Blockchain Papers

Alberto Montresor, Francesco De Pellegrini, Daniele Miorandi

No abstract is available for this record.

Ruud Corsel, Janelle Plummer

Transparency and openness in government is not easy to achieve where there has been a history of patronage and favoritism underlying service delivery. In Cambodia however, a small pilot now replicated by the World Bank financed DFGG project to reach twenty-five districts and municipalities has introduced a vastly different approach to the delivery of administrative services. Transparency of fees and processes has resulted in vastly improved performance and standards of services, fewer intermediaries in the process and a significant reduction in informal payments. While this approach still only represents a small portion of administrative services, it has set a new standard for sub-national administrations and offers a model for replication as functions are decentralized to local government. This note sets out how this transparency was achieved and the opportunities and challenges for the future.

Mark J. Flannery, Kristine Watson Hankins

No abstract is available for this record.

Edward Cohen

On 28 February 1895 Oscar Wilde arrived at his club, the Albemarle, after an absence of several weeks and was presented with an envelope containing the Marquis of Queensberry's calling card. On the back of the card were scrawled the words: "For Oscar Wilde Posing as a Somdomite [sic]." As the culmination of months of harassment by the Scottish aristocrat - who objected to Wilde's intimacy with his youngest son, Lord Alfred Douglas-the short text so incensed Wilde that it incited him to instigate legal action against its author. Filing charges under the 1843 Criminal Libel Act (6 and 7 Vict. I, c. 96), Wilde's legal representatives asked the court to interpret the marquis's text as a verbal attack upon his person and to hold its author criminally responsible for the consequences of his writing. Unfortunately for Wilde, the statute invoked on his behalf allowed the accused party a unique form of rejoinder: the defendant could assert his innocence by placing a competing interpretation of the alleged libel before the court - in what was termed a "plea of justification" - which sought to prove that the offending statement was both "true" and "published for the public benefit." If the court verified that both these conditions obtained, then the defendant would be deemed innocent of the charge and the libel found to be legally substantiated. Needless to say, the Marquis of Queensberry's lawyers quickly countercharged that such was the case. This defense tactic effectively transformed the legal proceeding in Wilde v. Queensberry into an interpretive contest both for determining the text's "true" meaning and for assessing its social significance. Hence, what was at stake in the proceedings of Wilde v. Queensberry was not simply whether or not the writing on the Marquis of Queensberry's card constituted a libel against Wilde, but also what it meant "to pose as a sodomite," whether Wilde had done so, and if publishing the knowledge of such a "pose" was in the public interest.\nFramed by the tenor of these questions, the trial necessarily foregrounded the specificity of the phrase "posing as a sodomite." Since the contested statement did not actually accuse Wilde of "sodomy" - or of being a sodomite - for which a strict standard of legal proof (i.e., proof of penetration) would have been required, the defense sought instead to show that Wilde was the kind of person--or at least that he had (re)presented himself as the kind of person-who would be inclined to commit sodomy. In support of this personification, the plea of justification tried to shift the legal focus on sodomy away from its traditional status as a criminally punishable sexual act so that it became in the defense's construction a defining characteristic of a type of sexual actor (the "sodomite"). In order to provide a credible standard of proof for this characterological claim, the defense's plea of justification listed thirteen allegations that "Oscar Fingal O'Flahertie Wills Wilde . ..did solicit and incite ... [another male person] to commit sodomy and other acts of gross indecency." Here, playing upon the indeterminacy introduced by the word "posing," the defense interpretation subsumed the specific cultural and legal history evoked by the word "sodomy" with the newer, relatively unknown category, "acts of gross indecency," metonymically subsuming the former within the behavioral penumbra of the latter. Thus, even as the defense plea displaces "sodomy's" historical privilege as the sole basis for criminalizing sexual acts between men and constitutes it as one of a number of "other acts of gross indecency," the earlier concept is simultaneously recouped by the defense plea as the legitimating criterion through which a much wider variety of "indecent" relationships between men can be brought within the legal purview.

Harold Tiemessen, Maria Fleischmann, Geert‐Jan van Houtum, J.A.E.E. van Nunen · 5 authors

No abstract is available for this record.

