Blockchain Papers

Jochen Zimmermann

The European Union (EU) is built on the federalist principle of subsidiarity, which we consider in the policy field of financial reporting. We attempt to answer the question, whether the current accounting regulation in Europe is sensibly balanced between centralized and decentralized decision making. Drawing on comparative accounting research to identify criteria for “local preferences,” we conclude that local solutions currently remain preferable for small and medium-sized companies. For them, a centralized solution would result in additional costs for at least some member states and their residents. Large international firms, in contrast, face an increasingly integrated capital market and rather need a central solution as currently implemented by the EU. However, recent developments in corporate finance may align local preferences on accountancy in the future.

David Gowland, Arthur Turner, Alex Wright

Despite its supranational characteristics, the EU remains to no small extent an intergovernmental entity. By default, therefore, its key players are the governments of its member states. Consequently the EU has posed something of a challenge for its regions and stateless nations. Until recently, to no small degree, they were relegated to mere bystanders as the European ‘experiment’ progressed. Indeed, for the EC’s first three decades, formally, they were for the most part excluded from a direct involvement in EC policy formulation. More particularly, as the EC acquired more and more competence it encroached increasingly on those areas of policy which, hitherto, fell within the exclusive competence of the regions, or which they shared with their central governments. The net result was that, over time, authority to make decisions in a swathe of policy fields resided increasingly in Brussels. However, in the aftermath of the SEA, it became increasingly untenable for governments, in federal polities especially, to monopolise the conduct of European affairs. It was less feasible for them to defend the premise that relations with the EC in a classic sense could be regarded as ‘foreign policy’ and thus should remain purely within the ambit of the central government. Rather, domestic policy had been ‘Europeanized’. In effect the dividing line between domestic and European policy matters had become ‘blurred’ as a result of European integration (Jeffery 1997a). Accordingly, territorial administrations in the regions and stateless nations began to undergo ‘Europeanization’. Europeanization is a multifaceted term, and there is no consensus on its exact meaning. Olsen suggested that there was a number of possible interpretations, including ‘the emergence of European level institutions’ and the ‘domestic impact of European-level institutions’. Essentially, these two forms of Europeanization were inter-connected. Institutionally, the extent to which Europeanization evolved at the European tier of government had a resonance domestically (J.P. Olsen c2002). Thus it could be supposed that Europeanization has been an incremental process at the territorial level.1 Primarily, this can be attributed to the manner by which the EU has evolved as a result of successive treaties starting with the EEC (1957), followed by the SEA (1986), the Treaty on European Union (1992), the Treaty of Amsterdam (1997), the Treaty of Nice (2001) and (if it is ratified) the Treaty of Lisbon (2007). As the EC and its policies began to affect the regions directly, the latter had little option but to respond. In addition, the reform of the structural funds in 1988 helped to fuel regional mobilization. Not only was EC regional aid more substantive than hitherto, from this point on, in theory at least, the regions were supposed to be ‘partners’ with regard to the implementation of the funds (Marks 1993). Yet territorial Europeanization was not merely concerned with acquiring EC aid, it was more pro-active. For example, it involved collaboration and networking, an underlying aim of which was to influence EU policy making. It therefore included the direct lobbying of the EU’s institutions and attempts to influence the EC’s wider agenda (John 1997: 133). In sum, sub-state actors re-structured their organizations over time and they reorientated their strategies, as bit by bit the EC began to affect their activities (see for example, Keating and Jones 1985; Jones and Keating 1995; Jeffery 1997b). Whilst few, if any, regions could ignore European integration, some were better able to mobilize than others by virtue of the political authority which they had at their disposal. This appeared especially to be the case in federal polities, where authority was ‘shared’ between the state and sub-state tiers of government. Transcending that was the ideal that both tiers of government aimed to work well together by dint of their commitment to ‘federal loyalty’. Consequently, the German Länder attained greater influence over European affairs during the latter part of the 1980s and continued into the 1990s (Gerstenlauer 1985, 1995, Jeffery 1997b). Initially they adopted a twin-track approach in their bid to secure more influence over the EC during the late 1980s. They played a leading role in the mobilization of the ‘third level’ (i.e. the territorial tier of government in the EC), and they also endeavoured to secure certain rights over the formulation of European policy in Germany (Börzel 2002, Jeffery 1997b). Third level mobilization did yield some tangible results at Maastricht, thanks to pressure from the Länder and the Belgian Sub-national Entities (SNE). Under the Treaty on European Union, where their state’s constitutions so allowed, ministers from sub-state administrations could vote in the Council (initially as representatives of their state). The formation of the Committee of the Regions (CoR) formally incorporated the regions into the EU’s policy processes in those areas which fell within its competence. Last, the principle of subsidiarity promised much. It was in part intended that where possible, as a matter of principle, decisions would be taken at the closest level to the citizen (see Chapter 4 for further material on subsidiarity). By the early 1990s, the Länder had also secured a number of mechanisms within the German polity which ensured that they enjoyed, collectively, greater influence over those EU matters which fell within their competence, as well as a potential veto over further transfers of competence to Brussels. The same applied to Belgium’s SNEs (Kerremans and Beyers 1997). The situation was less clear-cut for Spain’s Autonomous Communities, however, with the Basques, in particular, appearing to lose a degree of autonomy as a result of European integration (Bourne 2000, 2002). Consequently, it could be supposed that a region’s constitutional status could have a distinct bearing on its potential influence vis-à-vis the EU, both internally in relation to its central government’s formulation of EU policy, and externally with regard to the EU itself (Bourne 2003). Given the relative success of the Länder and the Belgian SNEs, it could therefore be inferred that regions in federal polities were best equipped to reap the benefits of Europeanization, thereby calling into question the influence of territories in more centralized states, such as the UK. As far as the UK is concerned, it is a union state, comprising a number of distinct territories, where formally sovereignty resides with the Westminster parliament. In theory, this is where supreme political authority is situated. This arrangement does not lend itself to a federal system of government, whereby sovereignty is ‘shared’ between the different tiers of government, because that would subvert the Westminster model (Keating and Jones 1995) and so threaten the current constitution in its entirety. However, sovereignty itself is something of a chimera, thanks in part to European integration. It could be claimed that by virtue of their membership of the EU, the member states are no longer wholly sovereign, whilst the EU itself is not yet sovereign either. Thus the term ‘post-sovereign’ could be a more apt description of the current situation for the EU and its member states (MacCormick 1999, Keating 2001). Even so, a primary concern of successive UK governments since the UK’s accession to the EC in 1973 has been, where possible, to defend the country’s (perceived) ‘sovereignty’. Prior to constitutional change in 1999, the UK’s situation was complicated further by the system of government in the UK, or more precisely by the distribution of authority between the ‘centre’ and the ‘periphery’. So far as Northern Ireland, Scotland andWales were concerned, each had its own territorial branches of government, albeit that its autonomy differed. In the decades the of a in Scotland can be whereby it a degree of autonomy in relation to the implementation of domestic policies that were purely 2003). Under the of the of secured a of which the of by Westminster in as a result of ‘the did not secure its own territorial of government and to with at the had a than its in began to change in it secured the and governments it was a of including and Jones 1997: Despite the of there was the that the a degree of autonomy from the especially between and to there within the UK a In effect the had its own polity which on matters of such as and policy, whilst the also had a which on domestic or to this the to be by on the premise that the of this arrangement was on the of an in and the therefore, a could the membership of the EC posed its own to the not because it could consensus that from the the polity was the in the were in the of the UK’s the in the as part of its attempts at which into question the of the In addition, the polity was further by the situation in Northern and the for in Scotland and in in the the UK’s accession to the EC in as the UK was to the it was not with a of political authority to but also pressure from the for greater these to a system of government which, and was also as far as EC affairs were concerned, the administrations were to the where the aftermath of supreme political authority continued to at the of the and administrations especially, accession to the EC was something of a into the they to lose as to become both and more of decisions taken in that would in the aftermath of accession was that, where the EC’s treaties so allowed, policies would be in Brussels. it could be claimed that their political would be further by European integration. they had direct to in For each had its own of was a member of the UK thereby that their could be and at the of government. their to would be in those areas of policy which fell within As far as intergovernmental were concerned, their would be by UK ministers from the in the Council of the Council of the from the the UK the this the relative autonomy Scotland and if any, substantive autonomy However, the UK’s accession with for This was most in Northern where had been in the aim of which was the of Whilst the situation in Northern was to that of Scotland or as far as the latter were concerned there had been pressure for greater autonomy during the late as the to make at the to the of a on the in the aim of which was to there was a for this to be by the UK’s membership of the EC and the to within the it its in Whilst the that the case for would not be as a result of the two of its and a of The latter that would be a for as there would be over the of competence and there was no point for regional governments in the at that in They therefore that there was little for as a Despite the of the the UK a in for Scotland and The as a the at Westminster during However, the of the administrations could best be in had to be The therefore that European affairs with the UK government and that the of territorial would be on As it to on this in Scotland and in Even so, it had been for some time that the EC would have far for the UK’s territories, of the constitutional within the UK. such was Scotland where well the UK’s accession to the its political