In classical modal semantics, a binary accessibility relation connects worlds. In this paper, we present a uniform and systematic treatment of modal semantics with a continuous accessibility relation alongside the continuous accessibility modal logics that they model. We develop several such logics for a variety of philosophical applications. Our main conclusions are as follows. Modal logics with a continuous accessibility relation are sound and complete in their natural classes of models. The class of Kripke frames where a continuous accessibility relation (...) has a magnitude characterizing its degree of accessibility is not modally definable, and this has unappreciated significance to completeness proofs for such logics, revealing a methodological advantage of using classical multimodal semantics over fuzzy modal semantics. There is a pseudometric space modal logic that is complete in the class of pseudometric spaces, a natural semantic setting for quantitative modal reasoning about similarity. There is a metric space modal logic that is complete in the class of metric spaces, a natural semantic setting for quantitative modal reasoning about neighborhoods and counterfactual stability. There is a real line continuous temporal logic that is canonical for real lines, a natural semantic setting for quantitative modal reasoning about time. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s (...) Hospital and Harvard University (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

Philosophical discussions of personal identity depend upon thought experiments which describe psychological vicissitudes and question whether the original person survives in the person resulting from the described change. These cases are meant to determine the types of psychological change compatible with personal continuation. Two main accounts of identity try to capture this distinction; psychological continuity theories and narrative theories. I argue that neither fully succeeds since both overlook the importance of a relationship I call “empathic access.” I define empathic (...) access and discuss its role in a complete account of personal identity. (shrink)

This article is currently available as a free download on ingentaconnect.

Illusions that produce perceptual suppression despite constant retinal input are used to manipulate visual consciousness. Here we report on a powerful variant of existing techniques, Continuous Flash Suppression. Distinct images flashed successively around 10 Hz into one eye reliably suppress an image presented to the other eye. Compared to binocular rivalry, the duration of perceptual suppression increased more than 10-fold. Using this tool we show that the strength of the negative afterimage of an adaptor was reduced by half when it (...) was perceptually suppressed by input from the other eye. The more likely the adaptor was completely suppressed, the larger the reduction of the afterimage intensity. Paradoxically, trial-to-trial visibility of the adaptor did not correlate with the degree of suppression. Our results imply that formation of afterimages involves neuronal structures that access input from both eyes, but that do not correspond directly to the neuronal correlates of perceptual awareness. (shrink)

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive (...) alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual‐ or gender‐minority groups who likewise seek to pursue parenthood. We examine the history of access to current family‐building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual‐ or gender‐minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice. (shrink)

Broadening access to both computational and educational resources is crit- ical to diffusing machine learning (ML) innovation. However, today, most ML resources and experts are siloed in a few countries and organizations. In this article, we describe our pedagogical approach to increasing access to applied ML through a massive open online course (MOOC) on Tiny Machine Learning (TinyML). We suggest that TinyML, applied ML on resource-constrained embedded devices, is an attractive means to widen access because TinyML leverages (...) low-cost and globally accessible hardware and encourages the development of complete, self-contained applications, from data collection to deployment. To this end, a collaboration between academia and industry produced a four part MOOC that provides application-oriented instruction on how to develop solutions using TinyML. The series is openly available on the edX MOOC platform, has no prerequisites beyond basic programming, and is designed for global learners from a variety of backgrounds. It introduces real-world applications, ML algorithms, data-set engineering, and the ethi- cal considerations of these technologies through hands-on programming and deployment of TinyML applications in both the cloud and on their own microcontrollers. To facili- tate continued learning, community building, and collaboration beyond the courses, we launched a standalone website, a forum, a chat, and an optional course-project com- petition. We also open-sourced the course materials, hoping they will inspire the next generation of ML practitioners and educators and further broaden access to cutting-edge ML technologies. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

