This paper is about the “long fought for” self-autonomy in Muslim Mindanao as conceived in the peace agreement between the government and the Muslim organization and the prospect of federalizing the ARMM to achieve good governance and quality public service. The realization of self-autonomy can be actualized through federalization or the creation of the BangsaMoro federal state. Given the prevailing conditions of the ARMM as an autonomous region, is federalization politically viable? The focused area of examination is the ARMM specifically its political structure. Also considered in the analysis is the political culture like how patronage politics affects certain aspects of fiscal governance of the ARMM and its repercussion to the delivery of basic services to the people. The methodology used in this study is basically a single-country or area studies which is extrapolative for informational purposes but are also useful for comparison. It is also considered a case study where the unit of analysis is a specific region - in this study the ARMM region which is said to be a test case for the potential of federalism. The most significant outcome of this study is that federalism is politically viable in the ARMM in terms of its political structure of decentralization arguing from Brillantes Model that the next viable step to decentralization is federalization. However, there is much to be desired in actualizing decentralization and the need to enhance governance capabilities through accountability of public officials and transparency as well as providing solutions to the serious problem of patronage politics in the region.
Functional decentralization is aimed at increasing the efficiency, effectiveness and quality of public services, among other advantages, by simplifying the organizational structure and by achieving greater proximity to the end user. Nonetheless, the creation of these entities has been criticized because of the potential to make political use of them to avoid the debt limits imposed on sub-national administrations, as debt would then be transferred to the accounting statements of these agencies. The empirical evidence found in the current study shows that the use of these companies as a mechanism for obtaining external financing is determined by the accounting regulations applicable in relation to the consolidation of accounts. Decentralization processes oriented toward increasing debt are more common among left-wing local governments and are strongly linked to fiscal pressure. Points for practitioners Our results show that foundations are now displacing public companies in decentralization processes in order to obtain external funds, since these agencies are not included in the consolidated accounts. Thus, more rigorous regulation should be established in Spain. This opportunistic use of decentralized agencies is developed on the whole by left-leaning political ideologies as a means of incurring more debt that they need. Thus, it is necessary that external auditing offices ( Cámaras de Cuentas) reinforce the monitoring process over local governments in order to circumvent their managerial discretion.
Bitcoin is a digital currency that was launched in 2009, and it has attracted much attention recently. This article reviews the mechanics of the currency and offers some thoughts on its characteristics.
The general purpose of this study is to thoroughly examine decentralization in education according to the literature and previous research, and to discuss the applicability of educational decentralization practices in Turkey. The literature was reviewed for the study and findings reported. It has been observed that decentralization in education practices were realized in many countries after the 1980’s. It is obvious that the educational system in Turkey has difficulty in meeting the needs, and encounters many problems due to its present centralist state. Educational decentralization can provide effective solutions for stakeholder engagement, educational financing and for problems in decision making and operation within the education system. However, the present state of local governments, the legal framework, geographical, cultural and social features indicate that Turkey’s conditions are not ready for decentralization in education. A decentralization model realized in the long run according to Turkey’s conditions, and as a result of a social consensus, can help resolve the problems of the Turkish education system.
Simone Fatichi, Sebastian Leuzinger, Christian Körner
Knowledge of future terrestrial carbon (C) pools and fluxes is based on simulations by Dynamic Global Vegetation Models (DGVMs; Cox et al., 2000; Sitch et al., 2008). For simplicity we used the DGVMs acronym to include all of the models able to simulate C and vegetation dynamics at large spatial scales, which are sometimes referred to as Terrestrial Biosphere Models, Terrestrial Ecosystem Models, vegetation components of Earth System Models, and Land Ecosystem Models. DGVMs are now typically coupled to climate models to account for biophysical and biogeochemical feedback caused by vegetation (Bonan, 2008; Chapin et al., 2008; Anderson et al., 2011). The ultimate aim is to simulate climate–vegetation dynamics that explicitly account for mutual interactions and thus provide us with a better spatiotemporal description of water fluxes together with the most realistic scenarios for the future climate and C cycle (Friedlingstein et al., 2006; Thornton et al., 2007; Bonan et al., 2011). Current DGVMs are simulating long-term tree and forest stand growth as a consequence of the amount of assimilated C, triggering an inevitable positive feedback between C assimilation and growth. The key factors affecting stomatal aperture and C assimilation are atmospheric CO2 concentration, water availability, light, vapor pressure deficit and temperature (Sellers et al., 1997; Lawson et al., 2011). However, direct control of C sinks (defined as growth in the sense of C investment on plant tissue expansion) via environmental factors has been shown to be more important than indirect control via photosynthesis (the C source, see Fig. 1). For example, water- or temperature-limited plants tend to reduce growth but increase C storage (Körner, 2003; Sala & Hoch, 2009; Woodruff & Meinzer, 2011; Sala et al., 2012), which suggests that environmental controls act first on sink activity rather than source activity (Körner, 2013). Nevertheless, in all existing DGVMs, plant growth is driven by photosynthesis directly without considering water and thermal limitations via metabolic, cambial and meristematic activity (blue arrows in Fig. 1; Bonan et al., 2003; Sitch et al., 2003; Krinner et al., 2005). The entire photosynthesized net C (the source) is then partitioned among different C pools, mostly based on allometric rules derived from observations (Poorter et al., 2012) or using simplified