Setting risk-adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single-and in most cases arbitrary-set of relative unit costs of services. This paper presents a method for estimating group-specific mean costs and capitation rates using a panel of aggregate cost data of the competing health plans and the composition of their populations. This method is used to estimate mean costs and capitation rates for the Israeli health care system. The limited data available severely constrains the range of estimable models, however, the results evoke some questions with regards to reimbursement and rates presently used, as well as to the methodology used to estimate them.
Artisans had autonomously decided the work processes and the wages in the traditional craft production, and their workshops was the basic unit of artisans' community. Between 1780 and 1820, however, the craft economy was radically transformed. The major impetus for change came from expanding markets. Recent work by a number of labor historians has shown that metropolitan industrialization did not proceed directly from craft to factory production in a single bound, but rather followed a more uneven course. Production was expanded in the antebellum decades through the reorganization of work and the division of labor rather than through the adoption of new machinery and methods of production. The high point of artisan protest, at least in New York and Philadelphia, was reached in the 1820s and 1830s with the formation of three successive workingmen's organizations: the Working Men's political parties of 1827-1831; the city-based General Trades' Unions of 1833-1839; and the Loco-foco Party in New York City of 1835-1837. Although none of these organizations lasted more than a few years, they have been viewed by many historians as the first signs of working-class consciousness in the United States. Artisans responded to metropolitan industrialization by calling into question existing economic and social relations and constructing in their stead a new, more class-conscious view of the world. Especially, the Working Men's parties and GTUs displayed a new level of collective identity or solidarity that enabled artisans to unite across the traditional boundaries of their trades. Thus, in the 1820s and 1830s, artisans' loyalties were no longer restricted to their craft, but increasingly were drawn along class lines, as artisans and employers began to organize across trades. Artisans drew on long-standing republican values to criticize the new economic order. Artisans extended the eighteenth-century assumptions to their own world, the world of work and production, and created their own variation on republican themes. Displaced artisans drew on republican notions of political rights and civic participation in order to protest the economic inequalities that accompanied industrialization. The major contribution of the republican tradition was that it provided displaced journeymen with a set of values and precepts with which to challenge the economic changes under way in the early nineteenth century. However, the principal social cleavage in the 1820s and 1830s was not yet between labor and capital, or workers and employers. Instead, skilled artisans considered themselves to be producers, allied with master craftsmen, small manufacturers, and farmers against the non-producing classes. Bankers, lawyers, merchants, and land speculators were the quintessential nonproducers. Producers were well aware that the world of work had changed dramatically in the first three decades of the nineteenth century. But producers did not understand such a change in the context of a struggle between capital and labor, but saw them in light of their established worldview. The division between producers and nonproducers undergirded antebellum social relations and political alliances as well. By 1870, workers' optimism about the possibility of sustaining a decentralized political economy based on the republical values had been considerably shaken. The process of industrialization in the United States shattered the producers' vision of regional economic growth, and as a consequence transformed workers' relationship to the state.
Cooperation between libraries is a universal language spoken in different dialects. In 1996 the libraries of the state-funded universities and the State Library of Catalonia (Spain) formed a consortium to act as a channel for cooperation. The organization, operation, and funding of the Consortium of Academic Libraries of Catalonia (CBUC) are an example of how this universal language has been adapted to the specific characteristics of the library and university system in Catalonia. The CBUC has a union catalogue, an interlibrary lending program, and other cooperation programs. In 1999 it set up the Digital Library of Catalonia, a series of electronic resources shared by all the libraries of the consortium. From their experience in the CBUC, the member libraries have found cooperation to be hard work but also a means of introducing changes and grasping the future. * Introduction The Registrum Librorum Angliae, a collective catalogue of the books of 186 monasteries in England, was drawn up in the late fourteenth century. This was a cooperative effort aimed at facilitating the location of documents and shows us that cooperation between libraries is a universal language spoken in different dialects. Spanish universities were organized centrally until the early 1980s. In 1984 the University Reform Law gave universities an autonomy that allowed them to renew their system of organization and to start a process of renewal of their libraries that has shown significant results in the last fifteen years.