In the human-computer interaction, electroencephalogram access for automatic emotion recognition is an effective way for robot brains to perceive human behavior. In order to improve the accuracy of the emotion recognition, a method of EEG access for emotion recognition based on a deep hybrid network was proposed in this paper. Firstly, the collected EEG was decomposed into four frequency band signals, and the multiscale sample entropy features of each frequency band were extracted. Secondly, the constructed 3D MSE feature (...) matrices were fed into a deep hybrid network for autonomous learning. The deep hybrid network was composed of a continuous convolutional neural network and hidden Markov models. Lastly, HMMs trained with multiple observation sequences were used to replace the artificial neural network classifier in the CNN, and the emotion recognition task was completed by HMM classifiers. The proposed method was applied to the DEAP dataset for emotion recognition experiments, and the average accuracy could achieve 79.77% on arousal, 83.09% on valence, and 81.83% on dominance. Compared with the latest related methods, the accuracy was improved by 0.99% on valence and 14.58% on dominance, which verified the effectiveness of the proposed method. (shrink)

Previous research has shown implicit semantic processing of faces or pictures, but whether symbolic carriers such as words can be processed this way remains controversial. Here we examine this issue by adopting the continuous flash suppression paradigm to ensure that the processing undergone is indeed unconscious without the involvement of partial awareness. Negative or neutral words projected into one eye were made invisible due to strong suppression induced by dynamic-noise patterns shown in the other eye through binocular rivalry. Inverted and (...) scrambled words were used as controls to provide baselines at orthographic and feature levels, respectively. Compared to neutral words, emotion-described and emotion-induced negative words required longer time to release from suppression, but only for upright words. These results suggest that words can be processed unconsciously up to semantic level since under interocular suppression completely invisible words can lead to different processing speed due to the emotion information they carry. (shrink)

Prior research examining mate expulsion indicates that women are more likely to expel a mate due to deficits in emotional access while men are more likely to expel a mate due to deficits in sexual access. Prior research highlights the importance of accounting for measurement limitations (e.g., the use of incremental vs. forced-choice measures) when assessing attitudes toward sexual and emotional infidelity; Wade & Brown, 2012; Sagarin et al., 2012). The present research uses conjoint analysis, a novel methodology (...) for controlling several limitations of using continuous self-report measures in mate expulsion research. Participants (N = 181; 128 women) recruited from Bucknell University and several psychology recruitment listservs in the US rated 9 profiles that varied in three potential levels of emotional and sexual accessibility. Men were more likely to want to break up with a partner due to sexual accessibility deficits, whereas women were more likely to want to break up due to emotional accessibility deficits. However, regardless of sex, emotional inaccessibility was more likely to produce mate expulsion. These findings are consistent with prior theory and highlight the need to disentangle emotional accessibility into its constituent in-pair benefits. This research also illustrates the utility of conjoint analysis as a statistical tool for studying how humans resolve trade-offs among competing outcomes during romantic decision-making. (shrink)

Conscious access to fear-relevant information is mediated by threshold The present report proposed a model of access consciousness to fear-relevant information according to which there is a threshold for emotional perception beyond that the subject makes hits with no false alarm. The model was examined by having the participants performed a confidence-ratings masking task with fearful faces. Measures of the thresholds for conscious access were taken by looking at the receiver operating characteristics curves generated from a three-state (...) low- and high-threshold model by Krantz. Indeed, the analysis of the masking data revealed that the ROCs had threshold-like-nature rather continuous challenging in this fashion the classical signal-detection view on perceptual processing. Moreover, the threshold ROC curve exhibited the specific y-intercepts relevant to conscious access performance. The study suggests that the threshold can be an intrinsic property of conscious access, mediating emotional contents between perceptual states and consciousness. (shrink)

Continuous culture techniques were developed in the early twentieth century to replace cumbersome studies of cell growth in batch cultures. In contrast to batch cultures, they constituted an open concept, as cells are forced to proliferate by adding new medium while cell suspension is constantly removed. During the 1940s and 1950s new devices have been designed—called “automatic syringe mechanism,” “turbidostat,” “chemostat,” “bactogen,” and “microbial auxanometer”—which allowed increasingly accurate quantitative measurements of bacterial growth. With these devices cell growth came under the (...) external control of the experimenters and thus accessible for developing a mathematical theory of growth kinetics—developed mainly by Jacques Monod, Aron Novick and Leo Szilard in the early 1950s and still in use today. The paper explores the development of continuous culture devices and claims that these devices are simulators for standard cells following specific requirements, in particular involving mathematical constraints in the design and setting of the devices as well as experiments. These requirements have led to contemporary designs of continuous culture techniques realizing a specific event-based flow algorithm able to simulate directed evolution and produce artificial cells and microorganisms. This current development is seen as an alternative approach to today’s synthetic biology. (shrink)