and was over the and of EC In the of the to the of the and on the that Westminster the authority to sovereignty to the In the Union was to membership on the that it would with the However, the of the of was in By this time, in the accession with a of and the they were concerned that it result in the they if the would the in relation to those areas of policy which Scotland they to little more than By however, it was that this was not to but were at the on that key were to so that they could on the In the aftermath of accession it became that EC membership was less in Scotland and Northern than in or As far as Northern was concerned, the from the that membership UK and in so it a to the of the regarded membership more for the same (Keating and Jones regard to there was the concern that the EC was and that the of did not the Thus in the to the on membership of the some in the for a on the that Scotland should from the of the UK and for membership on its own In within the were on the that the EC was concerned with the of shared to those of the for the EC during the early of UK membership from that of Scotland and Northern Whilst in in during the the for Scotland and Northern Ireland, were and with for and an of for the UK as a Yet it was early as far as the UK’s membership of the EC was concerned, it was that the latter was an impact at the territorial The for example, could not in European affairs. It a in EC and the It had also been concerned with the the of which was to was because the member states had a policy on to the UK’s accession with the result that the UK was with a whilst and government did not as a The was especially of the because the of UK was in Scotland and the was a in the and of the Consequently, during the first of the with some to defend the of as the more The on in the of the the and the of a could each be regarded as However, as time the became increasingly both in Scotland and in of the the the Europeanization of the with the SEA of As more and more decisions were taken in for European matters was from to This did not so to which the of the in it was concerned with more areas of policy such as or This was because the in were it sense for the to on European In addition, it was that the to influence the EC more directly, as it could not wholly on the to the of the the increasingly with the European albeit that it was on that its activities would not with the UK line on The also a degree of In its and European became key players Jones 1997: As far as the was concerned, that was the of EC structural In addition, at the of its of it relations with regions in the such as these were because they that the was not wholly on the by in it to in the European political as a in its own However, as was the case with the in of this was Whilst a number of Northern was involved in EC affairs the of and the of and had the in so far as it was by virtue of its involvement in the implementation of EC structural funds in the and However, that that most of its was to the of the therefore, Europeanization in Northern was to Europeanization there had been, was to no small degree by its More particularly, there was an of political Given the such as these were would have been more concerned the than the European Despite the which they the territorial of government were by no in with the also an in European their European activities to the Council in EC the SEA was something of a that on, were with a of European The SEA also the reform of the structural funds in a result of which was that in the which bid for if they were EC aid Consequently, a number of EC in to their EC and some or in Brussels. For their the the of part of was to in the EC (Keating and Jones However, the of the to with regional in the EC was by and the of did relations with such as the of Regions and the of European Regions Jones the of as the for government, or more especially the to with the EC on a to a they were in For a a more leading role but that was it and its EC by the actors from the UK’s territories to a in European affairs. The same applied increasingly to territorial pressure such as the and the had been involved in lobbying from the the UK the The same applied to the became involved in lobbying it became that they could no longer ignore the such was This had been in part because of the and also because of the of a in the As far as the latter was concerned, the underlying concern was that regional such as the in could Consequently, helped to the of European thereby its to a in the The situation for as a was less with the of the and the of a became more during the of government (Keating and Jones time pressure did direct in part because they did not that they would from In sum, from a territorial activities such as these that authority a swathe of policy areas no longer resided in Rather, increasingly it was in something which was to the of in and also in Despite their the and became more to the as time from the EC’s for small and in areas in the of the (Keating and The change of can be in to a member of the had been to EC to own which the By the to the of Scotland from the UK and a member state in the EC in its own for example, the was by no a with regard to however, and the key became in as the 1980s to a in therefore, the of territorial in the EC became more during the late 1980s and on into the The net effect was that, the with the UK government to that territorial were in its during a the impact of the EC was more was especially so for In the to the the a of its EC a was by no to the however, as in the government did the same 2003). However, the of the were by virtue of the extent to which the EU had on its The that some to of its were in work and that of its were The for EC to be more to the EC’s institutions and a further of with the EC As far as the latter was concerned, it was suggested that should remain in for an or so they so that they could with European However, by this time each of the three territories was to have its own in Brussels. The of Scotland the Northern in and the European in was of the for a more in the EC’s Even so, their was The was that they be as applied to Scotland as both the Union and it with concern as a to a agenda in the EC and In time however, the As far as was concerned, it would some of its and the had no as first and Scotland role on than political The latter therefore a in EC aid, and it its with on EC Despite the concern that they not have a political however, it was that these would their influence within the applied to As of its the its was that it would the of the in the the that played a Yet it was also that a number of including a of and a with the direct claimed that not only did ministers to the to and to on the work of but also the direct had a and approach to policy and For its whilst the European could be as something of a because it in it was by and with the over its role Jones 1997: each of these endeavoured to with the EC’s institutions and with regional their to influence the EC’s policy agenda appeared to be during the in with their German which better and which were more (Jeffery it is to that there was something of a in the sense that territorial pressure in and Northern to they to influence the EU, the was more no small extent the UK government as a between the territories and by virtue of the of the Council of the In addition, the government was for the implementation of EU policy in the UK. the and Northern were territorial branches of the UK government. The net result was that to ignore or the territorial administrations they to influence EU policy making. applied to the for example, the that the had its own the 1990s the a number of a number of which was to the is that competence for with the EU as a result of the which the of the were the to reform the and the accession of states from and than direct with the of and in the Union Scotland its on the at the In so it the approach adopted by pressure in Northern and in the case it did not have its own territorial as such and it therefore The underlying was that by of their territorial in relation to a such as the reform of the or the of they could greater pressure to on the government. however, on the that their territorial influence within and that the UK government itself was able to influence in Brussels. was not the The was (see also Chapter because it little influence the UK at over EU affairs. The to a in concern that which had could be to The UK government that UK of would be but the EU that there should be a this did not to in Northern Ireland, their in the UK less Despite the of the UK government, there was it could from a challenge in the and EU and the in to the of the The was as far as the of territorial was it was of the extent to which resided in Brussels. It to that the EU could its on of the UK, of the UK government or it to the UK’s relative of within the EU at that in is the adopted by the and governments (see Chapter The however, was by no the only that into question the extent to which territorial actors in the UK could influence European Whilst the UK secured a with regard to the in (see by the of the and on into the 1990s the was in as began to The was whereby the were more to such as In effect their potential to three to with the in option would have been to a of the In the EC would have aid for its the government to in with the result that the for example, did not in of the number of and more pressure during the 1990s The situation was to The of for during the if an had been in at the of the the not have evolved in the that it The implementation of the structural funds also to the extent to which the UK’s territories could be by decisions taken in In theory, EC aid was supposed to be to UK regional In the the was taken by successive UK governments that this was not to as EC structural funds were to be to the UK’s to the EC’s Keating and 1985; was because the a net to the The net result was that EC were not the of at the Even the of helped as late as 2000, that the constitutional reform of Consequently, Scotland and less regional aid than they were This was especially in the aftermath of the reform in 1988 the of by the EC to the In sum, these to the potential of the mechanisms within the UK. the which territorial over the formulation of European policy within the UK, were a of the and the The have been well by in and European were an of in a which on together with a of less the European was ‘the key in as the with regard to EU were to the it was to the latter to if there was a territorial to a that were so, the would be to the territorial the This arrangement was not For example, there were the was or late in the However, attempts were to this in the would an which would be by from a of government if those from territorial this was not its some that the from the territorial were and were to influence the to their and where the was to the matter could be to their In the however, ministers from the territorial the Council of the EU, of the three ministers from the to be more in Consequently, ministers at the territorial were in some within the UK so far as European affairs were They could as a if their the influence in they to influence a in the with regard to a from the EU, they could to the concerned or have a the in the of they could the matter to their of The territorial of on of which with European they had an involvement in EC albeit that this to matters of such as or the than policy such as a on In the of these was on the extent to which the territorial could and defend the at within the UK it was also on the of the UK to a territorial it was its with regard to EC it was also on the of the and by the UK government to and defend that within the This became more as the 1980s to a and it was further during not because an which was over the More particularly, there was little of political at the territorial level with regard to Scotland and the same applied to which shared a of territorial albeit with less autonomy than the there was no that subsidiarity would to the territories of the UK in the aftermath of the