(1) This renewal involved an increase in the budgets devoted to purchasing collections, building new buildings, and automating the libraries, which marked the beginning of association and cooperation between libraries. Coinciding with the process or reorganization of the state, the Spanish administration became decentralized, and the powers delegated to the regions include responsibility for certain aspects of higher education. Catalonia is an autonomous region of Spain with 6 million inhabitants and a university system of eight public universities and three private ones, forming a university community of 189,118 students, 13,358 lecturers, and 6,240 administrative staff. Catalonia has its own language--Catalan--and a national library, the Library of Catalonia, which pays special attention to regional culture. In the 1980s the Catalan libraries began to cooperate through associations of specialized libraries and the first union list of journals of university libraries, which was, however, discontinued. The decentralization of the administration and of university funding played an important role in finally converting these early attempts at cooperation into the Consortium of Academic Libraries of Catalonia in the '90s. * What is the CBUC? Background The Consortium of Academic Libraries of Catalonia (CBUC) is formed by eight public universities of Catalonia and the Library of Catalonia (figure 1), whose mission is to improve library services through cooperation. [Figure 1 ILLUSTRATION OMITTED] The origin of this consortium is found in the changes that took place in the university world and in their libraries in the early '90s. In 1990 there were three universities in Catalonia that were automated with in-house systems. In the following five years the number of universities increased considerably, and it became clear that the development of automated systems by the individual universities was not a feasible option for the future. Although each university completed an independent assessment of automated systems, the process was informally conditioned by the idea that it would be better to choose the same vendor in order to facilitate support and installation.(2) This informal collaboration strengthened relationships between the libraries and made their directors and the university managers see that working together could give results that the libraries alone could not achieve. …
Decentralization of social services is one of the central elements of the social policy reforms being carried out in Latin America in order to make the provision of such services more efficient and to strengthen the democratization processes. This article analyses the processes of decentralization of education in seven Latin American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Mexico and Nicaragua). It seeks to systematize these experiences, using a theoretical typology of reform models; to present some results and trends in terms of the efficiency and equity of the provision of these services, and to extract some useful lessons for the design of future reforms. Although the models developed in the various countries differ from each other, they nevertheless have some common features: they depend on the resources provided by the central level to finance the services, and in many cases they subordinate schools to decisions taken at other levels. Among the main economic and social effects of the reforms are the limited progress made in participation and, hence, social efficiency; the ambiguous results obtained in terms of technical efficiency, and a trend which is not yet fully confirmed towards greater inter-territorial disparities in educational indicators. Among the lessons for policy formulation is the importance of giving the new levels of supply some degree of real autonomy, using a system of transfers which encourages a quest for efficiency while at the same time safeguarding equity, taking care to preserve the internal coherence of the models, giving some responsibilities directly to the schools, and ensuring that there is a suitable framework for the regulation and supervision of decentralized service supply systems.
Bolivia has made tremendous progress in macroeconomic stabilization and in structural reforms. This Public Expenditure Review concentrates on three things: a) an evaluation of the budget as a whole; b) institutional issues in decentralization, domestic resource mobilization and external financing; and c) sector-thematic coverage of education, health, roads, and water & sanitation, and the most pressing generic issues in the public sector. The report discusses the following findings: there is a pervasive lack of operational and maintenance funds across the public sector; expenditures in education compare favorably internationally; roads pose a formidable challenge; and the budget process is too cumbersome. It also makes several recommendations for Bolivia, including: improve the non-pension fiscal balance; prepare a soft landing for the expected reduced access to concessional external financing; follow IMF ESAF fiscal deficit targets; increase tax collection efficiency; replace the RC-IVA with a simple, broad based income tax; human resource structural changes are needed; increase health expenditures while scrutinizing and removing the War of El Chaco Veterans' payments from the health budget; no public subsidies should be given to ameliorate the increase in water tariffs in Cochabamba; and the focus of decentralization should now shift to increase efficiency and equity impact of public expenditures.