ABSTRACT Many recent articles argue that participants who seroconvert during HIV prevention trials deserve treatment when they develop AIDS, and there is a general consensus that the participants in HIV/aids treatment trials should have continuing post‐trial access. As a result, the primary concern of many ethicists and activists has shifted from justifying an obligation to treat trial participants, to working out mechanisms through which treatment could be provided. In this paper I argue that this shift frequently conceals an important (...) assumption: that if there is an obligation to supply treatment, then any party who could provide it may be prevailed upon to discharge the obligation. This assumption is false. The reasons why trial participants should get ART affect who has the duty to provide it. We should not burden governments with the obligations of sponsors, nor researchers with the obligations of the international community. And we should not deprive a group of treatment because their need is less salient than that of research participants. Insisting otherwise may lead to people being wrongfully deprived of access to antiretrovirals. (shrink)

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre (...) HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. (shrink)

This paper deploys Laclau and Mouffe's discourse theory to examine the dispute over intellectual property protection and global HIV/aids medicines access. Over the 1980s and 1990s, major pharmaceutical companies and minority world governments successfully crafted a strong patent protection regime, institutionalized in the World Trade Organization's intellectual property rules. In the early 2000s, a transnational civil society campaign challenged this regime, positioning patents at the centre of a highly publicized dispute. This dispute has been retrospectively identified as a turning (...) point in medicines access discourse, with the 2001–2003 period dubbed the ‘golden window’ for expanded global HIV/aids medicines access. However, this ‘window’ has also been critiqued as an unsustainable aberration to a continuing hegemonic regime that prioritizes patent protection, to the detriment of equitable global medicines access. This paper draws on both political economy analyses and discourse theoretical concepts to examine the processes of rupture and suture in HIV/aids medicines access discourse. (shrink)

People with disabilities are often denied equal access to organ transplantation despite long‐standing federal nondiscrimination mandates. Under the Americans with Disabilities Act and the Rehabilitation Act, people cannot be excluded from consideration for organ transplantation because of disability itself, or because of stereotypes or assumptions about the value or quality of life with a disability. Instead, decisions concerning whether an individual is a candidate for organ transplantation should be based on an individualized assessment of the patient and on objective (...) medical evidence. Recent legal developments underscore these basic guarantees and signal a new focus on the policies, practices, and attitudes that continue to compromise equal access to life‐saving organ transplants for people with disabilities. (shrink)

Since 2001, the Commission of the European Union has instigated Peer Reviews to help countries preparing to accede to the European Union. Added to this has been the provision of workshops and individual expert inputs. This article recounts the experiences of the author in this process. It focuses on how a single directive has revealed major ethical challenges for nurses, their national associations and state governments as they seek to implement the changes required. In particular a sub-agenda has emerged relating (...) to general education, access to higher education and the position of women in these countries. The ethical challenges include freedom to practice and creation of competent authorities to provide proper oversight of the health care professions. In 2011, the directive is being reviewed and this article offers arguments for its continuation, even in an unreformed state. (shrink)

This edited volume offers empirical, evaluative, and philosophical perspectives on the question of higher education as a human right in the Asia Pacific. Throughout the region, higher education has grown rapidly in a variety of ways. Price, accessibility, mobility, and government funding are all key areas of interest, which likely shape the degree to which higher education may be viewed as a human right. Although enrollments continue to grow in many higher education systems, protests related to fees and other equity (...) issues continue to grow. This volume will include scholarly perspectives from around the region for a more extensive understanding of higher education as a human right in the Asia Pacific. (shrink)

The HIT model comes close to a view suggested by Donald Hebb, that cognitive representations are organized as distributed neuron webs, cell assemblies, whose components are mutually connected and whose internal connections provide continuous information exchange among sub-components of the representation. Two questions are asked related to (1) the organization of internal connections of a concept representation and (2) the conditions under which information exchange between components are assumed in the HIT model.