E.J.B. Bleumer, G. André, G. van Duinkerken

Daily concentrate allowances for individual dairy cows are usually based on empiric models. These models are generally based on regression equations derived from population data and do not take into account individual and temporal variation. An application was implemented in common practice which consists of an adaptive model for estimating the actual individual response in milk yield on concentrate intake using individual real time process data. Before the application was implemented, a prototype was developed by a team consisting of biometricians, animal nutritionists and ICT application specialists. It was tested in an animal experiment and further developed into a proof of principal, which was implemented for testing in a common practical setting on a research farm. Because the results were very promising, a workshop was organised to introduce the concept to software, hardware and feed industries where they were challenged to participate. In the next collaborative phase with industry involvement the further implementation into a management system was stepwise: (1) technical documentation of algorithms, (2) programming, (3) verification of algorithms, (4) on-farm implementation of the integrated software, and (5) on-farm evaluation. During the implementation it became clear that steps 1 to 3 were not difficult to perform and did not take much time. Steps 4 and 5 were more complicated because: (1) correct data must be generated from the management system as an input for the model, and (2) the output of the model has to be interpreted correctly for calculating concentrate allowances in the management system. However, not only technical aspects of an implementation process are important, also the communication with end users and stakeholders requires particular attention, for successful implementation of a new concept. While testing and implementing the application it became clear that end users and stake holders were willing to accept and use the innovative concept but interpreted the outcome based on traditional population knowledge and paradigms.

Jaka Sriyana

Intergovernmental fiscal transfers are critical elements of public finance in decentralized countries. In the context of Indonesia’s decentralization reforms, their design and implementation have significant impacts on the potential revenue and fiscal capacity of basic public service provision. The case of Indonesia’s 2001 Big Bang decentralization illustrates the challenges associated with implementing significant reforms in the intergovernmental fiscal system. The practice of decentralization policy in Indonesia since the time has not generally improved local development performance yet. This study evaluates fiscal decentralization, focusing on fiscal capacity as the impacts of the intergovernmental fiscal equalization transfers, in the case of Gunung Kidul, Yogyakarta. The study shows a low percentage of its own revenue compared to its total budget. It indicates the failure of fiscal decentralization policy in improving local government fiscal capacity.

Masahiro Kawai, Peter A. Petri, Elif Şişli‐Ciamarra

The global economic crisis refocused attention on the governance of international economic institutions (IEIs). This study uses the analytical framework of club theory to highlight structural obstacles to reform in international macroeconomic management, development finance, trade, and financial stability. The authors argue that reforms currently being discussed - for example, in voting power in the International Monetary Fund and the World Bank - are important, but not sufficient to make IEIs adaptable to the demands of a rapidly changing world economy. The authors propose transforming IEIs by shifting more decisions from the global to sub-global level. Partially decentralized decision making already exists in some policy areas (for example in regional development banks) and could expand and improve the provision of international public goods.