Computer Algebra Systems (CAS) can be used to help understand the behavior of cubics and other families of curves. The analysis of the parameters associated with a family of curves can give insight into the behavior of the family and can be used within the context of a mathematical model to determine a policy for the implementation of the model in a real-world setting. Examples of this use are included from a calculus-based analysis of a mathematical model and the behavior of a model described by a differential equation. The case is made that the ability, afforded by the use of CAS, to keep the parameter in symbolic form enables an analysis that goes beyond the standard analysis that may be done in the standard situation using numerical coefficients. (MM) Reproductions supplied by EDRS are the best that can be made from the original document. PERMISSION TO REPRODUCE AND DISSEMINATE THIS MATERIAL HAS BEEN GRANTED BY TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) Using Computer Algebra to Extract Meaning from Parameters John Moores University Liverpool, UK L3 3AF C.Leinbach @ 1 ivjm.ac.uk Introduction Carl Leinbach on leave from U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) Aq.hia document has been reproduced as received from the person or organization originating it. 0 Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. Gettysburg College Gettysburg, PA USA leinbach@cs.gettysburg.edu Understanding the meaning of a mathematical equation, model, or result comes from a variety of sources. It may come from the ability to estimate, a graphical intuition, or an understanding of the phenomena underlying the result. Ultimately, however, the most valuable insights are gained by understanding the parameters that are used to define the mathematical objects being considered. For example, the behavior of a cubic, ax3 + bx2 + cx + d, depends on the size, sign, and relationships that exist among the coefficients, a, b, c, and d. The fact that the polynomial is a cubic determines the general shape of the curve, but it is the parameters that determine the center of symmetry, the location of the maximum and minimum points, if any, and the distance between these points. In effect, the degree of a polynomial determines the general shape, and the parameters define the quality of the polynomial's behavior. While the analysis of parameters associated with a family of curves can give significant insights into the behavior of the family, there are other uses for this type of analysis. For example, parameters can be used within the context of a mathematical model to determine a policy for the implementation of the model in a real world setting. Examples of this use will be taken from a calculus based analysis of a mathematical model, and the discussion of the behavior of a model described by a differential equation. In each case we will show that the ability to keep the parameter in its symbolic form enables an analysis that goes beyond the standard analysis that may be done in the standard situation using numerical coefficients. Constructing Cubic Curves The general definition of a function determines the general shape of a process, but analysis of the parameters associated with the function detennine the quality of the process. For example, using our knowledge of trigonometry we can describe the process associated with the function, f(x)=ax + bsin(ax + p) as an oscillating curve that lies along a ray passing through the origin. The paranieter, a, determines the angle the curve makes with the x-axis, while b, a, and p determine the height, frequency and phase shift of the oscillation. The latter characteristics are important if one is describing a radio wave being broadcast to a destination. In a similar way the parameters associated with a polynomial function determine the behavior of the polynomial. We will first consider a cubic polynomial. 2 BEST COPY AVAILABLE Begin the analysis by considering a very straight forward cubic function of the form f(x) = ax3 13x We can learn a lot about this curve by doing some elementary reasoning and exploration r 1. The roots are located at x = 0, A , A a a 2. The graph is symmetric about the origin, i.e. flx) .f(x) 1 3. The graph has a and at x = ± --(1 or TI-1 if and only if 3a V3a a and 13 have the same sign. The last fact is easily determined using calculus techniques if the students have had an introduction to differential calculus. However, if they have not some elementary graphical analysis and algebraic manipulations using a CAS have the potential to make the exploration even more exciting. For example, one approach is to begin with a graphic justification of the tangent line as a limiting position for secant lines through a fixed point and a sequence of points becoming ever closer to the given point as is illustrated in the following screen taken from a TI-89 session. Each student can be given different points on the graph and a different sequence of points (values of h) each of which terminate at a point 'close' to the fixed point. The graphical evidence is convincing but not a proof. The CAS allows for a more convincing argument after the graphical case has been considered. It also leads us to the conclusion given in (3) above. rl. Tools F2. Algebra F3. Ca lc Fh. Other FT Pr nMO F6. Clean UP Define f(x) =a x3 B x Done f(x + h) f(x) 3-ax2+3.hax +h2.a-B (f(x+h)-f(x))/h MAIN RAD AUTO FUNC 2130 ri. Tools F2. Algebra F3. Cale Fh. Other FT rol0 F6. Clean Up MO 3. a x2 zeros(3. a x 2 B, {when(-,r378) -&l ,Trx wherl zeros ( 3*a*x^2-B, x) MAIN RAD AUTO FUNC ROO The screen on the left allows the student to easily manipulate the expression for the difference quotient. The obvious question is what happens as h becomes smaller and smaller in magnitude. This leads to the idea of a limit. The student now knows how to find the slope, and as a result the equation, of the tangent line to the graph of f(x) at any point on its graph. Now, the next question is what makes peaks and valleys interesting? Of course, these are points where the tangent line is horizontal! So the student solves for the points where the slope of the tangent is zero, and the students have shown statement number 3. In the process they see that the location of the peak and valley are related to Leinbach: The Role of Parameters