Elisa Sartori

In this decade, establishing structure-function relationships in human brain has become one of the most influential concepts in modern cognitive neuroscience since interactions among cerebral components are fundamental to explain cortical activities ([1]; [2]; [3]).
\nIn literature such relationships have been defined in terms of structural, functional and effective connectivity. This distinction, mainly focused on the theoretic concept, is also related to the different measurement instruments and analytical tools used for acquiring and processing the data. The structural connectivity refers to a pattern of anatomical links among brain regions. Its analysis aims to characterize the architecture of complex networks underlying the cerebral functional organization. Magnetic Resonance Imaging and especially Diffusion Tensor Imaging can be used to convey information concerning the physical connection between neuronal populations. Functional/effective connectivity aims at identifying the presence and the strength of connections in terms of statistically significant dependency. The former is defined as the temporal correlation between neurophysiological events occurring in distributed neuronal groups and areas. The latter describes the causal influence that one neural system exerts over another either directly or indirectly in terms of temporal precedence and physical control ([4];[5]). Functional and effective connectivity can be estimated exploiting both Functional Magnetic Resonance Imaging (fMRI) and electrophysiological signals, such as Electroencephalography (EEG) and Magnetoencephalography (MEG), with different advantages and drawbacks, respectively. fMRI provides high spatial resolution (mm) but poor temporal precision (s) while EEG/MEG has more limited spatial resolution (cm) and higher temporal precision (ms). Because functional and effective connectivity are largely estimated over time, EEG and MEG are more suitable for calculating such connectivity. In literature several methods have been developed to characterize brain connectivity in terms of network topology, connections strength and causality, following two main approaches: the data-driven, where topology, causality and strength are all inferred from data, and the neural model-based, where the model topology is postulated from a priori knowledge and only the connections strength is estimated from the data.
\n-\tData driven approach. The data driven approach includes linear, non-linear and information-based techniques. The linear ones provide a battery of indices derived by multivariate autoregressive models (MVAR) based on Granger causality principles ([6]) or MVAR frequency response ([7]). Such are Ordinary Coherence, Partial Coherence, Directed Transfer Function (DTF) and Partial Directed Coherence (PDC). These indexes measure the strength of the linear coupling between two signals; in addition DTF and PDC provide information about causal influence ([8]). 
\no\tAmong the non-linear techniques, phase synchronization has been shown to be very effcient in detecting interactions between oscillators. The phase locking values approach assumes that two dynamic systems may have their phases synchronized even if their amplitude are zero correlates ([9]). 
\no\tThe most representative information-based technique is the cross mutual information that measures the mutual dependence between two signals by quantifying the amount of information gained about one signal from measuring the other, as a function of delay between these two signals ([10]).
\n-\tNeural model based approach. Representative methods are the Structural Equations Modelling (SEM) and the Dynamic Causal Modelling (DCM) ([11]; [12]). They are multivariate technique used to test hypothesis regarding the influences among interacting variables, but different concepts underlies these two methods. SEM approach assumes that neuronal dynamics are very fast in relation to signals uctuations and, hence, is based on a static neuronal model. This case, the neuronal activity has reached steady-state and changes in connectivity are led directly by changes in the covariance structure of the observed time series ([13]). On the other hand, in DCM the observed time series are modelled as a deterministic dynamical system in which external inputs causes changes in neural activity and therefore in connectivity values ([14]).
\nMost approaches, like those based on Granger causality principles, have been examined in literature to quantify their ability in revealing cerebral connections ([15];[16]; [11]) but their simulation studies do not provide a comprehensive analysis because they use in silico data generated by self-referential linear methods which do not reproduce the complexity of brain. To overcome this issue, an innovative simulation approach has been developed in this work, based on a nonlinear neural mass model ([17]) totally independent of SEM and MVAR linear equation and able to address the complexity of neural networks. This no-self referential approach was exploited to generate in silico network data to be used as a benchmark, to quantitatively compare obtained results with true connections. The main objective of this work was to understand limits and advantages of MVAR indexes and SEM by exploiting the simulation study. Thus, it mainly serves as a proof-of-concept for connectivity measures under ideal conditions. Our purpose was to derive from simulation results some practical procedures in order to classify different brain states to support both cognitive research and clinical activity. First, research activity was focused to address connectivity on simulated data obtained on three regions networks characterized by different strength connections and based on different levels of non linearity. Second, a dataset, made available by Department of Medicine, University of Padova was used to explore application of these methods to real data by applying the simulation study suggestions.
\nThis thesis consists of three main section.
\nThe ffrst one includes Chapter 1-2-3 describing in detailed the considered connectivity measures, such are those based on Multivariate Autoregressive models and the Structural Equation Modelling, and the simulation study. The second part depicts in silico results and the application to EEG data. Finally, comments are reported in Discussion and Conclusions.
\nChapter 1 explains how the connecting parameters of MVAR and SEM models are identified on EEG data and describes procedures commonly exploited to analyse connectivity. Chapter 2 reports an overview about the principal models used to generate in silico data, namely the neural mass models, and described the neural mass model exploited in this work. Finally, it characterizes network models adopted to simulate data and lists the procedure followed to generate in silico datasets. Chapter 3 summarizes the computations implemented to have more insights on our data by analysing the output of each methods. It describes the procedure used to evaluate the statistical signiffcance of each index results, such are the F-test for Granger causality index and the null distribution threshold using surrogate data for MVAR frequency indexes. Chapter 4 illustrates the results obtained with the simulation study. First, we reported the complete analysis for a representative subset of experiments, then for all datasets we showed topology and strength estimates. Chapter 6 delineates the procedure followed to study the connectivity in case of hepatic encephalopathy. Chapter 7 covers the Discussion and Conclusions. The Appendix is a parallel work aimed to understand the meaning of connectivity indexes computed via Structural Equation Modelling. By exploiting the neural mass model used to simulate cortical data, the objective is to quantify which measure its estimates represent. We demonstrated that Granger causality is a good estimator with high values both of sensitivity and specificity, while frequency indexes, DTF and PDC, are too much affected by the threshold choice and their interpretation in terms of absolute strength connection is not clear. As regard SEM, we proved the difficulty of its approach to describe just simple situations. Even if SEM is based on linear regression as well as MVAR models, it differently assumes there is no connection with past information, as if brain connectivity could describe time series relationships by the instant we observe it. Hence, it is not sufficiently robust to characterize neuronal dynamic activity. 
\n