Darwin L. King, Kathleen M. Premo, Carl J. Case

ABSTRACT This paper reviews the significance of military cost accounting practices used during the U.S. Civil War. Many of our modern cost accounting practices were derived from those utilized by the U.S. Army from 1861 to 1865. Cost accounting practices were vitally important during this period in order to properly manage all expenses relating to men and Army accounting clerks and quartermasters were taught comprehensive accounting principles and practices at West Point. These practices were also used in military institutions such as the Springfield Armory. The majority of these military cost accounting principles are still in use today. Historical practices such as cost identification, cost classification, and budgeting (cost management) continue to provide modern business managers with the ability to effectively and efficiently control and manage expenditures. INTRODUCTION Modern business firms utilize a variety of cost accounting practices in an effort to manage expenditures and maximize profits. The origin of many of these can be traced to cost related principles taught by military institutions. This paper will first review the development of cost accounting prior to the Civil War. Cost accounting principles and practices developed rapidly during the early 1800s. Prior to that date, very little effort was made by business owners to classify and manage various costs. The bookkeeping principles introduced by Pacioli in 1494 were little changed until the turn of the nineteenth century. The second portion of this paper contains the major theme of this paper. It is the importance of the cost accounting practices used by the U.S. Army during the Civil War. These practices were quite revolutionary for the period and allowed the army to accurately classify and manage expenditures . Instructors at West Point were some of the leaders in the analysis and management of expenditures. They developed an accounting system that identified and classified all costs related to men and materials. Since the cost of the war was so enormous, the United States Government required adequate cost accounting from all military units of all expenditures for payroll, materials and supplies, food products, hired workers, and all other military costs. Without proper cost identification, classification, and management, the Union Army would not have succeeded in its war efforts. Seven cost related reports are included in the appendix and reviewed in this paper. The final portion of this paper reviews the importance of Civil War era cost accounting practices on modern procedures. These early practices have continued to be beneficial today in the effort to identify, classify, and manage costs. The cost accounting contributions of the military during the early to mid-eighteenth century have provided a theoretical basis for the accounting systems of today. Modern business firms continue to refine these principles in an effort to operate in a more efficient manner. EARLY COST ACCOUNTING HISTORY Prior to 1800, there was minimal interest in the process of identifying and managing costs. Accounting texts published in the United States in the late 1700s utilized the concepts of double entry bookkeeping that were originally published by Pacioli in his Summa text of 1494 (Previts & Merino, 20). Later, English textbooks by Oldcastle in 1543 and Peele in 1553 were, in effect, restatements of the principles introduced by Pacioli more that fifty years earlier. English accounting texts of the late eighteenth century were distributed in Colonial America and served to educate many notable Americans including George Washington. Washington kept personal ledgers that contained cash accounts with debits on the left pages and credits on the right side pages (Cloyd, 88). In addition, Washington regularly utilized a text called Bookkeeping Methodiz'd written by Scotland's John Mair in 1736 in an effort to maintain control over various farming cash receipts and expense accounts. …

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STRENGTH AND CONDITIONING PROFESSIONAL STANDARDS AND GUIDELINES: OVERVIEW The Strength & Conditioning profession has come to a defining moment. The profession involves the combined competencies of sport/exercise science, administration, management, teaching and coaching. Its practitioners must also comply with various laws and regulations while responding to instances of potential injury, and related claims and suits. This creates remarkable challenges, and requires substantial experience, expertise and other resources to effectively address them, especially in multi-sport (e.g., collegiate and scholastic) settings. Ample resources are available in some of these settings. In many others, however, they are not. Budgets, equipment, facilities and staff are often limited (or lacking altogether), with a resulting mismatch between the participants' demand for safe and effective programs and services, and the institution's provision of them. It is important for Strength & Conditioning practitioners and their employers to understand that this standard of care is a shared duty; the institution and individual are thus jointly responsible for fulfilling it. Collectively, these issues are the driving forces behind this project. The purpose of the NSCA Strength & Conditioning Professional Standards & Guidelines project is to help identify areas of risk exposure, increase safety and decrease the likelihood of injuries that might lead to claims, and ultimately improve the standard of care being offered. This document is intended to be neither rigid nor static. On the contrary, the need for discretion and insight is a fundamental theme throughout; and the information presented here will be revised periodically as the profession continues to evolve. It is hoped that Strength & Conditioning practitioners and the institutions employing them will mutually benefit from applying this information, and in turn significantly enhance the quality of services and programs provided to their participants. NOTICE This document is intended to provide relevant practice parameters for Strength & Conditioning professionals to utilize when carrying out their responsibilities in providing services to athletes or other participants. The standards and guidelines presented here are based on published scientific studies, pertinent statements from other associations, analysis of claims, and a consensus of expert views. However, this information is not a substitute for individualized judgment or independent professional advice. Neither the NSCA nor the contributors to this project assume any duty owed to third parties by those reading, interpreting or implementing this information. When rendering services to third parties, these standards and guidelines cannot be adopted for use with all participants without exercising independent judgment and decision-making based on the Strength & Conditioning professional's individual training, education and experience. Furthermore, Strength & Conditioning practitioners must stay abreast of new developments in the profession so that these standards and guidelines may evolve to meet particular service needs. Neither the NSCA nor the contributors to this project, by reason of authorship or publication of this document, shall be deemed to be engaged in practice of any branch of professional discipline (e.g., medicine, physical therapy, law). Strength & Conditioning practitioners utilizing this information are encouraged to seek and obtain such advice, if needed or desired, from licensed professionals. INTRODUCTION SCOPE OF PRACTICE The responsibilities and professional scope of practice for Strength & Conditioning professionals can be subdivided into two domains (58): “Scientific Foundations” and “Practical/Applied”. Each of these involves corresponding activities, responsibilities and knowledge requirements (refer to Appendices A & B): Scientific Foundations Exercise Sciences (Anatomy, Exercise Physiology, Biomechanics, etc) Nutrition Practical/Applied Program Design Exercise Technique Organization & Administration Testing & Evaluation DUTIES & CONCEPTS Strength & Conditioning practitioners have duties to provide an appropriate level of supervision and instruction in order to meet a reasonable standard of care, and to provide and maintain a safe environment for the participants under their supervision. These duties also involve informing users of risks inherent in and related to their activities, and preventing unreasonable risk or harm resulting from “negligent instruction or supervision”(28,29,36). Greenwood & Greenwood (Chapter 21 [pp. 543-568] of Essentials Of Strength Training & Conditioning (7)) summarize the following key liability concepts for the Strength & Conditioning professional: Assumption of risk: voluntarily participation in activity with knowledge of the inherent risk(s). Athletic activities, including Strength & Conditioning, involve certain risks. Participants must be informed of the risks of activity, and required to sign a statement to that effect. Responsibility, duty or obligation: Strength & Conditioning professionals have a duty to the participants they serve to take reasonable steps to prevent injury, and to act prudently when an injury occurs (12). Standard of care: what a prudent and reasonable person would do under similar circumstances. A Strength & Conditioning professional is expected to act according to his/her education, and (e.g., and to act as a reasonable and prudent person would under similar circumstances. must for a Strength & Conditioning professional to be for of and a Strength & Conditioning professional is if is to have a duty to and to have to act with the appropriate standard of care, injury or to Standards Guidelines It is important to between and has a required that a duty or for standard of care that the standard statements in this document utilize the The standards in this document may ultimately be as a standard of care to be into the of Strength & Conditioning programs and a and to enhance the quality of services provided that the statements in this document utilize the Guidelines are not intended to be standards of practice or to to duties of care, in certain they in and services the publication of this document not to a of the standard of care to be in a particular is that the standards may be Standards of of duty or standard of care can be in various of is from standards of practice published by professional and standards of practice can be to help a person in carrying out his/her duties they are as being of these issues in have that of such professional standards a of adopted and published standards of practice can liability with and serve as a for those comply with them. can also be as a those do not comply with them, liability risks with The key in this to be the of standards of practice in the provision of if his/her is to be with will be to of providing his/her is not to be with however, may be for the to of duty by to such can lead to a of OF STANDARDS In to standards for published by professional such as the are also standards for published by independent such as the & or These are standards of care can be to a professional by his/her with of expected In to the standards and guidelines from professional such as the OF and in this document, the following have also 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must be and not The & has for The by this practice and of the & related to that the & for standards for and is as a in this A is that the between and are not This is especially for athletes and such may that are by or the or use of such as and Furthermore, are new with of to identify those that may be A third is that and and related and regulations (e.g., a that is according to may be according to Furthermore, Strength & Conditioning practitioners institutions need to be of institution may provide to a any for the purpose of providing and provided the do not any The on & of has of these will as the continues to evolve and new are to the of the is an on of the The are according to the following and and & OF OF The of instruction and supervision can be or as a in the available information on injuries and with In some this is while in can be the corresponding standard of in is a reason for the of injury in this and on the information is to the fundamental of in fulfilling the institution's and Strength & Conditioning professional's shared duties for supervision and standard of Strength & Conditioning are the the in collegiate to on participation the of participants to between and Of are the in participation this The increase in participation to as with for to The and of participation has also in of the of and Strength & Conditioning liability and potential for injury, as as the corresponding standard of care on The published a of injury in collegiate and that has and with the increase in participants and The potential liability issues for Strength & Conditioning professionals and their employers are by the in and laws and to services, and facilities (refer to The of and on Strength & Conditioning in a in of demand for standard of care, and liability participation in to between and Of are the in participation this The increase in participation to as with for to is the in collegiate the of participation in a corresponding in liability and laws and creates a standard of care and in of duties for Strength & Conditioning practitioners and their employers (refer to a of in and while injuries are an injuries in out of a of for all for injuries in out of for all a increase of the and of injury injury similar of injury & that of injuries in training, with an injury of of In that of in a a of injuries in a of in of injuries are of and of these are in the NSCA and published statements on on the other have to and Each of these can be with a of on injuries that in from injuries related to activity or the a increase that the by the the of injury, in injury for and of participation in these the a in injury The of injury the or and on available the of injury to be of supervision and these can be with instruction and supervision. injuries to be with various (e.g., and (e.g., Of of and are often to be other a of injury in and that the injury in is that for and that of these injury those for (e.g., the on injury potential and safety of and that injuries 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under his/her supervision. These be and for a of by professional and & Strength & Conditioning professionals and their employers must provide training, services and related in with all regulations and requirements and and laws and regulations to institutions and professionals. or based or other such is STRENGTH & CONDITIONING under of not be to in Strength & Conditioning with or in facilities for use by and and be to such of Strength & Conditioning may be for such and be according to the professional and with a of instruction and supervision that to and in such be as in the for & (refer to between and of have a level of participation in Strength & Conditioning activities, as and by their care (or by the Strength & Conditioning professional in with a care and for participation as in the for & (refer to be by the Strength & Conditioning professional in with the and care if such may in such in areas and by and so such be and according to the professional in with the care and with a of instruction and supervision that to and of and according to the Strength & Conditioning professional have a level of them to in Strength & Conditioning they have for participation as in the for & to may in such in areas and by and with a of instruction and supervision that to while & Strength & Conditioning professionals must not or provide or that are or to participants for any purpose including or those that are and have to be or not may be or provided to participants by Strength & Conditioning and to or