Diabetic nephropathy is one of the most frequent and clinically important complications to diabetes mellitus (DM), affecting approximately 40% of patients who have had diabetes for more than 20 years and contributing to a substantial part of patients entering into end-stage renal failure programmes. Our knowledge of the clinical development and morphological basis for diabetic renal disease has augmented tremendously during the last half century [1,2] and during the last decade we have been able to understand at least some elements of its pathogenesis. Nephropathy in a patient suffering from DM may, however, not be related directly to the diabetic disease but may be a complicating renal disease, not due to the diabetic metabolic abnormality. The situation is further complicated since logically both lesions may be present in the same patient. While it was formerly held that non-diabetic renal disease was of minor importance in DM, this seems not so obvious to-day, and opinions of investigators about prevalence of non-diabetic renal disease in DM, as revealed by renal biopsies, have been conflicting. The correct diagnosis is important for the patient since prognosis and treatment may vary according to the underlying cause. Furthermore: if a substantial part of renal disease in diabetics had other causes than the diabetic metabolic derangement, this must be a confounding factor in the interpretation of intervention trials. The classical diabetic nephropathy is morphologically primarily a glomerulopathy, characterized clinically by proteinuria and progressive decrease of glomerular filtration. Tubular atrophy and interstitial fibrosis is a common final pathway for many renal diseases including diabetic nephropathy. These lesions have formerly been interpreted as ischaemic sequels to vascular and glomerular lesions but they may also occur in diabetics with only mild vascular and glomerular lesions and at an early stage of diabetic renal disease. In some reports this was even rather frequent [3,4] and it is today not at all obvious that tubulointerstitial lesions are of ischaemic origin. A competing hypothesis relates them to the diabetic state, just as glomerulopathy [5–7]. This problem will not be addressed here, I have been asked to provide a brief presentation of problems related to the differentiation of non-diabetic from diabetic glomerular lesions in renal biopsies. Since our problem is one of differential diagnosis it is first necessary to give a brief review of glomerular lesions, which can be regarded with confidence as being directly caused by the diabetic metabolic abnormalities. Following the first seminal report by Kimmelstiel and Wilson [8] and later on worked out in great detail by others, we have now a clear idea of the histopathology of diabetic renal disease and its progress with time. We know now, that at the onset of insulin dependent DM (IDDM) (in this type the zero time is well defined) there is enlargement of the glomeruli indicating increased glomerular function, but no other structural lesions by light microscopy (LM) or electron microscopy (EM). The first ultrastructural lesions (widening of the mesangial matrix and thickening of the peripheral glomerular basement membrane) can be morphometrically identified 2–3 years after onset [9]. Changes can usually not be seen by LM until several years of diabetic disease. They are described in two forms. In the diffuse form there is a widening of all mesangial regions as well as thickening of the peripheral capillary basement membranes, corresponding to what is already apparent at an earlier time from morphometry on EM pictures. The diffuse lesion is most conspicuous in PAS-stained sections. In the nodular type some of the mesangial regions take on the appearance of round nodules which are acellular in their centres but surrounded by a rim of mesangial nuclei. While these types are sometimes described as separate histologic entities, there are good reasons to regard the nodular type as a further development of the diffuse type. Missing a formal proof of this (e.g. by the study of sequential biopsies from the same patients), it is clear that nodules are formed from mesangial matrix, that they occur later in the disease than the diffuse lesion and that nodules never occur without associated marked diffuse lesions. To this account of what is regarded as the most important glomerular lesions may be added that hyaline (exudative) lesions sometimes occur in the form of capsular drops and hyaline caps. It is unclear whether mesangial hypercellularity is a feature of glomerular diabetic lesions. Using quantitative technique, Wehner and Anders [10] as well as Kimmelstiels group [11] found a significant increase of mesangial nuclei in nodular and diffuse diabetic glomerulopathy. On the other hand, Østerby, counting on EM