Maryam Rajabzadeh Asaar, Ali Vardasbi, Mahmoud Salmasizadeh

Strong designated verifier signature (SDVS) is characterized by two properties; namely the non-transferability and the privacy of the signer's identity (PSI). Non-transferability prevents anyone else other than the designated verifier to verify the signature, while PSI prevents a third party to distinguish between two different signers. In this paper, we propose a non-delegatable SDVS which uses a trusted third party for the key generation. Our signature scheme does not use bilinear pairings which makes it suitable for the resource constraint applications. Using one-way homomorphic functions, our scheme is presented at an abstract level, the unification of which was noticed by Maurer in the context of zero knowledge proofs of knowledge in Africacrypt 2009. The security of the proposed scheme is proved in the random oracle model, provided that the homomorphism one-wayness and the gap Diffie-Hellman assumptions hold. When a Schnorr-like homomorphism is used to construct our scheme, six exponentiations are needed in the signing step and seven for the verification step. This means a meaningful gap between the performance of our scheme and that of its predecessors which use pairings in their signing and/or verification steps.

Flavio Junqueira, I. W. Kelly, Benjamin Reed

Practical systems must often guarantee that changes to the system state are durable. Examples of such systems are databases, file systems, and messaging middleware with guaranteed delivery. One common way of implementing durability while keeping performance high is to use a log to persist updates to the system state. Such systems use the log to reconstruct the system state in the event of a crash. When implementing such a log, if the log is only stored locally, the system state is permanently lost when the server writing the log experiences a permanent hardware failure. BookKeeper is a system that exposes a log abstraction for building high performance, highly available distributed systems. BookKeeper transparently implements replication for high availability and striping for high performance. A Book- Keeper deployment comprises storage servers called bookies, which are designed to serve a large number of concurrent ledgers. BookKeeper is currently an open-source project and is in production use at Yahoo!

Bowen Shu, Chunsun Zhang, Da Xing

No abstract is available for this record.