Paolo Di Barba

No abstract is available for this record.

Tsutomu Zeniya, Yoshiyuki Hirano, Tomonori Sakimoto, Kentaro Ishida · 10 authors

We designed a concept of high resolution and quantitative SPECT for imaging a selected small region-of-interest (ROI) of human brain. This system is aimed at achieving high resolution less than 1 mm and being applied for imaging neurons and evaluating drug delivery system. Pinhole or cone-beam collimators are useful for high-resolution imaging of small ROI. However, when the ROI is smaller than the object, the projection data are truncated by radioisotope outside ROI. In the reconstructed image, the truncation causes the artifact and the overestimation of voxel value, which deceases quantitative accuracy of physiological functions. We are introducing the new truncation compensated 3D-OSEM (TC-3DOSEM) reconstruction method. The truncated data can be successfully reconstructed within ROI by fulfilling the condition that ROI contains a priori knowledge. In addition to small field-of-view (FOV) detector, we are introducing the parallel-hole collimator attached large FOV detector covering the entire brain, to acquire the non-truncated data and provide the priori knowledge in small ROI, even if the resolution of the detector is low. For imaging with high resolution, we are using LaBr3(Ce) scintillator with optically coupled to position-sensitive photomultiplier tube (H8500, Hamamatsu, Japan) as the detector. And also, for proof of our concept, we performed preliminary experiment using pinhole SPECT and brain phantom. The reconstruction ROI contained the region outside the brain, that is, zero count as the priori knowledge. The truncated data were reconstructed by TC-3DOSEM. The reconstructed image without artifact and overestimation was obtained with high resolution. This preliminary experiment suggested feasibility of high resolution and quantitative SPECT for imaging a selected small ROI of human brain.

Kazi Md. Rokibul Alam, Shinsuke Tamura

This paper proposes a new electronic voting (e-voting) scheme that fulfills all the security requirements of e-voting. The key mechanism is the one that uses confirmation numbers involved in individual votes to make votes verifiable while disabling all entities including voters themselves to know the linkages between voters and their votes. Unlike complicated zero knowledge proof involved in many e-voting schemes, the confirmation numbers attain the verifiability requirement in a much more simple and intuitive way, then the scheme becomes scalable and practical.