montages, did not find hypercellularity in the early stage of juvenile DM (0–5 years) [12]. In experimental diabetic nephropathy there is early mesangial proliferation and increased expression of growth factors [13]. Using immunofluorescence, a diffuse, linear localization of IgG in glomerular capillary walls, and sometimes also of small quantities of other plasma components, is frequent. There is general agreement that this is due to non-specific trapping of plasma components along the glomerular capillary wall, and they are not associated with presence of deposits on EM. In parallel with the progress of glomerulopathy, arteriolar sclerosis and hyalinosis develop. The hyaline arteriolosclerosis affects the afferent as well as the efferent arteriole, which is not the case with non-diabetic arteriolosclerosis. Otherwise there are no differences between the structure of arteriosclerosis and arteriolosclerosis in diabetics and non-diabetics. Arteriosclerosis occur earlier and in more severe degree in diabetics than in the non-diabetic population. It is therefore not unexpected that arteriosclerosis and focal scars are frequent in biopsies from patients with DM, especially non-insulin dependent DM (NIDDM) which occurs in older patients. It is generally held that GN complicating IDDM is comparatively rare, probably around 2–3% in unselected cases with proteinuria and duration of diabetes of more than 10 years. Some reports have shown an impressively high prevalence of GN in NIDDM. The widely diverging results of the reports indicate, however, that something must have gone wrong. We have recently analysed 10 renal biopsy studies (including our own) specifically dealing with NIDDM [3,4,14–21]. The rates of GN in these series vary between 0 and 66% and other complicating renal diseases were reported to be present in between 0 and 20%. These diverging results can of course be due to selection criteria (only one was a population based cross-sectional study [15]) or geographical differences, but the criteria for diagnosis of GN and interobserver variation in the pathologists interpretation of structural lesions may also be responsible. As most types of glomerulonephritis are due to deposition of antibodies in the glomerular capillary walls or the mesangium, immunohistochemical investigation will often, together with the LM characteristics of the glomerular lesions, provide an unambigous diagnosis. This applies to the most common GN form, IgA nephropathy, as well as several other such as membranous GN, membranoproliferative GN, postinfectious, complex mediated GN, and GN associated with systemic lupus erythematosus. GN in systemic vasculitis may be without immune deposits, but the LM picture (crescentic or focal, segmental proliferative GN) is easily distinguished from the lesions seen in diabetes. While the identification of these types in the reports of complicating renal disease in NIDDM must be regarded as unproblematic, this is certainly not the case for two other types: mesangial proliferative GN and minimal change disease. There is therefore reason to discuss these entities specifically. This is a descriptive term indicating diseases with increased mesangial cell number (more than three mesangial cells per mesangial region in at least 80% of all glomeruli). This light microscopical picture (as defined by a WHO committee [22]) can be seen in several types of GN such as IgA nephropathy, in the resolution phase of postinfectious GN, in some cases of GN associated with SLE etc. These types have all heavy immune deposits and their composition (immunoglobulin classes) pattern and location makes them easy to distinguish from diabetic glomerulopathy. There is, however, a comparatively rare mesangioproliferative GN without immune deposits. We meet two problems with this type if it is detected in a patient with diabetes. One is that mesangial hypercellularity (as discussed above) may be a feature of diabetic glomerulopathy, at least in some stages of its development. The other is that the usual evaluation of mesangial cell number is subjective, and as such dubious, especially in cases with only weak or moderate increase of the number of cells. A biopsy diagnosis in a diabetic patient of slight or moderate mesangioproliferative GN without immune deposits must therefore be regarded as questionable. This term indicates, according to the WHO classification of glomerular disease [22], conditions with normal glomerular structure or minor glomerular abnormalities such as slight mesangial hypercellularity. Clinically it comprises minimal change nephrotic syndrome as well as mild or moderate persistent isolated proteinuria. Significant immune deposits detected by immune histochemistry or on EM are not present. Podocyte foot processes are more or less effaced, but this is unspecific and can be seen in all renal diseases with proteinuria [23]. The pathogenesis is unknown. The application of this diagnosis in a patient with DM presents serious problems. Normal glomeruli by LM and no deposits by immunofluorescence or electron microscopy is completely compatible with early diabetic glomerulopathy with slight or even moderate albuminuria. On the other hand, patients suffering from DM may of course also be affected by other glomerular diseases, possibly even with a higher incidence that the non-diabetic population. Among these complicating conditions are the `classical', well defined glomerular immune disorders mentioned above, but also the less well characterized renal diseases collected under the term minimal change nephropathy. To