and Management Information System Contest.
Decentralization of welfare policy for the elderly in recent Japan made local municipalities have responsibility to provide services. This means, however, the varieties in the quantity and the quality of services between municipalities. It is difficult to obtain the land for institutions especially in urban municipalities because of the high price of land. Therefore, the shortage of provision is serious problem in urban administration. Furthermore, the demand for services can not be satisfied in own municipality and affects neighborhood municipalities.From these problems, the present paper aims to clarify how the institutional care services were provided and the needs for services were satisfied in and out of one municipality. Nagoya City, the study area, is one of the major metropolitan city in Japan, with over two million population and it is divided into 16 wards. The object of this study is nursing home for the elderly, which is the most major service in institutional care in Japan.The results of the study can be summarized as follows:1) The locations of nursing homes are remarkable in peripheral than central wards of the city relatively. The capacity of beds by wards is not proportional to the population 65 and above.2) Each nursing homes bases on a variety of types of the organizations; public, welfare facilities, hospital, religious group, private person and so on. Since 1994, the outer organization of the administration, which had financed half by the administration, had built many homes remarkably. Consequently, the location of homes proceeded also in the central wards, where there were no homes so far. This means that unless positive policy for the provision of homes by the administration is adopted it is not easy to increase homes in urban region, where the availability of land is low.3) Regarding use of nursing homes, many of migrations to enter homes leave for own or neighbor wards. There are more immigrations from other wards where the degree of congestion of homes (the number of beds per 100 people aged 65 years and over) is relatively loose.4) Correlation coefficient between the provision of nursing homes (the number of persons entered in homes) and the demand (the number of entered and waiting lists) was not significantly different from zero at the 0.05 level. Therefore, the level of territorial justice on nursing homes in Nagoya City is not high.5) As a result of the principal component analysis on the migrations to enter homes in Nagoya City, six components (cumulative percentage of the total variance; 73.3%) were extracted. By the interpretation of the components, major patterns of immigrants were to“northeast wards”, “southwest wards”and“eastern wards”.6) Although immigrations to other municipalities leave for the whole of Aichi Prefecture, municipalities in western region of the prefecture had accepted many people from Nagoya City. Immigrations to the municipalities in the next region, policy for provision of services for the elderly, of Nagoya City is surpassing from the peripheral ward which locates on a line from the central of Nagoya City toward to a municipality of destination.7) Although by municipalities in the prefecture the degree of congestion of homes doesn't have relations with the number of persons from Nagoya City, by the policy district it was obviously proportional to ones. Consequently, most of eleven cities with populated above 100 thousand people had so congested that immigrations from Nagoya City were not so many, except for Toyohashi and Toyokawa where the degree of congestion of homes were loose.8) Finally, horizontal intergovernmental relations between Nagoya City and its next municipalities were evaluated through the comparison the number of immigrations from Nagoya City and each of their own demand for homes.
We show simple constant-round interactive proof systems for problems capturing the approximability, to within a factor of n , of optimization problems in integer lattices, specifically, the closest vector problem (CVP) and the shortest vector problem (SVP). These interactive proofs are for the coNP direction; that is, we give an interactive protocol showing that a vector is far from the lattice (for CVP) and an interactive protocol showing that the shortest-lattice-vector is long (for SVP). Furthermore, these interactive proof systems are honest-verifier perfect zero-knowledge. We conclude that approximating CVP (resp., SVP) within a factor of n is in N P ∩co A M . Thus, it seems unlikely that approximating these problems to within a n factor is NP-hard. Previously, for the CVP (resp., SVP) problem, Lagarias et al. (1990, Combinatorica 10 , 333–348), Håstad (1988, Combinatorica 8 , 75–81), and Banaszczyk (1993, Math. Annal. 296 , 625–635) showed that the gap problem corresponding to approximating CVP (resp., SVP) within n is in N P ∩co N P . On the other hand, Arora et al. (1997, J. Comput. System Sci. 54 , 317–331) showed that the gap problem corresponding to approximating CVP within 2 log 0.999 n is quasi-NP-hard.