Although the study of visual perception has made more progress in the past 40 years than any other area of cognitive science, there remain major disagreements as to how closely vision is tied to general cognition. This paper sets out some of the arguments for both sides and defends the position that an important part of visual perception, which may be called early vision or just vision, is prohibited from accessing relevant expectations, knowledge and utilities - in other words it (...) is cognitively impenetrable. That part of vision is complex and articulated and provides a representation of the 3-D surfaces of objects sufficient to serve as an index into memory, with somewhat different outputs being made available to other systems such as those dealing with motor control. The paper also addresses certain conceptual and methodological issues, including the use of signal detection theory and event-related potentials to assess cognitive penetration of vision. A distinction is made among several stages in visual processing. These include, in addition to the inflexible early-vision stage, a pre-perceptual attention allocation stage and a post-perceptual evaluation, memory-accessing, and inference stage which provide several different highly constrained ways in which cognition can affect the outcome of visual perception. The paper discusses arguments that have been presented in both computer vision and psychology showing that vision is "intelligent" and involves elements of problem solving". It is suggested that these cases do not show cognitive penetration, but rather they show that certain natural constraints on interpretation, concerned primarily with optical and geometrical properties of the world, have been compiled into the visual system. The paper also examines a number of examples where instructions and "hints" are alleged to affect. (shrink)

In “Prediction, Understanding, and Medicine,” Alex Broadbent rejects the curative thesis, the view that the core medical competence is to cure, in favor of his predictive thesis that the main intellectual medical competence is to explain and the main practical medical competence is to predict. Broadbent thinks his account explains the phenomenon of multiple consultation, which is the fact that people persist in consulting alternative medical traditions despite having access to mainstream medicine. I argue that Broadbent’s explanation of multiple (...) consultation makes sense only from the perspective of patients who migrate from mainstream to alternative consultation. His explanation is not as convincing when we consider alternative-to-mainstream migration. I also provide an argument against Broadbent’s view that prediction is medicine’s main practical competence and argue that, when it comes to explaining most cases of multiple consultation, the curative thesis provides a more convincing explanation than the predictive thesis. (shrink)

The author examines the history of pragmatism and maintains that a thematic continuity runs through the classical pragmatists, neopragmatitsts and contemporary pragmatists. This continuity can be vaguely characterized as an integration of theory and practice, but experience gives theory its content such that action is always guiding the formation of knowledge. There are four implications of this continuity. Pragmatists are centrally concerned with the human relationship to a process-oriented and evolving conception of nature. For pragmatists, our beliefs are regarded not (...) as propositions that map onto a separate and fixed reality, but instead their truth emerges out of the habits beliefs generate. Pragmatism emphasizes an openness to possibility since our access to the world of experience is mediated by a variety of selective interests, intellectual histories, varying linguistic and discursive practices. Pragmatists are deeply concerned with the social and political problems that confront us on a daily basis. The author also examines the manner in which James understands the term “metaphysics” given that pragmatism is a method for settling “metaphysical disputes.” Jamesian existential pluralism implies to maximize all possibilities that can satisfy everyone as much as possible without impeding and harming another's capacity to experience a rich and novel world. The author analyzes Todd May’s approach to the analytic-continental divide and concludes that if settlement embraces James’s thick conception of experience, then the resulting ontological pluralism is the best settlement possible, and this commitment to pluralism requires dissolving the exclusionary practices the analytic-continental divide suggests philosophically. (shrink)

The present study provides evidence that the activation strength produced by emotional stimuli must pass a threshold level in order to be consciously perceived, contrary to the assumption of continuous quality of representation. An analysis of receiver operating characteristics for attentional blink performance was used to distinguish between two models of emotion perception by inspecting two different ROC’s shapes. Across all conditions, the results showed that performance in the attentional blink task was better described by the two-limbs ROC predicted by (...) the Krantz threshold model than by the curvilinear ROC implied by the signal-detection theory. (shrink)

The third edition of this popular reader reflects considerable changes. With over seventy readings representing a wide diversity of theorists, it offers a breadth of coverage not available in other collections. The framework for understanding theory as a set of conversations over time is maintained and deepened, with a focus on key transitional theorists who helped pave the way from classical to contemporary theory. New contextual and biographical materials surround the primary readings, and each chapter includes a study guide with (...) key terms, discussion questions, and innovative classroom exercises. The result is a fresh and expansive take on social theory that foregrounds a plurality of perspectives and defines contemporary trends in the field, while being both an accessible and manageable teaching tool. (shrink)