this may be added that it is well known that a collection of biopsies with normal glomeruli may comprise cases of the more serious renal disease, focal, segmental glomerulosclerosis and hyalinosis, due to missing representation of the abnormal glomeruli in a biopsy with a restricted number of glomeruli. The correct diagnosis may in such cases be made in a later biopsy from the patient. It will be clear from the above discussion that it is hazardous to make the diagnosis of glomerulonephritis based upon light microscopy alone, especially in the situation dealt with here. This may underestimate the prevalence of GN in DM [24], but probably also overestimate if slight or moderate mesangial hypercellularity alone is used as a criterium. Immunofluorescence microscopy should always be added to the investigation of such cases, and optimally also EM. The clinical context is of course also significant. If it is strongly different from diabetic nephropathy, for example, if nephrotic syndrome appears suddenly early in the course of the diabetic disease, the diagnosis of minimal change nephrotic syndrome becomes convincing. Haematuria, which is not characteristic for diabetic nephropathy may indicate GN. In the ten reports discussed above, many other renal diseases than GN was found, among these amyloidosis and myeloma which can also involve glomeruli. In amyloidosis there is deposition of the abnormal protein in the mesangial matrix and along the capillary walls. The morphology is usually different from diffuse and nodular diabetic glomerulopathy, but nodules may nevertheless be seen. Mesangial nodules can also be seen in myeloma and related dysproteinaemias [25]. The conclusion from these considerations must be the following. If a patient suffering from DM develops clinical nephropathy (proteinuria) there may logically be three reasons. Diabetic glomerulopathy may be in progress, non-diabetic renal disease alone may be responsible for the nephropathy, or both may be present. Non-diabetic nephropathy is most often glomerulonephritis, but also other renal diseases, not related to the diabetic disease (amyloidosis etc). A renal biopsy studied by light microscopy and immune fluoroscence may provide the key to correct diagnosis, either presenting characteristic diabetic glomerulopathy alone or unequivocal GN with glomerular immune deposits. There are, however, situations where a biopsy cannot lead to a reliable diagnosis. Renal diseases associated with normal glomerular structure (minimal change nephropathy) or with slight or moderate alterations which cannot with certainty be differentiated from diabetic renal disease in early stages (mesangial proliferative GN without immune deposits) may of course also occur in diabetics and proteinuria may be related to one of these diseases. Such a patient may belong to the category which never develop diabetic renal disease or he or she may have diabetic glomerulopathy at an early stage where there is proteinuria but no structural changes on LM. Even if the biopsy is investigated with EM the situation is not necessarily unambigous: slight or moderate thickening of the glomerular basement membrane or mesangial matrix may be present in patients with longstanding diabetes without proteinuria. We have expressed the opinion that complicating GN in NIDDM is present in about 10% [14], other investigators have reported 25% [15] or even more. Actually it may be impossible at the moment to gain reliable knowledge of the prevalence due to the problems discussed above. The group of patients with DM and normal glomeruli or slight or moderate mesangial proliferation should be investigated carefully in order to solve this important problem.
Allen J. Lockyer, Kevin H. Alt, Daniel P. Coughlin, Michael D. Durham · 7 authors
Documented herein is a review of progress for the recently completed 'Smart Skin Structure Technology Demonstration' (S<SUP>3</SUP>TD) contract number F33615-93-C-3200 performed by Northrop Grumman Corporation, Hawthorne, California and TRW/ASD, Rancho Bernardo, San Diego, California under the Air Force Research Laboratory, Flight Dynamics Directorate, Structures Division's direction and sponsorship. S<SUP>3</SUP>TD was conceived as the first serious attempt, to made a complex antenna become a bone fide aircraft structural panel, without loss of overall structural integrity or electrical performance. The program successfully demonstrated the design, fabrication, and structural validation of a load bearing multifunction antenna component panel subjected to realistic aircraft flight load conditions. The final demonstration article was a structurally effective 36 by 36 inch curved multifunction antenna component panel that withstood running loads of 4,000 pounds per inch, and principal strain levels of 4,700 microstrain. Testing the structural component to ultimate, the panel failed at the predicted limit of 148 kips equating to 150 percent design limit load, after successfully completing one lifetime of fatigue. The load conditions were representative of a mid-fuselage F-18 class fighter component panel installation. The panel was designed not to buckle at ultimate failure, and the dominant failure mode was face sheet pull off, as predicted. Structural test data correlated closely with analysis. Wide band electrical performance for the component antenna panel was validated using anechoic chamber measurements and near field probing techniques, covering avionics communication navigation and identification and electronic warfare functions in the 0.15 to 2.2 GHz frequency regimes.