Joseph Bernstein

The American malpractice system is a mess, and in orthopaedic surgery, it is messier still. One problem is frivolous lawsuits. The Harvard Medical Practice Study [5] reviewed the hospitalization records of more than 30,000 patients and determined for each case whether negligence was committed and a suit was filed. The researchers found most of the events for which claims were made did not involve negligence. It is small consolation that physicians usually prevail at trial. Even when a doctor wins the case, defending a malpractice claim is a losing proposition. At best, the physician is portrayed by the plaintiff’s counsel as a bumbling incompetent. Also, malpractice insurance (which routinely exceeds USD 100,000 per year in some states) indemnifies against only financial damages; the losses of time, reputation, and serenity are for the physician alone to bear. The net drain on happiness probably exceeds what one experiences in contracting appendicitis or breaking an ankle. In response, the orthopaedic surgery community has pressed for change. The hallmark of the orthopaedic approach is limits on noneconomic damages. These so-called “caps” would mandate that while all medical expenses and lost wages caused by malpractice are compensable, no more than a given amount, say USD 250,000, can be awarded for “pain and suffering.” Caps are an appeal to logic and fairness. For one thing, the argument goes, it is impossible to place a precise dollar value on pain and suffering, and if any amount is to be arbitrary, why not keep the dollar values modest? In addition, limits on noneconomic damages mitigate the harm caused by “runaway” juries, making the system less volatile and therefore less expensive for all. But let’s face it: the real appeal of caps is that they limit the number of suits. Most cases are brought forward on a contingency basis; the lawyers get paid only if they win. If the payoff of a case is limited, its attractiveness to an attorney is, likewise, limited. Caps work. In general, malpractice premiums are much lower in those states (such as California) that have caps in place [10]. But the problem with caps is that they solve the wrong problem. While there is plenty amiss with the American medical malpractice system, the largest flaw is not having too many lawsuits. If anything, there are too few. The Harvard Medical Practice Study cited above, for example, reported only eight of the 280 patients (2.9%) who were the victims of medical negligence actually filed malpractice claims. As such, if we can agree a central purpose of a malpractice system is to compensate victims of negligence, we can also agree caps, which discourage litigation across the board, and not just the frivolous cases, undermine that purpose. And, if another central purpose of a malpractice system is to deter errors, then we might also agree any method that discourages litigation in general, benefiting bad physicians as well as good ones, similarly undermines deterrence. Orthopaedic surgeons should favor a system that minimizes physician pain yet allows victims of error unfettered access to fair compensation. Abraham and Weiler [1] have proposed such a system. They call it “enterprise liability.” Under this approach, it is the organization, not the physician, that is named as the defendant in a suit. The rationale is simple: because many medical errors are, in fact, systems failures, it stands to reason that the enterprise should bear primary responsibility for compensation and deterrence. Local enterprises, when held accountable in this way, should likewise do a better job of policing practice and eliminating bad practitioners, as opposed to the current approach to malpractice, which indiscriminately lumps (and punishes) many good surgeons along with the few bad players. There are, of course, impediments to applying enterprise liability. For one thing, even for procedure-oriented specialties like orthopaedic surgery, much health care is not delivered within the confines of a single enterprise. Also, it is not assured that enterprises themselves will avoid hunting for scapegoats. Even so, the advent of Accountable Care Organizations (as promoted by the 2010 Patient Protection and Affordable Care Act) and the heightened political awareness among physicians regarding liability rules will, respectively, mitigate those concerns. Enterprise liability is a practical option moving forward. We orthopaedic surgeons, as advocates for our patients, should favor a system that limits error and compensates victims when errors occur. As human beings, we can’t help but hate attacks on our competence and character. Thus, we are also right to favor a system that minimizes finger pointing. A system of enterprise liability meets all of those standards. Enterprise liability, not caps on noneconomic damages, should be our favored approach. Commentary James Herndon MD, MBA Chairman Emeritus, Department of Orthopaedic Surgery, Harvard Medical School; Partners Healthcare System, Boston, MA, USA Dr. Bernstein has raised an important issue: the use of a method of professional liability reform called enterprise liability. The US medicolegal system has not accepted it in the past, and it will be difficult to implement such a major culture change in the future. However, Dr. Bernstein raised this method of compensating injured patients because he sees a new opportunity for change under the Patient Protection and Affordable Care Act, with the new development of Accountable Care Organizations. I agree with him on this point and would argue it is also a desired method in the new practice model in which physicians are increasingly becoming paid employees of a hospital or hospital system. The best example of enterprise liability in practice that I know of involves the aviation industry. As in medicine, system errors can occur, but also individuals make mistakes. In the case of an airplane crash, the airline company is responsible for all damages. The pilots are not personally liable because their profession has agreed to full transparency and reporting of individual errors. However, the pilot does bear individual responsibility under two circumstances: when he or she is under the influence of drugs or alcohol at the time of the crash or if he or she did not follow the required checklist for flying the aircraft. This model seems perfect for surgeons and hospital systems to adopt. But I am pessimistic that it will happen. In the past, trial lawyers have mounted strong opposition to any professional liability reform; the courts and our legislators (most of whom are lawyers) likewise have not favored such change. There is too much money at stake. Also, I am pessimistic that even our own profession would support enterprise liability. For just as pilots have to admit and disclose their individual errors, so would surgeons under this approach. Physicians fear the loss of reputation, the resultant loss of income, and the difficulty of admitting to colleagues and patients that we erred and caused harm. I believe our profession would accept individual responsibility for errors committed while under the influence of drugs or alcohol, but the challenge for many surgeons will be the acceptance and use of required checklists before, during, and after surgery. Most changes in past attempts at healthcare reform have been at the margins: a small fix or BAND-AID® here, a small change there. It would be wonderful if leaders of the professions of medicine, law, and politics, along with our patients, would come together and implement enterprise liability in health care as it is used in the airline industry. Such are quixotic dreams. Only if state and federal leaders, along with physicians, agreed such reform was necessary because of the continued rise in healthcare costs, the continued threat of adverse events, and the importance of shared decision making, would such reform become a possibility. Even then, though, it would be but a small one. Commentary Christopher D. Stombaugh JD Laufenberg, Stombaugh & Jassak, SC, Milwaukee, WI, USA “It isn’t what we don’t know that gives us trouble, it’s what we know that ain’t so.” Will Rogers It is becoming more and more difficult to engage physicians and lawyers who represent patients in a productive dialogue about fixing what ails the medical liability system. Each group views the other with suspicion and distrust. Nonetheless, to have a productive dialogue, the participants must first agree about the nature of reality. Evidence-based liability reform, like evidence-based medicine, must look at the facts as they are, not as we assume them to be. The arguments in favor of medical liability reform are more faith-based than fact-driven. The author begins by rounding up the usual suspects: “frivolous lawsuits,” caps on “pain and suffering,” discouraging lawyers from bringing cases. These are driven by fears. The fears of plaintiff’s counsel, loss of reputation, rising liability insurance premiums, loss of time, loss of peace and enjoyment of life, runaway juries. Fears, although real, do not make the thing feared a reality. Truth should matter, especially when it comes to changing our laws to deny a person his or her right to full and fair compensation. That