functional allocation schemes (Friedlingstein et al., 1998; Franklin et al., 2012). Allocation to carbohydrate reserves, root exudates and export to symbionts are mostly missing. This opens up a huge discrepancy between the way plant growth is modeled today (blue arrows in Fig. 1) and the way it is understood based on experimental evidence (red arrows in Fig. 1). In this article, we suggest a revised hierarchy of plant growth control by removing the causal link from C assimilation to plant growth and by providing a description of the mechanistic connections among processes. Available soil water, temperature, nutrients, light, and CO2 are indisputably the key drivers of plant growth (Boisvenue & Running, 2006; McMurtrie et al., 2008; Ågren et al., 2012; Fig. 1). The former three (water, temperature, and nutrients) are fundamentally different from the latter two (light and CO2) because they can affect both sink and source activities, while light and CO2 only affect the source activity (C assimilation, Fig. 1). In this section, we compare the hierarchy of such limitations based on experimental evidence, which will lead into the discussion of strategies for modeling plant growth. When water limitations occur, there is evidence that cambial and leaf growth are inhibited at much lower levels of water stress (higher water potentials) than photosynthesis (Fig. 2; Boyer, 1970; Hsiao, 1973; Hsiao et al., 1976; Muller et al., 2011; Tardieu et al., 2011). Because organ expansion is affected earlier and more intensively than photosynthesis, plants experiencing soil water deficit often accumulate nonstructural carbohydrates (NSC) and reduce growth (Würth et al., 2005; Woodruff & Meinzer, 2011). Drought stressed or more apical parts of trees show lower xylem- or leaf-water potential than well-watered or more basal parts. This decrease in xylem- or leaf-water potential implies a reduction in cell turgor and in the capacity to transport sugars (Woodruff et al., 2004; Sala et al., 2011; Woodruff & Meinzer, 2011). Specifically, lower cell turgor has the potential to limit cell wall expansion, cell wall synthesis and protein synthesis (Lockhart, 1965; Hsiao, 1973; Sala et al., 2011). This means that C assimilation continues while sink activity (tissue growth) is inhibited, which most likely explains the accumulation of NSC in stressed plants (Körner, 2003). For example, Sala & Hoch (2009) showed that in Pinus ponderosa, mobile C compounds increase with increasing tree height. The possibility of plants actively prioritizing storage over growth allows additional interpretations of the role of accumulating NSC, for example, to maintain the integrity of the hydraulic system (Sala et al., 2012) or for signaling purposes (Rolland et al., 2006). However, recent evidence seems to support that when hydraulic transport is not affected, NSC is significantly depleted as a consequence of C demand (Hartmann et al., 2013; Sevanto et al., 2013). Exacerbation of these mechanisms (low turgor and incapability to transport sugars) also seems to play an important role in tree mortality and therefore long-term forest dynamics (McDowell, 2011; McDowell et al., 2011). Inhibition of sink activity via low water potentials and the resulting accumulation of photo-assimilates in leaves can also lead to direct feedback, that is downregulating photosynthesis (Paul & Foyer, 2001; Nikinmaa et al., 2013), which demonstrates a direct control of photosynthesis via growth (red horizontal arrow in Fig. 1). Similarly to water stressed plants, temperature-limited plants such as trees at the treeline and winter crops are typically limited by sink activity (tissue expansion) earlier than by source activity (C assimilation; Fig. 1; Körner, 2012). Consequently, cold-limited plants show an increase rather than a decrease in NSC with colder temperatures (Körner, 2008; Fajardo et al., 2012; Hoch & Körner, 2012). Temperature influences several metabolic processes (e.g. cell doubling time), determining the potential growth rate of organs in the absence of other growth limiting factors (Pantin et al., 2012). Most temperature-controlled processes of plant growth have been summarized by Boltzmann–Arrhenius type equations, which describe a decrease in growth rates at sub-optimal and supra-optimal temperatures (Parent et al., 2010). Furthermore, a 5–6°C threshold has often been identified to limit growth in cold adapted species, irrespective of photosynthetic activity which typically ceases only at freezing point (Körner, 2008). Nutrient limitation is well known to exert a negative feedback on photosynthesis via the amount of fundamental enzymes needed for C assimilation that can be produced. The amount of synthesized Rubisco, for example, is strongly controlled by nitrogen availability (Kattge et al., 2009). However, nutrients also act as direct plant growth control due to the relatively constant stoichiometry of plant tissue composition (Sterner et al., 2002; Leuzinger & Hättenschwiler, 2013). This has emerged clearly from FACE experiments where progressive nitrogen limitation (Luo et al., 2004) has been demonstrated to limit plant growth (Norby et al., 2010). While plants have the capacity to recruit additional nutrients by expanding their root system and via mycorrhizal symbioses, nutrient limitations are likely to progressively emerge at the landscape scale. Importantly, no study has been able to clearly quantify nutrient limitation acting on sink (tissue growth) vs source activity (C assimilation). Light as well as atmospheric CO2 clearly limit photosynthesis (the source), and unlike the previous factors discussed, they do not affect the C sinks directly. Therefore, the question here is whether (and if yes, when) the effect of CO2 and light is limiting sink activity (growth) via source activity (blue arrows from source to sink activity via the tree in Fig. 1). In other words, is plant growth C limited and under what conditions? Arguments in favor of C limitation of plant growth are either based on young seedlings and saplings in the forest understory or on individual leaves in dense canopies that are almost always operating below light saturation (Turner, 2001; Lloyd & Farquhar, 2008). Accordingly, CO2 was found to have a stimulatory effect on growth of plants in the understory (Würth et al., 1998; Hättenschwiler & Körner, 2000). Lloyd & Farquhar (2008) inferred that growth of tropical forests is C limited using the relationship between growth and photosynthesis: Np = Gp[1 − φ] where Np is net primary production (new growth), Gp is the average rate of photosynthesis, and φ is the proportion of assimilated C lost via total respiration plus volatile organic C emissions and root C exudation. They argue that higher Gp as a consequence of increasing CO2 concentration or incoming light necessarily leads to enhanced growth. However, we propose that this equation should generally read Np = Gp(Np)[1 − φ(Gp(Np))], thus