Michael A. Weber

Academic physicians are under attack in the United States. Federal and state politicians, the lay media, some regulatory agencies, medical journals, and even medical schools have voiced strong concerns over the relationships between academic physicians and the pharmaceutical and device industries. These industries have been accused of corrupting medical research, education, and practice; and so, by extension, academic physicians who participate in these activities have become a focus of unfriendly attention. In their clamor, critics have not been reluctant to use the pejorative and misleading term conflict of interest in describing these academic-industry relationships. Physicians are notoriously slow to react, but in the end a group of academics from diverse medical specialties met at Harvard in late July to conduct the inaugural public meeting of a new organization: The Association of Clinical Researchers and Educators (obviously now known as ACRE). And, in the interests of transparency, let me immediately state that not only do I participate in research and educational services supported by industry, but that I was one of the founders of ACRE and took part actively at the Harvard meeting. Why in the United States—and throughout much of the world, for that matter—have academic physicians and industry forged their collaborations? In reality, a large part of medical research and education in contemporary times is based on this relationship. Dr Jeffrey Flier, Dean of Harvard Medical School, acknowledged at the ACRE meeting that his school’s mission to promote medical education and research requires interaction with industry.1 Most of the major advances in recent decades in conditions such as cancer and heart disease, and their incorporation into medical practice, have resulted from this partnering between academia and industry. Academic physicians are uniquely qualified to identify unmet medical needs and, working collaboratively with industry colleagues, to devise and conduct the types of basic research and clinical trials that lead to therapeutic breakthroughs. It is not difficult to understand why our critics have come to question this relationship, including legitimate concerns about preserving the independence of academic physicians. But one of the dominant motivations for this negativity comes from the costs—admittedly, often quite high—of new developments in patient care. Government agencies with limited budgets and commercial health plans with financial obligations to investors understandably look with dismay as relatively more costly tests, procedures, and therapies are developed and made available by industry and its academic advisors. From the perspective of health plan operators, the situation only gets worse when academic physicians teach their practicing colleagues about the attributes of these new developments. ACRE’s first meeting, which played to a packed house in the Bornstein Amphitheater at the Brigham and Women’s Hospital, attracted a wide range of speakers. There were representatives of medical societies, including such disciplines as diabetes, lymphoma, myeloma, and hypertension. As well, there were representatives of patient advocacy groups passionately committed to preserving the productive academia-industry collaboration needed to address unmet needs across a broad range of serious illnesses. An important insight came from a nationally recognized medical ethicist, Lance Stell, who is a professor of philosophy and Director of the Medical Humanities Program at Davidson College. “Conflict of interest” in the medical context has a clear meaning. Specifically, it occurs when practitioners accept personal rewards (such as fees, grants, awards, or recognition) in return for actions that could violate their professional obligations. In essence, to accuse a clinician of conflict of interest would require empirical proof that, in return for a reward, an action was taken that resulted in diminished care or even harm to patients. Clearly, such occurrences are extraordinarily rare in the conduct of medical research and education activities. There are words that are more accurate and less emotive than “conflict,” and we are starting to see a preference for such terms as duality, concordance, or alignment of interests. It is ironical that another speaker at the ACRE meeting discussed how certain actions in the medical setting, which perhaps really do represent true conflicts of interest, go without criticism. For instance, some commercial health plans offer practitioners direct monetary rewards for switching their patients from more expensive to less expensive drugs, or, possibly, for reducing their use of tests, referrals, and therapies so as to minimize the insurers’ outlays. Much of the information received by practicing clinicians comes from events that are funded, directly or indirectly, by industry. Partly, this is by default. After all, who else has both the responsibility as well as the resources to provide ongoing education in the clinical sciences? Inevitably this type of sponsorship has been criticized on the grounds that industry is not providing support out of altruistic principles, but rather is more intent on marketing its products. Apart from unrestricted grants that industry can provide to medical schools or hospitals to support educational ventures of their own choosing, there are two main types of industry-supported education. The first of these comes under the heading of promotional activities, and the second is labeled as continuing medical education, or CME. Each of these has its share of critics. Promotional education programs can take place in hospitals, medical offices, or at outside venues such as restaurants and are designed to provide information directly about a company’s product. These types of activities are regulated by such agencies as the Food and Drug Administration. In the case of a pharmaceutical agent, the information presented must be balanced, providing information about risks as well as benefits, and must conform largely to what is stated about the drug in its approved product label. Claiming a desire to comply with these rules, many pharmaceutical companies have tightly scripted the content of these presentations, typically demanding that presenters faithfully use a company-provided slide set without allowing them the option to add, delete, or make any other changes. This requirement obviously creates fundamental problems for academic physicians invited to present at such events. After all, how can well-regarded experts stake their reputations, not to mention the reputations of their academic institutions, on material that has been created by unknown persons at the behest of a pharmaceutical company? Not surprisingly, some major medical schools have now instructed their faculty members not to give such lectures unless they have meaningful control over the content. For community practitioners who attend such events, this is an unfortunate development, for it deprives them of beneficial teaching interactions with true medical leaders. Some observers believe that industry lawyers, in imposing this censorship, have overreacted to regulatory requirements, and there is even a suspicion that these rules—rather too conveniently—enable companies to focus more directly on their marketing messages. Rescuing this situation and re-creating collegial educational experiences in the community will require negotiations between industry and academia and, in all likelihood, regulatory agencies as well. CME is a very demanding proposition. On the one hand, industry has a compelling obligation to facilitate high-quality educational opportunities and updates for the users of its products. But, at the same time, CME rules demand that industry has a “hands off” involvement in such events, merely serving as a provider of grants. The contents of CME programs usually are created by academic faculty and are subjected to peer review (similar to an article submitted to a journal) to ensure their objectivity. Even so, some critics still claim that industry can exert a bias on this process simply by selecting which types of programs they will support. But while it is true that pharmaceutical companies are more likely to support CME activities within their areas of medical interest, industry now goes to considerable pains to ensure that its grant decision processes are kept entirely separate from marketing activities. The opponents of industry support for CME activities still claim that, despite the firewalls, industry is still rewarded for its support of CME activities by increased sales of its products. Even if this were true, it is a not unreasonable proposition that if well-balanced data, presented in an unbiased fashion, affects the subsequent utilization of drugs or devices, this will very likely be to the benefit of patients. From the perspective of academic clinicians, rigorously conducted CME events in which they are free to select the content and ideas represent ideal opportunities to enhance practitioner knowledge and patient care. Attempts by legislators (and others who regard medical education as a health–care cost driver) to prevent or limit industry support of CME could have the effect of diminishing the quality of medical practice. Again, it is the responsibility of physicians and organizations like ACRE to argue the value to patients of cooperation between academia and industry in medical education as well as in research. Many medical societies, particularly small specialty organizations, depend on industry support. The operating costs of societies, as well as the cost of meetings, publications, patient education and other professional activities cannot be fully funded by member subscriptions. Support from industry is often essential and comes in the form of corporate memberships, sponsorship of CME or other activities at scientific meetings, exhibit fees, and journal advertising. This support has been criticized by the media as indicative of excess industry influence on professional activities. And, indeed, it might be appropriate for societies to consider whether funding from industry and income from members should be directed selectively to purposes relevant to those funding sources. It is worth noting that the mistrust between the provider of health services and the worlds of academia and industry became a major public issue in Great Britain about 4 years ago. In fact, a committee of Parliament issued a report expressing concern at the failure of the academic community and the health service to work more closely with the pharmaceutical industry to minimize inappropriate or suboptimal use of drugs in clinical practice.2 Subsequently, in a high-profile report issued early this year, the Royal College of Physicians (which represents a broad range of medical specialists) stated that the interests of patients and their clinicians are best served by close cooperation between academia, industry, and the health services.3 It is unfortunate that we have lagged behind on this side of the Atlantic. Indeed, one of the most telling statements made at the Harvard meeting came from Massachusetts State Representative Michael Rodrigues, who helped lead the opposition in the legislature to a now-enacted law that dramatically curtails interactions between physicians and industry in that state. It was particularly discouraging to hear from this representative that he and his colleagues lost their opportunity to block the legislation when local physician leaders gave up the fight and decided to remain silent. The responsibility of ACRE is to re-establish the partnership of academia, industry, clinicians, and patients in the United States. Among its initial goals is educating the lay public as well as the medical community about the value to patients of the research and educational collaborations between academia and industry. This will be no easy task, for so many negative items have already appeared in the media regarding the alleged manipulation of physicians by industry, usually with only weak rebuttals by academic or industry leaders. Indeed, one of ACRE’s main responsibilities will be to develop a public voice that gets heard and quoted when such issues arise. There already has been one such success: Dr Thomas Stossel, one of ACRE’s leaders and the chair of the Harvard meeting, was invited to testify at a high-profile US Senate hearing on CME in late July. Another of ACRE’s main tasks will be to set up codes of conduct or guidelines designed to ensure that relationships between academic physicians and industry are ethical and clearly targeted at improving outcomes for our patients. This, again, will take considerable thought and discussion. As Dean Flier pointed out, we still need to figure out how best to “strike a wise balance” and create “manageable tension” in optimizing productive interactions between academics and industry. From the perspective of the many of us involved in cardiovascular medicine, it is easy to see the dramatic improvements in patient care that have resulted from the academic-industry partnership in recent years. Major clinical events and mortality have been sharply reduced in such areas as hypertension, lipid disorders, diabetes, heart failure, acute coronary syndromes and chronic kidney disease by this collaboration. ACRE’s members, in common with most physicians, no longer find it acceptable to let others unilaterally set up the rules by which we are expected to function in performing these vital tasks. It is long overdue that we take responsibility for our professional activites in research, education, and practice. More information about ACRE can be found on its Web site: http://www.acreonline.org The site also has information about how to become a member.