person would surely be awarded compensation if only he or she had been injured in a road wreck caused by driver error, rather than violation of the standard of medical care by a physician who commits medical errors. Review of the relevant literature shows the arguments made in support of so-called reform proposals are simply untrue [3]. An ambitious project of the nonprofit Center for Justice & Democracy at New York Law School [3] is an updated survey of the data every orthopaedic surgeon should read. This freely downloadable, heavily footnoted book leads to the conclusion that whatever the infirmities of the current system, they cannot be laid at the feet of the injured patients and their advocates. Rather, we learn the inconvenient truth: We are not inundated with frivolous medical lawsuits. “[P]ortraits of a malpractice system that is stricken with frivolous litigation are overblown” [7]. Capping pain and suffering damages does not reduce malpractice insurance premiums [9] and does not affect physician supply, but it does prevent legitimate cases from being filed [3]. Legitimate cases actually improve the cause of patient safety [3]. Dr. Bernstein’s contention that too few malpractice cases are being filed is also borne out by the literature [2]. Medical errors occur at an alarming number and are, largely, system failures [4]. Recently, there have been small steps in increasing acceptance for physicians to admit medical mistakes as part of the healing process. Most notable was the recent Technology, Entertainment, Design (TED) talk of Canadian emergency physician Brian Goldman MD [8]. This is also good for the overall cause of improving patient safety. In place of the current system, Dr. Bernstein advances the idea of enterprise liability. Enterprise liability has several advantages as a method of bearing the costs of medical errors, obtaining coverage in a pool, holding the system responsible for system failures, and making system wide improvements in the interest of patient safety. Additionally, the enterprise is in a better position to police the few bad, serial malpracticing physicians who create most of the medical negligence payouts and who receive shockingly little discipline from state medical boards [6]. An enterprise liability system would also have the benefit of depersonalizing the effects of litigation. Unfortunately, as of now, this is not the law anywhere in America. A reasonable, workable alternative is the Wisconsin system, The Injured Patients and Families Compensation Fund. Doctors in Wisconsin have unlimited coverage since every healthcare provider has that type of coverage. The fund has nearly USD 1 billion in assets and pays out only a small portion of that every year and is financed through assessments on healthcare providers. Commentary David Seligson MD Chief of Orthopedics, Department of Orthopedic Surgery, University of Louisville Hospital, Louisville, KY, USA Our current tort system resolves disputes through litigation. Dr. Bernstein notes researchers found most events for which claims were made did not involve negligence. This suggests the current system works, since most malpractice suits find for the defendants. Error is not the same thing as malpractice. Although malpractice litigation is demeaning, can be tedious, and certainly is expensive, the alternative—compensating those who allegedly suffer from medical misadventures—would be far worse. Prioritizing the business of medicine first and putting the patient with a bad result in charge are mistakes. Here’s why: Among the patients whose treatment could have been better are other people who think they have been mistreated, and worse, individuals who believe they deserve compensation for actual or imagined dysfunction. Our society, our hospitals, and our prisons are loaded with folks who feel they are entitled. Compensation for situations that are judged by some flawed process to have been caused by medical care will provide a whole new apparatus for undeserved rewards. In real life, few patients tell the whole truth about what happened to them, what they have taken, or what they have done. Review of the discovery process of any lawsuit makes this clear enough. Enterprise liability is a concept borrowed from manufacturing. If a part fails, the company issues a recall and fixes the problem. The underlying assumption is that there has been a flaw in the creation of the product somewhere from design to production and the process is at fault. This concept fits less well when applied to an unemployed motorcycle driver on alcohol and drugs who loses his leg in a high-speed injury that he or she caused. My wise accountant opined any audit will disclose discrepancies; similarly any chart review will find courses of action that might have led to better results. Where will the funds come from to compensate patients for damages they allege? Government? Healthcare insurers? Doctors? Surely a torrent of preferred pathways, algorithms for treatment, and computer-driven systems to control losses will follow; these will, almost necessarily, stifle innovation. We can develop a new system wherein a well-intentioned (though perhaps not well informed) someone will assert an adverse outcome could have been averted, and we even can compensate patients under such a system. But we will probably find ourselves with much more paperwork and in a much-less favorable atmosphere to treat patients as individuals and with dignity and kindness. Commentary Mark A. Geistfeld JD Sheila Lubetsky Birnbaum Professor of Civil Litigation, New York University School of Law, New York, NY, USA The claim that more tort liability could be a cure for our ailing system of medical malpractice liability will undoubtedly strike many physicians as preposterous. The logic of this proposed tort reform, however, is compellingly as laid out by Joseph Bernstein in this column on medical malpractice. Indeed, the case for enterprise liability—a system that shifts liability from physicians to the enterprises that supply health care—is even stronger than Dr. Bernstein shows. In sharp contrast to the current system, enterprise liability is triggered by the occurrence of medically caused injuries, regardless of fault. No-fault liability would result in more tort liability across the run of cases, but this expansion of tort liability could solve the malpractice problem by removing blame from the liability equation. No one likes to be sued, especially when the allegation is one of professional malpractice. Rather than having one’s competence impugned, many physicians understandably engage in defensive medicine or otherwise cover up their mistakes. These allegations can also be upsetting to patients who place faith in their physicians and feel grateful for the care that they have received, even when the physician ultimately is unable to provide a cure. These patients are often loath to sue their physicians, regardless of whether further investigation would support a malpractice claim, whereas others who feel their physicians have not been adequately sensitive can end up blaming the physician for the failure to provide a cure, even if malpractice is not involved. The resultant mismatch between the incidence of medical error and the incidence of malpractice claims is well described by Bernstein and more extensively documented by others [2]. To be sure, fault-based liability has a number of appealing attributes. It requires proof that the defendant was legally at fault for the plaintiff’s injury, enabling risky actors to avoid tort liability by exercising reasonable care. The failure to exercise reasonable care constitutes legal fault, a conclusion that can be quite different from the colloquial attribution of fault. No one can be blamed for not being perfect. We all make mistakes, but any misstep, whether the result of professional incompetence or a simple lapse of attention, can be sufficient to establish negligence liability. The frequency of these mistakes can be reduced by procedures or the design of systems for delivering health care, but fault-based liability largely ignores these issues by instead placing blame on the provider whose inadvertent mistake directly caused the patient’s harm. Requiring the patient to prove instead that the “fault” lies with the enterprise is no panacea because the optimal design of systems and procedures involves complexities that render such proof practically inaccessible to plaintiffs. Is the injured patient, or more precisely, the contingency-fee lawyer, really the party best able to identify the practices that ought to be utilized by the enterprise of health care? By placing responsibility for all medically caused injuries on the enterprise itself, tort liability would create financial incentives for these institutions to adopt procedures and systems that would both reduce the incidence of inadvertent error and provide internal mechanisms for addressing instances of professional incompetence. Eliminating blame from the liability inquiry could be the best way to address the problem of medical error, but doing so requires an expansion and redirection of tort liability, a reform quite different from the reduction of tort liability often championed by medical professionals.