not be interpreted as a direct causal link between photosynthesis and growth, because φ is a function of Gp, and Np can feedback on photosynthesis, that is, Gp = f(Np). Rewritten in these terms the equation is highly nonlinear and an increase in Gp does not imply a proportional increase in growth. Leaf level light responses of seedling and single leaves are difficult to extrapolate to the forest level, because this would imply that a forest stand behaves like a single leaf or shadowed tree. Light and consequently CO2 limitations of individual leaves, saplings or trees are not a demonstration that the entire forest community operates below its CO2 uptake capacity and even less that C acquisition is limiting forest growth (Körner, 2009; Clark et al., 2013). The Leaf Area Index (LAI) in several ecosystems (e.g. tropical forest, alpine grassland) may be higher than needed to sustain maximal productivity (Amiro et al., 2010; Gough et al., 2013; S. Fatichi, M. J. Zeeman, J. Fuhrer & P. Burlando, unpublished). Many studies suggest that partial (moderate) defoliation hardly affects tree growth or forest productivity (Ericsson et al., 1985; Hoogesteger & Karlsson, 1992; Reich et al., 1993; Kaitaniemi et al., 1999; Volin et al., 2002). A larger than necessary LAI typically has evolutionary rather than physiological reasons: to shade competing neighbors and thus limit their performance; as insurance against herbivory and storm damage; and as an additional option to store nutrients (especially in evergreen trees). Therefore, while light and CO2 may limit growth at the leaf or plant level, they unlikely do so at the landscape (whole forest) level and in the longer term (Leuzinger & Hättenschwiler, 2013). Short-term benefits of extra light (Graham et al., 2003) or elevated CO2 (Norby & Zak, 2011) can only be sustained to the extent a higher growth rate is supported by higher nutrient availability. Current atmospheric CO2 concentration (close to 400 ppm) additionally represents a rather exceptional forcing in the evolutionary context, with the current species having evolved in CO2 concentrations between 180 and 290 ppm (Siegenthaler et al., 2005; Lüthi et al., 2008). This suggests that C availability is at least less limiting nowadays (Körner, 2006). Accordingly, CO2 enrichment experiments with closed forest canopies did not show a sustained stimulation of growth by elevated CO2, except under high nutrient availability (Finzi et al., 2007; Norby et al., 2010; Bader et al., 2013; Sigurdsson et al., 2013). The differential sensitivity of C source and sink activities to water, temperature, and nutrient controls could lead to an imbalance between C supplied by photosynthesis and C used for tissue growth and respiratory costs. A mismatch between these two quantities would be sub-optimal and create a long-term surplus of assimilated C. In normal conditions, this situation is avoided through at least three mechanisms. First, in the short term, acclimation of photosynthesis occurs through negative feedback given by accumulation of starch or higher concentration of sucrose at the leaf level (Paul & Foyer, 2001). However, such a strategy would not be very effective to counteract mid/long-term source–sink imbalance. Second, therefore, in the mid-term, plants use sophisticated mechanisms of C storage at the leaf and whole plant level through accumulation and depletion of NSC (Kozlowski, 1992; Hoch et al., 2003; Gough et al., 2009; Richardson et al., 2013). Fluctuations of NSC are expected to buffer the difference between C supply and demand for timescales from hours to a few years. NSC dynamics are likely to be actively controlled by plants rather than a pure passive deposit of C (Sala et al., 2012). Third, in the long-term, evolutionary processes likely fine-tuned the photosynthesis apparatus (C source) to match long-term investment capacity (C sinks), which is the first to be controlled by environmental limitations. This of source–sink can be summarized as controls (Körner, and the between sinks and which is likely for the hierarchy of controls in the enrichment experiments as well as of water or temperature limitations have the possibility to the between C and For an increase of NSC is typically found in CO2 enrichment Furthermore, atmospheric CO2 almost always enhanced photosynthesis with or no et al., 2005; Bader et al., 2010). However, this typically does not into enhanced growth, in the term and for forests (Leuzinger et al., 2011; Norby & Zak, 2011; Bader et al., 2013). Because the C has to be this imbalance has several the of the & 2013). the extra C is and et al., 2006). Therefore, the of the extra C in CO2 experiments is to root exudates and export to et al., 2012). C assimilation respiration because of the larger and and thus transport respiration & 2000). if root is as a et al., a larger concentration in would more exudates due to the concentration the nutrient limitation through under elevated CO2 et al., 1993; Hättenschwiler & Körner, The use of experiments (e.g. with elevated CO2) is to the C source–sink and therefore the drivers of plant growth, under different environmental there is evidence that tissue growth is mostly under direct control of environmental rather than via the of assimilated C (Fig. and arrows in Fig. which for a of the hierarchy of plant growth control in This implies a from the current C source driven to where C sinks are the Because processes shown in Fig. are strongly and by it is to with either in the short For example, production will decrease with whether the is on growth or whether temperature assimilation and thus growth. However, the processes are fundamentally argue that if these processes and the are not it is unlikely DGVMs will simulate future C storage except under when photosynthesis may as shown in a in Fig. Furthermore, forest and composition are likely to feedback on C assimilation, they will also in long-term C the role of temperature and plant water in growth, of the existing DGVMs we are of include such a even in a simplified or et al., et al., 1997; et al., 2001; Bonan et al., 2003; Sitch et al., 2003; Krinner et al., 2005; et al., 2007; et al., 2009; Clark et al., 2011; et al., 2013; et al., 2013). the of the potential role of nutrients in limiting C from ecosystems et al., nitrogen and more have been in DGVMs et al., 2006; & 2008; & 2010; et al., 2012). However, all these models thermal and water limitations only in to C assimilation but not in to cambial or meristematic The of DGVMs also the that C processes such as photosynthesis (e.g. leaf are while processes of plant growth such as the rate of cell cell expansion, transport or cambial growth (C sink are much to quantify at high (Körner, 2013), even and to a source of et al., 2006; et al., 2013; & 2013). The of C fluxes and the between C and water through stomatal mostly to the of models and of and photosynthesis fluxes (Sellers et al., rather