H A ElZein, Maureen Birmingham, Z. A. Karrar, A A Elhassan · 5 authors
In 1993 a large outbreak of paralytic poliomyelitis occurred in Sudan as a result of an accumulation of large numbers of susceptible children that was accelerated by faltering immunization services. The extent of the outbreak led to the rapid rehabilitation of Sudan's Expanded Programme on Immunization (EPI); the government began financing vaccine purchase, operational aspects of EPI were decentralized, vaccine delivery was changed from a mobile to a fixed-site strategy, a solar cold chain network was installed, inservice training was resuscitated, and social mobilization was enhanced. National immunization days (NIDs) for poliomyelitis eradication were conducted throughout the country, including the southern states during a cease fire in areas of conflict. Measles immunization coverage was increased by offering measles vaccine during the second round of NIDs and subsequently through routine immunization services. Supplemental tetanus toxoid immunization of women of child-bearing age began in three provinces at high risk for neonatal tetanus. From 1994 to 1996 reported immunization coverage increased and the incidence of all EPI target diseases fell. Trends in coverage, disease incidence, financing, and the implementation of WHO-recommended disease-control strategies suggest that more sustainable immunization services have been re-established in Sudan.
National leprosy control programmes currently face a number of changes to the environment within which they operate. This paper examines the issues arising from these. It focuses, in particular, on those arising from changes in the structure of the health sector as a result of policies of health sector reform which are being considered or adopted in many developing countries. These include decentralization, financing strategies, greater role for the private and NGO sectors and the integration of vertical programmes. The paper is structured around a number of key steps in the development of a strategy for sustainability of appropriate leprosy services. These are the assessment of the epidemiological, social and health services context, development of programme objectives, planning of human and financial resources, development of the strategy, mapping the roles of potential actors, development of regulatory and incentive mechanism, action planning and managing change and, finally, re-evaluation of the programme objectives and service delivery organization. The paper stresses the importance of process in developing ownership of a strategy. It concludes with a set of key questions which it suggests need to be addressed by leprosy programme managers in the development of a proactive response to the changes.
This paper describes a new approach to design modern information systems that offer an integrated access to the data and knowledge that is available in local applications. By integrating the local data management activities into one transparent information distribution process, modern organizations can offer better support for its workers in the execution and coordination of their work activities. Observing practical applications of decentralized, autonomous and heterogeneous information systems we see deficiencies in currently available approaches to model such information systems. They do not acknowledge the pivotal role that (informal) communicating workers play in the context of an entire organization. The interaction between the members of social and informal groups of employees makes it possible that (in many of today’s information-intensive enterprises) the local structured procedures can be effectively and flexibly integrated into global work processes supporting the business goals. Traditional design techniques concentrate on either the structured local procedures (and its local database applications), the structured global process (and its global business goals), or the informal (less structured) communication between individuals. We suggest to combine an activity-based model (suited to describe the structured parts of the processes) with a goal- or conversation-based model to tie the different elements together. Using an agent architecture we show that it is possible to implement this integrated approach. The different types of cooperating agents support the individual workers by assessing the goal of the activity, the applicability of the standard procedure, and the availability of alternative knowledge and information in order to supply the necessary information.
The internationalization of capital markets that occurred during the era of the classical gold standard (1870-1914) was part of a broader set of trends that threatened to drain local markets from capital and channel that capital to the national financial center and, from there, toward other national financial centers. Still, internationalization was neither inevitable, uniform, nor irreversible but was a political choice informed by redistributional considerations between rival domestic interests and decided by politically dominant coalitions. The domestic institutional structure in each country determined the composition of the politically dominant coalition. Decentralized structures allowed potential losers to curb public policies favorable to capital market internationalization, whereas centralized structures allowed expected winners to promote such policies. As a result, economies with centralized states ended up being the most dependent on the international capital market, whereas economies with decentralized states took a less active part in the globalization of finance.