The treaty of Lisbon makes European Union (EU) accession to the European Convention on Human Rights (ECHR) an obligation of result. The issue has been intensely discussed for more than thirty years, arguing that such accession is necessary in view of the need to ensure the ECHR standard of fundamental rights protection in Europe. This question again gains prominence as the EU member states and the institutions seek to agree on the negotiation directives of EU accession to the ECHR. The (...) process brings up the difficulties involved in creating a mechanism which would both facilitate the autonomy of the EU legal order and enable individuals to bring claims against the EU to the European Court of Human Rights (ECtHR). This involves the questions how it would be possible to ensure quick access to justice, and whether the ECtHR would continue to apply the doctrine of equivalent protection in relation to EU even after the latter becomes bound by the ECHR. The article argues that EU accession to the Convention is a prominent political step ensuring coherence of human rights protection mechanism in Europe. (shrink)

The issue of representing access control requirements continues to demand significant attention. The focus of researchers has traditionally been on developing particular access control models and policy specification languages for particular applications. However, this approach has resulted in an unnecessary surfeit of models and languages. In contrast, we describe a general access control model and a logic-based specification language from which both existing and novel access control models may be derived as particular cases and from which (...) several approaches can be developed for domain-specific applications. We will argue that our general framework has a number of specific attractions and an implication of our work is to encourage a methodological shift from a study of the particulars of access control to its generalities. (shrink)

Objectives To analyse the perspective of clinical research stakeholders concerning post-trial access to study medication. Methods Questionnaires and informed consents were sent through e-mail to 599 ethics committee (EC) members, 290 clinical investigators (HIV/AIDS and Diabetes) and 53 sponsors in Brazil. Investigators were also asked to submit the questionnaire to their research patients. Two reminders were sent to participants. Results The response rate was 21%, 20% and 45% in EC, investigators and sponsors’ groups, respectively. 54 patients answered the questionnaire (...) through their doctors. The least informative item in the consent form was how to obtain the study medication after trial. If a benefit were demonstrated in the study, 60% of research participants and 35% of EC answered that all patients should continue receiving study medication after trial; 43% of investigators believed the medication should be given to participants, and 40% to subjects who participated and benefited from treatment. For 50% of the sponsors, study medication should be assured to participants who had benefited from treatment. The majority of responders answered that medication should be provided free by sponsors; investigators and sponsors believed the medication should be kept until available in the public health sector; EC members said that the patient should keep the benefit; patients answered that benefits should be assured for life. Conclusions Due to the study limitations, the results cannot be generalised; however, the data can contribute to discussion of this complex topic through analysing the views of stakeholders in clinical research in Brazil. (shrink)

To really appreciate the range of his achievements, we need an interdisciplinary effort; we need a carefully researched definitive edition of Russell's work, edited by a team consisting of, among others, philosophers and historians, a journal devoted to studying the various aspects of his activities and a whole army of researchers with access to a well-catalogued archive of his papers.

When research concludes, post-trial access to the trial intervention or standard healthcare can be crucial for participants who are ill such as those in resource-poor countries with inadequate healthcare, British participants testing ‘last-chance drugs’ unavailable on the National Health Service and underinsured US participants. Yet, many researchers are unclear about their obligations regarding the post-trial period, and many research ethics committees do not know what to require of researchers. Consequences include participants who reasonably expect but lack PTA to the (...) trial intervention, unplanned financial liabilities for NHS Trusts forced to fund this, negative press and potential to undermine public trust.1–3,iOne reason for the lack of clarity is controversy over whether and when participants should have access, after the study, to the study intervention. At one extreme is the view that continued access should be ensured when the intervention has benefited the participant or when it has proven safe and effective for the participant population, irrespective of the cost and burden of ensuring continued access. At the other extreme is the view that continued access need never be provided so long as non-availability of the study intervention post-trial was adequately disclosed when participants were invited to participate.6 There is also disagreement about when poststudy access to the study intervention should be considered beneficial for participants. The spectrum ranges from the view that the intervention should be regarded as beneficial for a proposed use only after the …. (shrink)