than plant growth. models that et al., to up the of DGVMs, and while they C assimilation, they in plant growth control that is based on observations in controlled but supported by observations in a the key of DGVMs and are almost to of the photosynthesis as for by et Fig. see also Bonan et al., 2012). short few from such DGVMs are typically by C fluxes derived from et al., 2006; et al., However, such only C and not plant growth that is they at show a over a given DGVMs are used to future from C pools and in models may lead us to a because of the Fig. that in models allocation can be controlled to extent by nutrients and environmental For water and light availability can control the differential C allocation to and (Friedlingstein et al., 1998; Krinner et al., 2005). However, this is rather different from having environmental directly control growth because the assimilated C is necessarily to C export to symbionts are mostly and mobile C are only in a of models in a simplified et al., 2005; et al., 2008; & 2010; et al., 2012; et al., 2012; et al., 2013). Therefore, C assimilation is typically to growth, which evidence that between assimilation and growth et al., 2006; Gough et al., 2009; Richardson et al., 2013). This also implies that if more C is assimilated in a under of elevated atmospheric CO2) the vegetation will more with positive feedback to C assimilation through which us with the for the way is to to the existing of DGVMs by direct growth control based on environmental drivers (Leuzinger et al., 2013; see also Fig. we tissue is controlled by environmental the amount of C to be to growth at a given should be of the amount of assimilated C. growth is by the limiting the of all other factors water, and nutrient are this with the that is the C source However, we argue that this is and only under such as in a a modeling the of or of species or plant functional type growth responses to environmental controls (water, temperature, This does not to the current of the could be but no longer the amount of C used for growth. The needed for such will a large of experimental A more to DGVMs on a more realistic of C models that simulate C and water fluxes the nutrient allocation to and from nonstructural C storage and to and root (Fig. This in its was in studies and more have been in models that et al., 2005; et al., 2010; et al., 2012) simulate transport et al., 2002; et al., as well as fluxes and cell growth activities & 2010; et al., 2010). This in the most components where C and water fluxes and are the plant between and in the (Fig. modeling of C assimilation and 1) is in most DGVMs et al., 2011). However, in the water and assimilated C are by leaf water and C and are to buffer the of C assimilation, an almost constant of sucrose to the at the & growth and can be explicitly modeled as a function of cell wall and protein and cell the that nutrients and C are is driven by cell turgor a threshold (Lockhart, which for water limitation to growth. cell typically a Boltzmann–Arrhenius function of temperature (Parent et al., with a temperature most for growth, which represents the thermal limitation to growth. When these two controls are plant growth can be A given by the of water potential and pressure that in also on sucrose concentration, is turgor In to for and et al., can be used for and transport and This will create a coupled system where and in and in and tissue (e.g. are The C is modeled as the of carbohydrates in the and by the of storage This C is then for growth, and for root and export to growth control by nutrients can also be in such a because nutrient through root uptake or can be explicitly and are up both via and actively through the of concentration et al., 2003; & 2012). C can be modeled as a et al., while modeling with is more and from understood which a in providing see While the mechanistic of for example, the leaf water and C or transport is relatively and can be into a of for the of C storage and sink as well as with to storage is a function of plant environmental and For at and C is from storage at the of the to support cambial activity and growth. also C their for example, leaves storage the is not and likely to with plant and plant stress (e.g. such of C allocation are not understood and the of Fig. will a spatial of C allocation with the more parts less C. a of the C sink is and the key for such a that a of the in Fig. is not given the limited we argue that current is for modeling most of the also that such components may to be in DGVMs and would a large of However, its can the for of environmental control of growth and of mechanistic C allocation schemes that could be into A where plant transport and tissue expansion are using well and among as was for photosynthesis is likely to way of modeling plant growth. a can also the of on plant C storage and sink which is fundamental for increasing and long-term scenarios for the C The of photosynthetic and the of mechanistic models of C assimilation that simulate observations have the of DGVMs, which have few over the identified 2006; et al., the of models mostly However, current physiological of tissue growth and expansion is in to it is in Current scenarios the between climate and vegetation are likely affected by a of plant growth and are therefore argue that direct environmental controls water and nutrient on tissue expansion and meristematic activity are fundamental than on the of C because they mostly limiting to plant growth photosynthesis Because C can only be to the extent other nutrients as well as water availability and temperature these drivers of growth will be over C assimilation This in of plant growth drivers has for the of terrestrial C fluxes and storage in the The of the in DGVMs will be but fundamental for future of the C In to this we two of different to growth in current DGVMs to growth limiting to mechanistic of plant transport and tissue expansion as was for photosynthesis While additional may be to of the we argue that there is evidence to the of the of current DGVMs, from to a plant growth. The three and the for on an earlier of this with are also
The purpose of this article is to compare systems of fiscal decentralization in EU member states according to selected quantitative criteria. The results indicate that a higher number of lower levels of government usually indicate a greater share of local finance; however, this finding does not confirm the inverse link. Although the structure of expenditures is similar, the shares of funds for the implementation of individual tasks differ significantly. On average, the countries allocate most funds to education, social security, healthcare, and administration, with only a quarter of the countries recording the same or higher amounts of revenues than expenditures. Most countries still cover the existing deficit through transfers from the central government, equalization schemes, or borrowed funds.