Samir D. Parikh

Bankruptcy proceedings tend to involve civil disputes where nothing more than money is at stake. In such instances, the application of the preponderance-of-the-evidence standard of proof offers the greatest utility and is aligned with the comparatively minimal importance society places on purely monetary disputes. However, bankruptcy courts are not viewed as typical civil courts. Rather, many view these courts as “courts of equity” and this perception serves as a crutch which many bankruptcy judges use in advocating the application of the clear-and-convincing standard of proof to customary civil disputes. These actions distort the accepted risk allocation schemes implicit in standards of proof; the consequence of which often is inequitable results. A lack of direction by the Supreme Court is a key factor in this process failure. The Court has addressed the application of standards of proof infrequently and, when it has, the holding has been narrowly tailored. In 1990, the Court issued a ruling in Grogan v. Garner, 498 U.S. 279 (1991), that appeared to provide guidance. Unfortunately, as of late, the ruling has been misinterpreted by a number of courts and has led to additional confusion on an issue that was already elusive. In my article, I propose a new, comprehensive normative approach to determine which standard of proof is applicable in disputes involving debtors in possession under the Bankruptcy Code. My approach is based on a coextensive reading of applicable Supreme Court precedent that honors the narrow basis on which many of these rulings are made. I urge use of an approach that will engender greater uniformity on this fundamental issue. Further, I analyze some key forms of relief available under the Bankruptcy Code in which courts have advocated the application of the clear-and-convincing standard of proof but failed to provide any explanation for this action. By applying my approach, I evaluate bankruptcy case law and isolate instances where bankruptcy courts impermissibly distort accepted risk allocation schemes. Finally, I attempt to show that some unexplained applications of the clear-and-convincing standard of proof are justified.

계이기, 김만배, 최황규

This paper proposes a new undeniable signature scheme which uses one-way function and partition-selection method to proof its zero-knowledge respectively. The main idea is to protect the signer of a document against the document being digitally distributed without knowledge of signer. And we show that our scheme is so effective that message exchange only needs much fewer times during the confirmation protocol and disavowal protocol respectively. which is very useful for poor network environment keeping the communication times with both sides as few as possible. And our scheme allows verifier to verify that the signature is valid, while the signer doesn't know the original message and the signature, to preserve the privacy of the verifier.

Fiona A. Miller

No abstract is available for this record.

Endre Bangerter, Stephan Krenn, Ahmad‐Reza Sadeghi, Thomas Schneider · 5 authors

Abstract. Zero-knowledge proofs of knowledge (ZK-PoK) play an important role in many cryptographic applications. Direct anonymous attestation (DAA) and the identity mixer anonymous authentication system are first real world applications using ZK-PoK as building blocks. But although being used for many years now, design and implementation of sound ZK-PoK remains challenging. In fact, there are security flaws in various protocols found in literatur. Especially for non-experts in the field it is often hard to design ZK-PoK, since a unified and easy to use theoretical framework on ZK-PoK is missing. With this paper we overcome important challenges and facilitate the design and implementation of efficient and sound ZK-PoK in practice. First, Camenisch et al. have presented at EUROCRYPT 2009 a first unified and modular theoretical framework for ZK-PoK. This is compelling, but makes use of a rather inefficient 6-move protocol. We extend and improve their framework in terms of efficiency and show how to realize it using efficient 3-move Σ-protocols. Second, we perform an exact security and efficiency analysis for our new protocol and various protocols found in the literature. The analysis yields novel- and perhaps surprising- results and insights. It reveals for instance that using a 2048 bit RSA modulus, as specified in the DAA standard, only guarantees an upper bound on the success probability of a malicious prover between 1/2 4 and 1/2 24. Also, based on that analysis we show how to select the most efficient protocol to realize a given proof goal. Finally, we also provide low-level support to a designer by presenting a compiler realizing our framework and optimization techniques, allowing easy implementation of efficient and sound protocols.

Beth Luey

I promise to do all I can to make you a great publisher even as I expect you to do all you can to make me a great author. Robert Frost to Alfred Harcourt Faculty members are always writing or talking about writing and of necessity are always thinking about publishing. Each has an article nearly finished, about to be started, or stuck somewhere in the middle. Many have a book manuscript under way or under consideration at a press. And some are complaining, half-sincerely, about the tedium of reading page proofs. Although writing and publishing are discrete processes, they are interdependent. Why write if no one will publish? And what is there to publish if no one writes? Despite this interdependence, academic authors and publishers of scholarly books and journals do not always understand each other very well, and they sometimes find it difficult to coexist peacefully. Publishers and journal editors lose sight of the tremendous pressure to publish that is exerted on scholars, particularly young, untenured scholars. Authors, for their part, are guilty of not understanding either how publishing works or how to use the system to their advantage. Publishers' indifference to the scholar's plight, although perhaps regrettable, does serve a purpose. The editor considering a manuscript who remains conscious at every moment that the fate of another human being is at stake may not make the best decision.

Gregor Pavlin, Patrick de Oude, Marinus Maris, Jan Nunnink · 5 authors

No abstract is available for this record.

Jacob S. Hacker

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans.1 Polls have shown that a substantial majority of Americans support the public option as well.Yet the idea has occasioned considerable controversy on Capitol Hill. Senate Finance Committee chairman Max Baucus (D-MT) recently unveiled his draft bill (the chairman's “mark”), which contains no competing public plan. Instead, it substitutes the largely untested idea of providing federal loans and start-up funds to encourage the creation of decentralized, member-run health care “cooperatives.” Another . . .

Anthony S. Chen, Margaret Weir

Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.

Benjamin Golub, R. Preston McAfee

No abstract is available for this record.