This paper discusses a general equilibrium model of an economy with multiple separately provided public projects. We assume an additively separable cost structure and consider valuation equilibria with separated finance systems, one for each collective good. Under non‐Euclidean representation we show the decentralization of Pareto efficient allocations by valuation equilibria and the equivalence of the core and the set of nonnegative valuation equilibria. In the case of Euclidean representation, every Pareto efficient allocation is shown to be supported as an affine valuation equilibrium that is characterized by a personalized price per unit of each public good and a personalized lump sum tax or subsidy. These results complement and clarify already established insights into Lindahl pricing and its generalizations developed in the literature.
A specialist on Russian politics and society examines the apparent success of economic and political liberalism in Novgorod oblast' in the 1990s. The article is based on published and unpublished documentary sources from the region, as well as in-depth, repeated interviews with local officials during 1997-1999. Focus is on progress in economic reform, finance, and foreign investment, forms of political decentralization and representation, the growth civic associations, and styles of political leadership. Several explanations for these outcomes are proposed and discussed.
Adoption of decentralized energy technologies will be crucial in the evolving structure of energy markets and the magnitude of future greenhouse gas emissions. This detailed analysis of the adoption of engine cogeneration gives insights into organizational decision making regarding the diffusion of a cost effective decentralized energy technology. Detailed site information on over 600 UK cogeneration installations was collected and analyzed for the six year period during which UK energy markets were in the process of deregulation. A detailed examination using standard investment criteria of the cogeneration schemes indicated that over 70% of investments were of questionable economic value to adopters. This was because these installations were below the calculated minimum economic size threshold. A key determinant of this size threshold was found to be the fixed costs of maintenance. Analysis of the financing of installations revealed that the largest fraction of poor investments occurred in energy services agreements between suppliers and adopters. The policy implications for decentralized energy technologies of a minimum size threshold and poor investment decisions by early adopters are discussed. Further research aims to explore postulated explanations for the observed decline in early adoption of UK engine cogeneration.
OBJECTIVE: Previous economic analyses of tuberculosis control interventions have focused on the provider perspective. To assess the overall economic impact of the disease and the adequacy of current control strategies from a societal viewpoint, the determination of direct and indirect patient costs is required. SETTING AND DESIGN: In a cross-sectional survey, all adult tuberculosis patients who completed treatment between August 1996 and February 1997 at 16 randomly selected government health care facilities in Thailand (n = 673) were interviewed using a structured questionnaire. Information were obtained on direct and indirect patient costs before and after diagnosis, and on financing methods and changes in household consumption patterns. All results were stratified for three levels of patient household income: above national average, below national average but above the poverty line, and below the poverty line. RESULTS: Illness-related costs particularly affected patients with incomes below the poverty line (n = 153). In this group, average out-of-pocket expenditures for the disease amounted to more than 15% of annual household income, while incomes were reduced by 5 % due to illness-related effects. Expenditures were most frequently financed from household savings or transfer payments from community members and relatives. However, 11.8% of patient households took out bank loans, and 15.9% sold part of their property. CONCLUSION: The current low case detection and treatment completion rates for tuberculosis patients in Thailand may partly be due to the inability of poor patients to cope with the economic consequences of diagnosis and treatment. Suggested improvements include the strict enforcement of an existing government policy of free care, the further decentralization of services to reduce travel costs and work absences, and social security payments for patients undergoing treatment.