Since action for itself requires a particular content and a determinate end, whereas duty in the abstract contains nothing of the kind, the question arises: what is duty? For this definition [Bestimmung], all that is available so far is this: to do right, and to promote welfare, one’s own welfare and welfare in its universal determination, the welfare of others. (Hegel, 1991 [1821], 161, §134) Nothing in particular follows from general concepts of the right, the good, the just, or the virtuous; not even in bioethics. Even to sort useful information from noise, one must first specify a moral context within which to make decisions. Without particular content, morality cannot provide definitive guidance for choosing among different accounts of human flourishing or the proper ranking of virtues, much less how to proceed when the right and the good conflict.1 If morality is to be more than a mere formalism—for example, the empty repetition of rhetorical phrases, such as “respect patient autonomy” or “preserve human dignity”—then particular content must be specified to orient proper decision making.2 Among the challenges is that medicine is an applied science as well as a social endeavor. Medical science and the treatment of patients are always set within particular cultures and human interests. Consequently, the actual practice of health care involves an overlapping set of communities (scientific, moral, religious, and political) striving to understand and to manipulate the world in ways that humans find socially useful, morally appropriate, aesthetically pleasing, or otherwise fitting. As a result, medical reality and the expectations of clinical judgment are inevitably historically and culturally conditioned. In turn, such taken for granted background conditions impact our appreciation of moral obligations. This issue of The Journal of Medicine and Philosophy brings together three clusters of essays, focused in turn on research ethics, clinical ethics, and moral theory. Despite the array of topics, each author carefully explores core questions of bioethics: Which moral standard? Whose account of moral obligations ought to guide health care as both a theoretical and a practical endeavor? The first cluster of articles explores moral standards for guiding medical research. In medicine, one must abandon the assumption that accepted treatments are good simply because they are accepted. Instead, one must critically examine the standard of care together with new and innovative alternatives. Thorough scientific research together with robust scholarly debate is integral to reigning in the untutored human desire to ameliorate pain and suffering so that treatments do more benefit than harm. Moreover, it is difficult to know truly in medicine. Problems such as spontaneous remission and natural cures, physician remembrance of therapeutic triumphs more clearly than failures, the psychology of discovery, and the placebo effect distort judgments of a treatment’s effectiveness. At times and in various ways, patients, physicians, and scientists see what they anticipate. Medicine adds to these challenges the all too human urge to help those in need. Yet, as the history of medicine pays witness, many interventions do more harm than benefit. Human suffering caused by ill-founded but well meaning treatments has been significant. As Gelfand (2013), Meyerson (2013), and Potts et al. (2013) each make clear, rigorous scientific research and open scholarly debate are central to the advancement of medical practice and the protection of patients. Gelfand and Meyerson document, for example, the way in which clinical research with human subjects often involves a conflict between judgments regarding the proper treatment of patients and appropriate methods for obtaining good scientific data. Physicians who are both researchers and clinicians have competing professional interests, for example. The primary goal of clinicians is generally doing what is best for one’s patients within certain constraints, such as informed consent, the standard of care, and resource availability. Clinicians recommend treatments and interventions based on what they believe is in the best interests of particular patients. The primary goal of researchers, however, is the discovery of data to address research questions. The objective in a scientific inquiry is to follow an approved protocol to obtain data, to test research hypotheses or theoretical constructions, and to contribute to the base of scientific knowledge. Researchers are, however, constrained in how they may use subjects who may or may not benefit from the study design. Particular moral standards, such as “clinical equipoise,” the “precautionary principle,” and prohibitions against lying, are routinely identified as essential for fulfilling our duties to protect patients from unethical researcher conduct. Consider, for example, “clinical equipoise” which requires that clinician-researchers terminate a study when accumulated evidence so thoroughly supports one treatment arm that “the committee of investigators believe no open-minded clinician informed of the results would still favor” the other treatments being tested (Freedman, 1987, 145; cited in Gelfand, 2013, 593). Is clinical equipoise an adequate guide to appropriate ethical research on human subjects? Gelfand concludes that clinical equipoise is both morally and conceptually problematic. Morally, the difficulty is that clinical equipoise, if taken seriously, requires shutting down too many well-structured randomized clinical trials as unethical. Conceptually, the challenge lies in attempting to flesh out the ambiguous “open-minded clinician” standard. Although there is some disagreement concerning who should determine whether clinical equipoise exists, I will assume, as do most others, that this determination should be made by the physician-researcher conducting the randomized clinical trial. Presumably, the physician-researcher should begin this process by attributing knowledge of preliminary studies to these clinicians. In addition, she would have to assume that clinicians in her clinical community were aware of the general facts/theories/beliefs relevant to the clinical trial. Put differently, whether one will conclude that clinical equipoise exists depends, among other things, on what beliefs one attributes to members of the clinical community. (Gelfand, 2013, 594–95) Gelfand rightly notes that it is a very common psychological phenomenon to conclude that those who disagree with you “. . . are wrong or unaware of all the relevant facts or for some reason misunderstand the issue. Many of us often assume that if others truly understood the issues, they would agree with us” (2013, 595). Clinical equipoise, he argues, assumes that all “properly open-minded” clinicians who are informed regarding the research data would share the same background information, beliefs, standards for evaluation, and interpretation of results, as well as clinical or research goals. Having reasoned in such a fashion, however, once the physician-researcher conducting the trial concludes that clinical equipoise does not exist, he may terminate important clinical trials before adequate data can be collected. Researchers who disagree with such a conclusion may be easily ruled out as failing to be properly “open minded.” The “precautionary principle” raises related challenges. As with other human endeavors, medicine can become infatuated with the seemingly original and progressive. That technological or surgical innovations are new, however, guarantees neither superiority nor safety. The underlying rationale of the precautionary principle is to treat unproven scientific innovation with appropriate regulatory caution. When there is good reason to conclude that an innovation may cause serious harm, even though uncertainty exists regarding the