Jeffrey S. Flier

A persistent headache is a symptom, but the underlying cause can be anything from a migraine to a brain tumor. Good medicine means identifying and treating the cause as well as the symptom. The same is true in health care reform. Though most Americans are satisfied with their own health care, they also see the need for substantial reform. Unfortunately, the well-meaning plans currently presented to Congress are the wrong therapy because they mistake the symptoms for the underlying disease. Nearly everyone agrees on the symptoms: rapidly growing health expenditures, diminished access to affordable insurance causing many to be uninsured, and inadequate quality and outcomes for the dollars spent. But what are the root causes? While there are many contributing factors, three merit special attention. First, there is our inefficient and inequitable system of tax-advantaged, employer-based health insurance. While the federal tax code promotes overspending by making the majority unaware of the true cost of their insurance and care, the code is grossly unfair to the self-employed, small businesses, workers who stick with a bad job because they need the coverage, and workers who lose their jobs after getting sick. This employer-based system arose not by thoughtful design but as an unforeseen result of price controls during World War II and subsequent tax policy. How this developed and persisted despite its unfairness and maladaptive consequences is a powerful illustration of the law of unintended consequences and the fact that government can take six decades or more to fix its obvious mistakes. Second, in health care as in other markets, real progress depends on innovation. Yet health care markets rarely conduct successful experiments with new ways of paying for and organizing health care delivery. Why? Although health care markets have some unique attributes, these are not the explanation for lack of successful innovation. Rather, health insurance markets suffer from overregulation, which limits innovation in both insurance and new ways of delivering medical care. Third, we have Medicaid and Medicare. These enormous federal programs address critical needs by delivering health care to the poor, the disabled, and the elderly. These programs pay providers by administrative pricing formulas that are well documented to promote both overuse and underuse of appropriate care, have led to rising expenditures decoupled from better health, and obligate massive future deficits that everyone agrees are unsustainable. They are also rife with fraud and abuse. And yet the current political debate and the several and incomplete versions of “reform” proposals do little to address these core problems. Proposals such as those that would create a new public insurance program, for example, would likely magnify them and create a new generation of problems that will be as difficult to fix as Medicare has proven to be. Why does the current set of reforms fall short? One reason is that all changes must pass through the political process. For example, any effort at Medicare reform rapidly morphs into a struggle for influence between insurers and pharmaceutical companies, big-city academic health centers and hospitals in rural areas, specialists and primary care providers, federal and state governments, and on down the line. Sadly, innovators — and all too often patients — get lost in these power struggles. Any reform effort that fails to correct the acknowledged fiscal and organizational flaws of Medicare and Medicaid while extending the political gridlock that attends it to a broader segment of the health care system is doomed to failure. Some have offered novel approaches to “payment reform,” but none of these can realistically claim to both increase quality and reduce costs, while being acceptable to Congress. One proposal would create a new executive branch commission to propose changes to Medicare benefits and price controls that Congress could only override with a supermajority vote. While such an experiment might have the potential to reduce political gridlock, it would centralize power in a manner that seems exceptionally risky for a field that accounts for one-sixth of our economy and affects the lives of hundreds of millions of people. I anticipate many new advances in diagnostics, therapeutics, and devices over the coming decades. Optimal development and application of these will flow from a decentralized and innovative health care market and will be suppressed by a system that relies on politics and an all-powerful commission. Some have proposed that comprehensive reform must be achieved quickly, capitalizing on a sense of crisis. I see unacceptable risks to this approach. Instead of achieving a far-reaching and necessary solution for our economy and the nation’s health, the necessity of pleasing enough special interests to get a bill passed will exacerbate our long-term crisis of cost and access. Who can tell what deals within a thousand-page bill that few, apart from lobbyists, have read will influence the state of health care for decades to come? Now that a vote on health care reform will not occur until at least the fall, we should seize this opportunity by stepping back, making the right diagnosis, and then applying therapies that address the underlying disease. Here are a few ideas, based on the diagnoses discussed above, that may work. As with any therapy, these should be introduced as pilot programs, to be extended only if data reveal the desired outcomes. While such an approach will not fulfill the wish to produce a dramatic cure through a single stroke of legislation, it may avoid the pitfalls of the latter approach and have a greater likelihood of reducing the number of uninsured while controlling costs and enhancing outcomes. I propose this without any relationship to the partisan politics of the day that substitutes slogans and misinformation on both sides for meaningful analysis. First, make the tax shelter for health insurance, currently limited to employers, independent of employment. This single, and morally imperative, step would enable the uninsured to use tax-sheltered money to buy health insurance for themselves while permitting insured employees, who are currently limited to a few employer-selected health insurance choices, to become more central in decision making. Second, identify and eliminate the many barriers to entry and innovation in the health care and insurance marketplace. Eliminating what are often hidden barriers to competition will encourage entrepreneurs to offer lower-cost ways of financing and delivering health care, approaches that will deliver greater health care value for the dollars spent. Third, make a serious effort, despite the context of widespread political demagoguery, toward deeply reforming Medicare and Medicaid. As one of many possible examples, try giving some Medicare and Medicaid enrollees earned income credits so they can make cost-conscious decisions among competing health plans. The sicker and less affluent should receive larger transfers, so they can buy adequate coverage. Among other benefits, such an experiment could break the logjam in payment reform and reliance on fee for service and centralized price controls. Reducing rather than increasing the role of politics in health care decisions, while providing assistance for those in need, these pilot therapies would have the salutary effect of placing patients and innovators in a more central role as we determine the future of health care in America. And we would then, at last, be able to align the treatment with the disease, a fundamental principle of responsible medicine. Addendum. I coauthored an article on health care reform and its underlying issues in 1994, and although it was written fifteen years ago, some of the concepts within this article may be relevant today (1). In addition, a recent article in the Atlantic magazine addresses key issues underlying this discussion that I find quite compelling but could not address due to considerations of length (2).

Vesna Pendovska, Aleksandra Maksimovska Veljanovska

This paper is about the local utility services in the decentralization process in the Republic of Macedonia. Particular emphasis is placed on the legal framework for financing municipal utility services through the decentralization process. Since the utility service tariffs are relatively low, the Macedonian utility companies want to increase their tariffs up to cost recovery levels to achieve higher standards required by the EU Directives. The paper also deals with financial relations between the central and local authorities versus the utility company management and the current state of providing utility services in light of financial issues. It has been found out that there is a huge potential to improve user charges. However, due to the current economic situation and the unwillingness of customers to pay higher fees, this solution cannot be applied for the time being. KEY WORDS: • public service delivery • financing municipal activities • public enterprise • Macedonia

Vinod K. Paul

Neonatal mortality in the country continues to be unacceptably high and unrelenting with wide variations across states. Six high population states account for 60% burden of neonatal deaths. Most of the evidence-based interventions are reflected in the programs, but the coverage levels are low due to poor implementation resulting from missed opportunities and weak health systems. Action is required at the home and community level, as well as at the outreach and facility levels in rural and urban settings. ASHAs must be engaged in home care of neonates. Private sector needs to be involved for providing care to neonates of poor families. Demand side financing and incentives could be game-changers in enhancing care seeking and service uptake. Effective programming would require still higher budgets, decentralized planning, managerial support, proper monitoring and a massive human resources capacity development. Community mobilization is essential for which panchayati raj institutions can play an important role. Advoa.cy efforts should not be diluted because there still is a long way to attain an acceptable level of newborn survival.

Massoud Hadian Dehkordi, Reza Alimoradi

Identification protocols have a very important role in the world of electronic communication. In an identification protocol, the prover (user) proves to the verifier (center) that it is truly the authorized user who is communicating with the center. In one round of batch identification scheme a user with several secret keys (identities) can prove itself to the verifier instead of several proofs. In this paper, the first Weil pairing will be introduced. In addition, we propose a new batch zero-knowledge identification scheme based on the Weil pairing hereafter considered the security analysis of our proposed scheme.