This paper explores how using a domains of ethics analysis approach might constructively contribute to an enhanced understanding (among those without specialized ethics training) of ethically-complex health care practices through the consideration of one such sample practice, i.e., deep and continuous palliative sedation (DCPS). For this purpose, I select four sample ethics domains (from a variety of possible relevant domains) for use in the consideration of this practice, i.e., autonomous choice, motives, actions and consequences. These particular domains were choosen because (...) of their relevance to the analysis of DCPS and their relative ease of access to those without ethics training. The analysis demonstrates that such an approach could facilitate the emergence of accessible arguments and discussion points that could enhance the understanding and appreciation of this and other health care practices with strong ethics dimensions. (shrink)

Context: The recent death of Ernst von Glasersfeld opens a space in which there is an important opportunity to re-present and highlight key aspects of his life’s work constructing his model of radical constructivism. Purpose: To make available in a synthetic form one of his particular efforts to elaborate RC in a project that lasted 13 years. This particular project was conducted on the Oikos web site under the title of “Ask von Glasersfeld” and consisted of an opportunity for questioners (...) to pose any type of query directly to von Glasersfeld and normally expect a rapid reply. He was busy composing considered answers right up to his death in November 2010. Method: My intention is to re-present the liveliness of his explicatory interactions with all types of questioners by selecting eight categories of “Questions & Answers” from the web site. Because the selected contents are so extensive these eight categories will be presented in a series of four articles of which this is the first. Implications: This re-presentation of von Glasersfeld’s ideas offers an easily accessible resource for people of all levels of understanding who are seeking to deepen their appreciation of his work. One can come to appreciate not only the lucidity of his writings but also glean “insights” into the person himself, who can be glimpsed between the lines of these various interactions. (shrink)

Context: Under the title “Ask von Glasersfeld,” for 13 years the Oikos web site offered the opportunity to questioners to pose any type of query directly to Ernst von Glasersfeld. Purpose: Based on the collected questions and answers gathered on the web site, this series of four articles re-presents and highlights key aspects of von Glasersfeld’s life’s work constructing his model of radical constructivism. Method: The question-answer pairs are grouped into eight categories. Because the selected contents are so extensive, these (...) eight categories are presented in a series of four articles, of which this is the second and which deals with with von Glasersfeld’s views on human experience. The material is divided into two main themes: the first deals with his views on “experiential reality” and the second deals with the issue of “learning.” Results: One of von Glasersfeld’s main objectives was to define clearly that which we can rationally claim to know. As part of this task, in the first section of this article he deals with the question of how we go about constructing our personal experiential reality. The second part deals with his views on how to apply practically the tenets of radical constructivism in a variety of fields. He is especially interested in redefining what “learning” means and in creating novel approaches to teaching and training students. Implications: This re-presentation of von Glasersfeld’s ideas offers an easily accessible resource for people of all levels of understanding who are seeking to deepen their appreciation of his work. One can come to appreciate not only the lucidity of his writings but also glean “insights” into the person himself, who can be glimpsed between the lines of these various interactions. (shrink)

Romanis has written another interesting and important paper on reproductive ethics entitled assisted gestative technologies.1 In this short commentary, I continue the discussion on the question of who should have access to AGTs. This commentary should not be understood as a critical reply but as a friendly extension of one of the paper’s themes. I am not trying to solve the question of who should have access to these technologies but I put forth some groundwork for future work. (...) Romanis calls AGTs new technologies that allow people to undertake gestation involving technological intervention—or to have another person or a device perform the reproductive and gestational labour on their behalf. People using AGTs might or might not use their own genetic material for reproduction. Romanis argues that these AGTs—such as uterus transplantation or artificial wombs—collectively raise ethical, legal and social issues that are distinct for example from assisted conception. One important question related to AGTs is who should have access to such technologies. This is crucial especially …. (shrink)