probability or level of risk, the precautionary principle holds that regulatory action should proceed as if such innovation is in fact dangerous. Meyerson argues that the core difficulty with the precautionary principle is that it is unduly vague. Again, there is a need for the specification of a particular standard. All choices involve risk. How much risk and of what sort is morally acceptable? Taken too weakly, the precautionary principle offers almost no guidance: “. . . if all that is meant by the precautionary principle is that the absence of scientific certainty does not necessarily justify the refusal to regulate risky new technologies, then it is hard to see what is supposed to be distinctive about the guidance it offers” (Meyerson, 2013, 610). On the other hand, understood in a very strong manner, the principle rules out beneficial innovation: “At its strongest, the precautionary principle insists that potential benefits should be foregone unless it can be shown that they pose no risk at all. This is obviously an unacceptable position” (Sunstein, 2005; Meyerson, 2013, 610). Seeking to clarify a more moderate approach, Meyerson argues that there should be a general presumption in favor of restricting innovative technologies when they appear to pose a serious risk of harm. Proponents of the new technology, she concludes, bear the burden of proof to demonstrate the utility and relative safety of the innovation. Applied to the example of innovative surgical techniques, Meyerson argues that such a moderate approach helps to avoid the dangers that occur when surgeons are prone to bias in favor of new innovations, especially when they have a financial stake in the use of the invention, while also permitting advocates to demonstrate the safety and effectiveness of new technology. Discerning readers might at this point wish to raise the following questions: What are the risks of a bias in favor of the status quo? How should we assess the dangers of delaying innovation?3 What if, for example, scientific debate is stifled so as to preserve the status quo? In this issue, Potts et al. (2013) explore just such key concerns. For example, should researchers self censure scientific results that might undermine public confidence in medical judgment, such as the diagnosis of brain death? And, should professional journals refuse to publish articles that call into question current medical orthodoxy on such matters? Recent debate has brought brain-oriented criteria for determining death and donation after cardiac death policies into public scrutiny (see, e.g., Bernat, 2010; Iltis and Cherry, 2010; Khushf, 2010; Miller, Truog, and Brock, 2010; Shewmon, 2010; and Veatch, 2010). Some proponents of organ transplantation have argued that responsible scholarship requires refusing to publish any such results. As Potts et al. summarize: Some articles call for a closing of the debate over the criteria for death since such criteria are related to organ donation, and an ongoing debate about death criteria may negatively affect the public’s willingness to donate. They suggest allowing only ‘responsible scholarship’ in the area (according to which ‘irresponsible scholarship’ is considered to be critiquing brain-based criteria for death. . . . (2013, 626) Such debate, critics argue, creates unnecessary doubt among members of the public regarding the certainty of brain-oriented determinations of death and, consequently, for the appropriateness of procuring organs from donors who have been declared dead based on such criteria. To further complicate matters, institutional policy for determining that brain-based criteria for death has been satisfied may vary among institutions. Potts and his colleagues argue that without sustained and open debate, the harms caused by adherence to the status quo may never be adequately exposed. Is it morally appropriate to stifle or otherwise censor open-minded and scientific debate so as to further one’s preferred social goal, such as greater access to organ transplantation (or, perhaps, ever more government action on so-called human-caused global warming)? The next brace of essays turn the discussion to moral duties in clinical ethics. Mills (2013) and Reed (2013) focus on elements of procreative liberty, Stoyles and Costreie (2013) rethink voluntary euthanasia, whereas Cohen and Shapiro explore whether placebo treatment violates moral prohibitions against lying. To begin, Mills argues that reproductive liberty ought to be appreciated as a positive entitlement: “that is, a freedom to make oneself according to various ethical and aesthetic principles or values” (2013, 639). Mills contends that Michel Faucult’s analysis of the “practice of liberty” together with a naturalistic approach to rights entails at least limited positive claim rights in support of reproductive autonomy, “. . . one that requires that reproductive projects are promoted rather than simply honored, for example” (2013, 655). Reed in turn shifts our attention to an exploration of Plan B “emergency” contraception. Reed’s conceptual geography maps the moral location of emergency contraceptive pills relative to the ongoing abortion debates. He argues, for example, that “If we know that there are no postfertilization effects, then emergency contraception becomes morally similar to barrier methods: it prevents pregnancy without interfering with a fertilized egg” (2013, 670). However, insofar as Plan B contraception has a postimplantation effect, resulting in the abortion of a fetus, then abortion is an intended consequence of emergency contraception. As a result, abortion would not rightly be described as an unintended side effect of taking Plan B contraception; utilizing emergency contraception would be morally similar to other forms of early abortion. How should we appreciate reproductive liberty? And, which moral context applies to such choices? Sometimes to gain insight into the proper standards for clinical ethics, we must learn to see moral debates from new perspectives. The next two essays seek to reframe the bioethical debates regarding euthanasia and patient deception in terms of the “patient’s interests.” Stoyles and Costreie (2013) hold that the euthanasia debate has gone astray by emphasizing the importance of such distinctions as voluntary, involuntary, and nonvoluntary euthanasia. The question, they believe, is whether the practice of euthanasia accords with the “patient’s interests.” Insofar as euthanasia advances a patient’s interests, it ought to be appreciated as morally permissible. Similarly, Cohen and Shapiro conclude that while lying to patients is, all things considered, morally wrong, placebos are permissible precisely when they advance the patient’s interests in ways comparable to other forms of therapy. For example: Placebo analgesia refers to the reduction in pain following the administration of an otherwise inert substance, e.g., administering a starch pill (that does not directly alter pain physiology), which is believed by the subject to be an analgesic drug. The administration of a placebo is not inert, however, and its effects far from imaginary. Most strikingly, various findings show that placebo analgesia can under certain conditions mimic the actions of opiates on the opioidergic system, the most potent pain reducing system of the body. (2013, 699) An undue focus on deception, they argue, inappropriately skews the moral analysis. Insofar, as placebo treatment has an appropriate therapeutic effect comparable to other forms of therapy, it should not be morally ruled out. In each case, the authors challenge the reader’s perspective on such bioethical questions so as to assist us to see our moral duties anew. The final two essays take a conceptual step back from applied ethics, actively to engage moral theory. Sjöstrand et al. (2013) argue that preserving the value of patient