Elizabeth Taylor, Mark Baine, Annette Killmer, Marion Howard

No abstract is available for this record.

B Sarno

This research of The Regions OriginalRevenue Realization Potency in Achieving Region Finance Independence of Regency Sekadau Year 2006-2011. it aims to analyze regency region financial conditions of Seakdau Regency, how is growth, composition, effectiveness, self region acceptance liability, and PADS acceptance elasticity at Sekadau Regency, as one of financial performance indicator region, on year period that is utilized 2006 to 2011. The variable that analyzed is, all the regions revenue's component, PAD, taxes, retribution, etc. propertied region, Population, and PDRB by use of data skunder that acquired of on duty Regency Region Income sekadau and BPS (Sekadaus Regency in Numeral). Result observationaling to point out that up to growth research period PAD Sekadaus Regency as big as 45.94 % by Region Taxes compositions 27%, Region Retribution 18%, Wealth management result region 7%, and etc. PAD is 48%. While PADS acceptance effectiveness up to that period average as big as 98.61%. Degrees arithmetic result Decentralize Fiscal at Regency sekadau that bottommost, up to year period 2006-2011 which is average just as big as 2,73 %. this bottommost bases Depdagris criterion. Elasticities arithmetic result point out PADS growth sekadau inelastiss regency to PDRB namely as big as 0,35. Meanwhile elasticity to population as big as 0,05(inelastis). Its mean is changed or added islandic as big as 1 % make changing or added total PADS acceptances as big as 0,35%, and is changed or added islandic as big as 1 % make changing or added total PADS acceptances as big as 0,055%, . Key word: Effectiveness, Elasticity, PAD, Financially Region.