Over the past decade, the multilateral development community' has espoused the fiscal and administrative decentralization of the social sectors and often specifically of primary and secondary schooling (e.g., see IDB, 1994: 194; Dillinger, 1995). Although nearly every country in Latin America has undertaken some form of educational decentralization, very little is known about the attributes of such policies. They often go hand in hand with a call for increased parental and community involvement (see Dimmock, Donoghue, and Robb, 1996) that has come both from the top down (e.g., from the multilateral community) and from the bottom up (e.g., from grassroots organizations and nongovernmental organizations [NGOs]). Since 1993, Nicaragua has set in motion one of the most radical educational decentralization experiments in Latin America. Its autonomous schools program implements a system of school-based management with local school-site councils that have a voting majority of parents and allocate resources that derive in part from fees charged to parents. Nowhere in Latin America have parents officially been given so much responsibility, and nowhere have they been asked to provide directly such a large proportion of school resources. The confluence of transferring responsibilities to schoolsite councils and the charging of fees is not coincidental. Both derive from social movements solidly within the so-called neoliberal reform model
Before the Revolution, tax-collecting was a very profitable private business. Using fiscal receipts, tax-collectors lent money to the Crown, instead of giving it without delay, so the State paid interest on public funds. To accelerate the receipts of the Royal Treasury and to diminish the interest paid by the King, in 1716 the French government introduced a reform based on a key technical innovation: double-entry bookkeeping was used to control tax-collectors' activities. The experiment was gradually extended to the various branches of the royal finances, but the scope provided by the new system for more effective supervision rapidly met with the hostility of the financiers. These attempts to rationalize public finance were interrupted in 1726 and the four Paris brothers who were the promoters of the reforms were distanced from royal finances. After relating these events, this paper tries to measure their significance. The interest of this accounting change goes further than the technical aspects, because it was linked with a fundamental organizational change. The Paris brothers attempted to replace a set of decentralized contractual relations with a centralized bureaucratic administration, conceiving of accounting as a sophisticated instrument of supervision, able to modify the behaviour of the financiers. This experiment can be seen as an eighteenth-century example of what Foucault referred to as the emergence of disciplinary technologies. It was the product of the ambition for scientific government, such as was to be found throughout Europe during the Enlightenment, and the Paris brothers' manuscripts may be ranked among the first manifestations of a literature which was soon termed the 'science of administration'.
Bolivia has made tremendous progress in macroeconomic stabilization and in structural reforms. This Public Expenditure Review concentrates on three things: a) an evaluation of the budget as a whole; b) institutional issues in decentralization, domestic resource mobilization and external financing; and c) sector-thematic coverage of education, health, roads, and water & sanitation, and the most pressing generic issues in the public sector. The report discusses the following findings: there is a pervasive lack of operational and maintenance funds across the public sector; expenditures in education compare favorably internationally; roads pose a formidable challenge; and the budget process is too cumbersome. It also makes several recommendations for Bolivia, including: improve the non-pension fiscal balance; prepare a soft landing for the expected reduced access to concessional external financing; follow IMF ESAF fiscal deficit targets; increase tax collection efficiency; replace the RC-IVA with a simple, broad based income tax; human resource structural changes are needed; increase health expenditures while scrutinizing and removing the War of El Chaco Veterans' payments from the health budget; no public subsidies should be given to ameliorate the increase in water tariffs in Cochabamba; and the focus of decentralization should now shift to increase efficiency and equity impact of public expenditures.
Complex organizations exhibit surprising, nonlinear behavior. Although organization scientists have studied complex organizations for many years, a developing set of conceptual and computational tools makes possible new approaches to modeling nonlinear interactions within and between organizations. Complex adaptive system models represent a genuinely new way of simplifying the complex. They are characterized by four key elements: agents with schemata, self-organizing networks sustained by importing energy, coevolution to the edge of chaos, and system evolution based on recombination. New types of models that incorporate these elements will push organization science forward by merging empirical observation with computational agent-based simulation. Applying complex adaptive systems models to strategic management leads to an emphasis on building systems that can rapidly evolve effective adaptive solutions. Strategic direction of complex organizations consists of establishing and modifying environments within which effective, improvised, self-organized solutions can evolve. Managers influence strategic behavior by altering the fitness landscape for local agents and reconfiguring the organizational architecture within which agents adapt.
AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund.
Fiscal Decentralization is a popular economic development strategy among transition and developing countries. This article reviews the advantages of fiscal decentralization in a theoretical context, but critiques the relevance of the standard theory of federalism as it applies to emerging economies. It is argued that the macroeconomic benefits of fiscal centralization, the absence of good instruments of local government finance, and the centralist politics that characterize most low income countries have been strong enough to hold back increased emphasis on local government finance.