autonomy may require medical paternalism, whereas Pamental (2013) explores the utility of pragmatism as a moral theory to guide bioethical decision making. On the one hand, Sjöstrand et al. (2013) hold that there are good reasons to support patient autonomy and to promote autonomy as a value in healthcare decision making. As a practical matter, however, sometimes weak forms of paternalism ought to be accepted to promote patient autonomy over the long term. Theoretical clarity regarding autonomy as a value is necessary, they argue, if we are to determine how best to respond to patient choices that appear to limit autonomy. If only capacity is valuable, paternalism is easily justified as soon as a patient acts or decides in a way that threatens her future autonomy. It seems strange to claim that autonomy is valuable, but that there is no value in actually having one’s autonomous decisions regarding important things in life respected. If exercise of autonomy is also valuable, paternalism for the sake of autonomy is less easily justified, since any infringement of a person’s exercise of her autonomy would be of direct negative value. (2013, 719–20) Pragmatism, on the other hand, Pamental argues, embraces the view that the role of philosophy is to change the world. Pragmatism is a form of what he terms “radical empiricism”: “At its heart, radical empiricism presupposes two things: first, that experience is more than simply phenomenological . . . [and second] experience can provide us with both the tools for making things better and the criteria for evaluating what better means” (2013, 728). Moreover, pragmatism is a form of moral contextualism: “. . . any feature of a situation is potentially morally significant, but that even generally accepted moral features are not always so” (2013, 737). As a result, moral principles are not absolutes; they are contingent and relative to the subjective interests of particular individuals, who themselves are situated within particular cultural and social backgrounds. It is this practical starting point, he argues, that both sets the moral context and directs moral inquiry in the clinical setting. What are our moral duties? In terms of which ranking of cardinal human goods and right-making conditions ought we to evaluate the moral significance of medical research on human subjects, reproductive liberty and abortion, organ transplantation, medical deception and euthanasia? As this issue of The Journal of Medicine and Philosophy makes clear, the field of bioethics faces a plurality of moral rationalities that are grounded in various rankings of cardinal values and right-making conditions, calculations of harms and benefits, claims to virtue or vice, as well as competing understandings of human flourishing. Different rankings and accounts of right-making conditions also presume divergent rules of moral evidence and valid moral inference. All such standards also appear to be deeply embedded within and conditioned by particular cultural and social circumstances (see, e.g., Cherry, 2012; Delkeskamp-Hayes, 2012; Engelhardt, 2012). Insofar, as all we have to work with are our and contingent subjective of itself to be once precisely on is the of all
Claudio Ronco, G. Mason, A. Nayak Karopadi, Ashlea Bennett Milburn · 5 authors
Today, health policy seems to be on the top of governments' agendas around the world. Healthcare systems are challenged by a number of phenomena happening on a global scale; these trends include demographic change in terms of an ageing population, an increase in chronic disease, patients having higher expectations on healthcare delivery and above all a major pressure on public finances to slow increasing healthcare expenditures. Such developments are forcing policy-makers to reform healthcare systems. First, there is a tendency towards decentralization of responsibilities. Second, governments are moving towards reimbursement schemes rewarding good outcomes and performance. Third, great importance is being attributed to transparency and accountability, and to introduce competition in healthcare. Fourth, attention is being shifted from simple treatment of a disease towards preventive initiatives, in a more holistic approach to health. Finally, healthcare policy-makers are recognizing the importance of empowering patients to give them control over decisions regarding their own health. These dynamics can be observed in chronic kidney disease, the management of which is a huge economic burden to healthcare systems globally, and which represents a good example of a field where important changes can be witnessed in therapy, technology, delivery and financing.
Open access
Chronic Disease Management Strategies
Health Systems, Economic Evaluations, Quality of Life
This Note discusses the relationship of Bitcoins, a cyber-currency, to the Bank Secrecy Act and discusses money laundering and tax evasion. This Note highlights the use and potentially problematic implications of Bitcoins in commerce and discusses their current regulation by the government, both within the United States and internationally, to guard against these threats. This Note addresses the regulation of Bitcoin exchanges, the exchanges' vulnerability to cyber-attacks, and the value of trust to the users of Bitcoin exchanges. This Note concludes that well known exchanges that operate both within and outside the United States generally self-regulate in order to gain the trust of their users despite the cyber-attacks on exchanges in the past. This Note also addresses the tax-reporting implications of foreign Bitcoin exchanges, looking by analogy at attempts to gain information from known tax havens.This Note argues that, given the applicability of the BSA to Bitcoin exchanges, the Bitcoin system poses serious questions relating to money laundering and tax reporting, mostly with regard to the less trustworthy exchanges known for their illegal activity. Some Bitcoin exchanges and e-wallets may also have the potential to become the next tax havens. Many exchanges voluntarily implement measures amounting to self-regulation in attempts to appear more trustworthy to wary consumers or in attempts to avoid criminal or civil sanctions. Whether this self-regulation is sufficient to achieve the goals of preventing money laundering and other criminal activity is debatable. Exchanges that have no need to appear trustworthy, however, still pose the same risks of money laundering and other illegal activity contemplated by the FBI. Moreover, ways exist in which criminals can work around the current regulatory scheme to achieve criminal goals; in that respect, the current regulatory scheme is ineffective to prevent the targeted criminal activity. This Note recommends a supplemental regulatory scheme that would target the areas that current regulation fails to address in combating money laundering, tax evasion, and other criminal activity.
Masayuki Abe, Jan Camenisch, Maria Dubovitskaya, Ryo Nishimaki
In this paper, we provide the first scheme that realises an attribute-based access control system for static resources that offers maximal privacy and is secure in the universal composability framework (UC). More precisely, we offer a protocol for adaptive oblivious transfer, where the sender can enforce an attribute-based access control policy for each record and nevertheless learns neither which record a user retrieves nor which attributes a user has. As additional results we provide a new structure-preserving signature scheme from the SXDH assumption and a new universally composable adaptive oblivious transfer protocol that is secure under two DDH-like assumptions and is the most efficient one secure under ``non $q$-type'' assumptions. We believe the new signature scheme to be of independent interest as a building block that is compatible with Groth-Sahai non-interactive zero-knowledge proofs.