Majed Haddad, Eitan Altman, Sana Ben Jemaa, Salah Eddine Elayoubi · 5 authors

Distributing Radio Resource Management (RRM) in heterogeneous wireless networks is an important research and development axis that aims at reducing network complexity, signaling, and processing load in heterogeneous environments. Performing decision-making involves incorporating cognitive capabilities into the mobiles such as sensing the environment and learning capabilities. This falls within the larger framework of cognitive radio (Mitola, 2000) and self-organizing networks (3GPP, 2008). In this context, RRM decision making can be delegated to mobiles by incorporating cognitive capabilities into mobile handsets, resulting in the reduction of signaling and processing burden. This may however result in inefficiencies such as those known as the “Tragedy of commons” (Hardin, 1968) that are inherent to equilibria in non-cooperative games. Due to the concern for efficiency, centralized network architectures and protocols keep being considered and being compared to decentralized ones. From the point of view of the network architecture, this implies the co-existence of network-centric and terminal-centric RRM schemes. Instead of taking part within the debate among the supporters of each solution, the authors propose a hybrid scheme where the wireless users are assisted in their decisions by the network that broadcasts aggregated load information (Elayoubi, 2010). At some system’s states, the network manager may impose his decisions on the network users. In other states, the mobiles may take autonomous actions in reaction to information sent by the network. Specifically, the authors derive analytically the utilities related to the Quality of Service (QoS) perceived by mobile users and develop a Bayesian framework to obtain the equilibria. They then analyze the performance of the proposed scheme in terms of achievable throughput (for both mobile terminals and the network) and evaluate the price of anarchy which measures how good the system performance is when users play selfishly instead of playing to achieve the social optimum (Johari, 2004). Numerical results illustrate the advantages of using the hybrid game framework in a network composed of HSDPA and 3G LTE system that serve streaming and elastic flows. Finally, this chapter addresses current questions regarding the integration of the proposed hybrid Stackelberg scheme in practical wireless systems, leading to a better understanding of actual cognitive radio gains.

Rebecca June

Gender and the Fate of Julian’s Short Text Most studies of Julian of Norwich’s Showings juxtapose her Short and Long texts, with a marked lack of enthusiasm for the Short Text in contrast to its longer, revised form thought to be textually and theologically superior. This essay asks what is at stake in the rigorous defense of Julian’s Long Text and argues that the issue of gender is central both to its revisions and to its favorable reception. The most noted revision related to gender in the Long Text is the addition of its maternal Jesus, characterized as redemptive of femininity. Concurrently, many scholars remark on the removal of references to women and Julian's sexual identity--changes troubling for an author thought of as a proto-feminist, but either minimized as irrelevant or rationalized as integral to Julian's expanded theology, thus rendering its diminished female presence proof of the Long Text's superiority. While discussions tend to address one or two revisions related to gender, this study presents a comprehensive interrogation, ultimately suggesting that our preference for the Long Text (and disregard for the Short) has been shaped by our desire to promote Julian as a woman ahead of her time, but paradoxically perpetuates the very gender hierarchy and biases that likely compelled Julian's revisions and that we wish for her Showings to challenge.

Thomas Aitken

The more one penetrates the role of the manager abroad, the more it becomes apparent that it depends on the degree of centralization or decentralization to which his company is committed. However, this apparent simplification conceals complexities within it. As we have seen, even the most decentralized firm tends to hold a firm rein on financial management and as we will observe, the most home-office oriented corporations must concede considerable freedom to the manager afield in the matter of marketing. The qualifications do not end there, because while different industries may share the same viewpoint on finance, their emphasis on marketing varies tremendously. It is not unusual for a man who has made his mark in marketing consumer goods abroad to wind up his career as president of the firm at headquarters, but this is most unlikely when the company is in the petroleum business, heavy industry or banking.

Seog‐Chan Oh, Alfred J. Hildreth

Smart grids enable a two-way energy demand response capability through which a utility company offers its industrial customers various call options for energy load curtailment. If a customer has the capability to accurately determine whether to accept an offer or not, then in the case of accepting an offer, the customer can earn both an option premium to participate, and a strike price for load curtailments if requested. However, today most manufacturing companies lack the capability to make the correct contract decisions for given offers. This paper proposes a novel decision model based on activity-based costing (ABC) and stochastic programming, developed to accurately evaluate the impact of load curtailments and determine as to whether or not to accept an energy load curtailment offer. The proposed model specifically targets state-transition flexible and Quality-of-Service (QoS) flexible energy use activities to reduce the peak energy demand rate. An illustrative example with the proposed decision model under a call-option based energy demand response scenario is presented. As shown from the example results, the proposed decision model can be used with emerging smart grid opportunities to provide a competitive advantage to the manufacturing industry.

Jeremy Johnson

No abstract is available for this record.