Purpose – Due to the great distinctions for the legal environments, institutions and taxations, the restrictive external financing and costly financing cost, and great influence of macroeconomy or regulations on single industry, firms may change or adjust their organization structure to adapt to rapidly changing environment. Flat structure can decentralize the powers to subsidiary managers and can internalize the managerial market to promote competition among subsidiary managers and create an internal capital market within firms to alleviate external financing constrains, and it is matched with the diversification strategy to lower the operation risk and regulation risk for firms in changing environment. The paper aims to discuss these issues. Design/methodology/approach – The data of 6,065 listed corporations in China securities market since 2001-2006 are used to empirically test the hypotheses. Findings – The paper examines the efficiency of flat structure within the firm, investigating its influence on capital allocation and corporate performance. It shows that flat structure is better in emerging market since it is efficient in capital allocation, reducing the inefficient investment by reducing the overinvestment and alleviating the underinvestment, thus beneficial for corporate performance, both short-term and long-term accounting returns. Practical implications – From the results of this study, the paper can derive the important managerial implications that top managers should strengthen flexibility through flat structure so that their firms can grasp opportunities and obtain advantages through efficient improvement of mobility, adaptability, and combination in an uncertain environment. Moreover, flat structure can decentralize the powers to subordinate managers and create an internal managerial market and internal capital market within firms. Originality/value – By using the previous and change of multi-unit structure, the change of corporate performance, diverse and concentrated firms, the paper shows that results are not due to the endogenous problem. The study finds that in less-developed capital market under the current situation, flat structure is better, which suggests that flat structure can properly implement the strategies in emerging market and beneficial for corporate performance.
George Danezis, Cédric Fournet, Markulf Kohlweiss, Bryan Parno
Bitcoin is the first widely adopted distributed e-cash system and Zerocoin is a recent proposal to extend Bitcoin with anonymous transactions. The original Zerocoin protocol relies heavily on the Strong RSA assumption and double-discrete logarithm proofs, long-standing techniques with known performance restrictions. We show a variant of the Zerocoin protocol using instead elliptic curves and bilinear pairings. The proof system makes use of modern techniques based on quadratic arithmetic programs resulting in smaller proofs and quicker verification. We remark on several extensions to Zerocoin that are enabled by the general-purpose nature of these techniques.
We present BLACRONYM, a suite of new communication- and computation-efficient protocols for anonymous blacklisting without trusted third parties. Our protocols improve on Tsang et al.'s Blacklistable Anonymous Credentials (BLAC) system and its variants by incorporating novel batch zero-knowledge proof and verification techniques. BLACRONYM provides comparable functionality and security guarantees to those of BLAC and its derivatives, but it is substantially faster and consumes much less bandwidth. At the heart of BLACRONYM is the first batch zero-knowledge protocol in the literature for proofs of partial knowledge over non-monotone access structures; we suspect that our new techniques will find applications in speeding up other cryptographic constructions that require proofs of similar statements.
Antonis Papadimitriou, Mingchen Zhao, Andreas Haeberlen
In this paper, we discuss the problem of detecting general faults in distributed systems that handle confidential information. Detecting non-crash faults is difficult in this setting because, to check the behavior of a given node, we need to know its expected behavior -- but that can depend on the confidential information. Classical zero-knowledge proofs are difficult to apply because they are designed to verify functions with a fixed number of inputs, but in many distributed systems, both the size and the number of a node's "inputs" (the messages it has received from other nodes) are not known.
We describe the design, fabrication, and characterization of a novel pneumatic artificial muscle actuator with embedded contraction sensing. The muscle is composed of three main components: elastomer air chamber, embedded Kevlar threads, and a helical microchannel filled with a liquid conductor. When the air chamber is inflated with compressed air, the constrained length of the Kevlar threads causes the muscle to contract in the axial direction. During this contraction, the microchannel can detect the shape change of the muscle by sensing, the expansion of the air chamber. This sensing capability increases the controllability of pneumatic muscles. A novel manufacturing method is proposed to embed Kevlar threads and a helical microchannel in an elastomer tube. Then, a liquid metal is injected into the microchannel to make a soft sensor that can detect the geometrical change of the muscle. The muscle prototype was characterized to demonstrate its actuation and sensing capability.
Liu and Carless (2006) propose that peer assessment through peer feedback giving has its potential for enhanced student learning. Introducing formative assessment, using valid and reliable rubrics, can be beneficial to both teachers and learners in the process of learner improvement. However, Carless’s experiences in Hong Kong, a Confucius-based society where high-stake summative examinations are heavily prioritised, are solid proofs of how culture can interfere with education. In Asian societies, including Thailand, teachers having superior and absolute power in assessment are respected by students and hence, teacher voices take precedence over those of their peers. Implementing peer assessment in Asian classrooms, therefore, is problematic and to a certain extent, impossible. In this research, in order to expand our students’ learning boundaries beyond familiar, traditional ways of teacher assessment of which an end result is a grade, we introduced peer assessment rubrics to our reading classroom to allow them to monitor their friends’ reading progress. The peer evaluation results and comments were analyzed and compared with that of the teacher. An in-depth interview was also conducted with six subjects after the assessment process. The findings showed that as most of our students were engineering students and the texts they were reading were literary excerpts, employing rubrics was very helpful in the learning process. Nevertheless, as a result of long standing culture, final grades were still their priority. Our conclusive suggestions were that structural changes in assessment would be needed and they would certainly take time amidst the assessment culture in Thailand. DOI: 10.5901/mjss.2013.v4n14p279
Md Samsuzzaman, Mohamed Tahir Hj A Rahman, Mohammad Tariqul Islam, Rahman Rahman · 6 authors
Semantic web offers a smarter web service which synchronizes and arranges all the data over the web in a disciplined pattern. In data mining over the web, accuracy of selecting necessary data as user demand and pick them for output counts as a major key challenge from long ago. Our approach contributes a complete and automatic mapping of data over web3. 0 through ontology and accesses them by intelligent web agent. The agent offers all possible output related to user request, from which user could find desired information. When a user has insufficient data parameters to search, they can gain knowledge from the relational outputs provided by the agent and thus semantic web mining enables unknown knowledge acquisition or discovery. Here, in this paper we briefly illustrate and discuss the architecture of semantic web, then propose a model for web mining to discover knowledge under a framework of agent, and finally discusses the ways, how agent finds out user query related nodes from ontology.