Marina Zaharioaie

This paper’s purpose is to analyse the financial situation of the local authorities in the EU countries and to consider alternative funding through public-private partnership. Both because of the economic and financial crises that has affected the earned income but also because of the decentralization process that has enlarged the responsibilities, local authorities are put into difficulty in providing public services at a higher quality level and starting new public investments. Empirical research on this track will reveal the public role that the public-private partnership can play at a local level, but also various obstacles that inhibit its usage in some of the EU countries. In this article we also aim to determine certain methods to overcome the obstacles that stand in the way of increasing public-private use at a local level. Thus, we emphasize the context in which public-private partnership is a local solution and that is sustainable on a long term. To achieve this objective we will make a foray into the literature and the specialty studies in the field and we will analyse the factual situation that exists at the level of local communities in EU countries.

Li Yang, Ying Cui, Guo Sufang, Philippa Brant · 6 authors

OBJECTIVE: To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China. METHODS: Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interviewed. Service provision, finances, prescriptions, inpatient records and the expenditures of patients with certain diagnoses were investigated in township hospitals and village clinics. The results were compared with the corresponding data recorded before NEMS was introduced. FINDINGS: Following the introduction of NEMS, drug procurement in each study location was systematized. Total drug costs declined. This, and improved prescribing, reduced the costs of outpatient and inpatient care and led, apparently, to increased uptake of health services. However, the prices of some drugs had increased and the availability of others had declined. The compensation of health-care providers for NEMS-related reductions in their incomes had been largely ineffective. As a result of the introduction of NEMS, health facilities relied more on public financing. Many health-care providers complained about higher workloads and lower incomes. CONCLUSION: Although it was well conceived, the introduction of NEMS into China's decentralized, fee-for-service system of health care has not been straightforward. It has highlighted the problems associated with attempts to modernize health care and health financing for patients' benefit. Sustainable mechanisms to compensate health-care providers for lost income are needed to ensure that NEMS is a success.

Heiner Grosskurth, Ruari Brugha, Benson Droti, Susan D. Foster

Levels of care Peripheral health units, such as health centres, dispensaries or community health posts, are the first places where patients meet the formal public health care system in most rural African districts. People also consult private clinics, pharmacies, formal or informal drug retailers and traditional providers, who are popular for psychosocial and mental health problems, when people suspect spiritual factors, in AIDS, tuberculosis and epilepsy or when orthodox medicine does not meet their needs. Together, these providers represent primary medical care; better district care must involve all of them. In most countries health care is decentralized and largely devolved to district health services. The Ministry of Health formulates policy, sets standards and ensures quality assurance and is responsible for mobilizing resources and monitoring and evaluation nationally. It oversees and sometimes manages nationally co-ordinated services such as epidemic control. However, the district health management team (DHMT), led by the district medical officer and the district hospital form the backbone of the health services. The health care system, especially in Anglophone African countries, is organized around the district health service. The district hospital provides secondary level medical care; whilst regional (provincial) and national hospitals provide tertiary specialist care. A referral chain, up which patients move, is thus established but, in reality, most district and tertiary hospitals have busy outpatient departments that give primary care to their community. As urbanization accelerates, urban polyclinics function like district hospitals and provide an intermediate tier between smaller urban clinics and specialist hospitals.

Norman Gemmell, Richard Kneller, Ismael Sanz

This article examines whether the efficiency gains accompanying fiscal decentralization generate higher growth in more decentralized economies, applying pooled‐mean group techniques to a panel dataset of 23 Organization for Economic Co‐operation and Development (OECD) countries, 1972–2005. We find that spending decentralization has tended to be associated with lower economic growth while revenue decentralization has been associated with higher growth. Since OECD countries are substantially more spending than revenue decentralized, this is consistent with Oates' (1972) hypothesis that maximum efficiency gains require a close match between spending and revenue decentralization. It suggests reducing expenditure decentralization, and simultaneously increasing the fraction financed locally, would be growth‐enhancing. (JEL E62, H71, H72 )

Francisco S. Melo, Manuela Veloso

No abstract is available for this record.

Daniel Moeller, Ramamohan Paturi, Moshe Hoffman

No abstract is available for this record.

Anca Gheaus

Concerns about implicit bias against female academic philosophers have recently led to efforts to make academic philosophy a more inclusive discipline. Prominent examples of such initiatives are the Gendered Conference Campaign, encouraging event organisers to include women amongst invited speakers, and calls to philosophy book editors to include female authors in their collections. At the same time, initiatives such as the GCC raise worries about tokenism. Many people believe that being a token woman is an awful situation to be in. They think it is humiliating to accept a position if one has been offered it because of one's sex. And women often worry that, if there are rules to include them in positions of visibility or prestige, or if significant social pressures towards gender inclusiveness play a role in selection processes, their achievements will be discounted. Luckily, there is no good reason for these fears. I argue that there are several legitimate grounds – independent from professional merit – for including people in positions of visibility and prestige and that sometimes sex can be such a legitimate reason.