Purpose– This paper aims to consider selected results from the Arts and Humanities Research Council -funded “Managing Access to the internet in Public Libraries” project, from 2012-2014. MAIPLE has explored the ways in which public library services manage use of the internet connections that they provide for the public. This included the how public library services balance their legal obligations and the needs of their communities in a public space and the ethical dilemmas that arise.Design/methodology/approach– The researchers used a (...) mixed-method approach involving a review of the literature, legal analysis, a questionnaire survey and case studies in five public library authorities.Findings– UK public library services use a range of methods to regulate internet access. The research also confirms previous findings that filtering software is an ubiquitous tool for controlling access to and protecting library users from “inappropriate”, illegal and harmful internet content. There is a general, if sometimes reluctant, acceptance of filtering software as a practical tool by library staff, which seems to contrast with professional codes of ethics and attitudes in other countries. The research indicates that public library internet access will be a valued service for some time to come, but that some aspects of how public library services regulate internet access is currently managed can have socially undesirable consequences, including blocking legitimate sites and preventing users from accessing government services. Education could play a greater part in helping the general population to exercise judgement in selection of materials to view and use. This does not preclude implementing stricter controls to protect children, whilst allowing public libraries to continue providing a social good to those who are unable to otherwise participate in the digital age.Research limitations/implications– The response to the survey was 39 per cent meaning that findings may not apply across the whole of the UK. The findings of this study are compared with and supplemented by other quantitative sources, but a strength of this study is the depth of understanding afforded by the use of case studies.Originality/value– This paper provides both a quantitative and qualitative analysis of how internet access is managed in UK public libraries, including how library services fulfil their legal obligations and the ethical implications of how they balance their role in facilitating access to information with their perceived role as a safe and trusted environment for all members of their communities. The findings add to the international discussion on this issue and stimulate debate and policy making in the UK. (shrink)

In May 2011, the Brazilian Ministry of Health announced the distribution of the first batch of locally produced generic tenofovir disoproxil fumarate (TDF) to support its program of universal and free access for the treatment of HIV/AIDS. The inclusion of TDF in the public health program illustrates what has been considered the ‘Brazilian model’ of HIV/AIDS response, as it illustrates the current phase of the Brazilian pharmaceutical economy. Brazil is known for having managed to control the expansion of HIV/AIDS (...) through a unique initiative combining the public health and the industrial production of generics. But, if at first local manufacturers could freely copy ARVs and produce cheaper generic versions that were delivered to the Ministry of Health, since the country started to grant patents on drugs in 1996, the sustainability of this policy has been challenged by the high cost of patented second-line HIV/AIDS treatments. In order to assure continuity of the local production of ARVs, and keep the program of public health alive, Brazilians are now forced to deal with conflicts of drugs' intellectual property rights in order to open the path to generic production. This article aims to describe the experiences surrounding TDF in Brazil and the unprecedented conflicts and challenges it has brought for our different interviewees. Blurring the frontier between the public and the private, the TDF case was driven at the same time by an ethic of drug access and regulation of drug quality, which has inspired Brazilians to intervene and transform the world they live in. (shrink)

René Descartes with his theory of continued creation occupies an exceptional place in the philosophy of Henri Bergson: Descartes is subjected to Bergson’s repeated criticism like no other philosopher. Yet, in L’évolution créatrice Bergson appears to oscillate in his criticism of Descartes. Bergson discovers in the theory of continued creation a thought of freedom, of an indeterminate future, which is not far from his own thought of duration. Bergson thus advances a thesis in accordance with which Descartes’ theory (...) of continued creation has two irreconcilable aspects: continued creation and continuous creation. The difference between these two aspects, however, is not just about the choice between a participle and an adjective. The aim of this article is to show how Descartes’ theory of continued creation lends itself to such a double interpretation. While the former aspect originates in Descartes’ project of mechanistic physics, the latter aspect is accessible but from the standpoint of human freedom, as well as Descartes’ critique of finalism. The article thus shows that Descartes’ theory of continued creation constitutes a point of convergence between the questions of mechanism and human freedom, where the latter is an exception to the former. However, the exceptional status of human freedom in Descartes’ philosophy renders Bergson’ thesis about Descartes’ oscillation between two aspects somewhat problematic. (shrink)

We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those (...) in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature. (shrink)

Federal and state budgetary constraints continually challenge Medicaid. The effects of benefit cuts are common: long waiting lists for community‐based services, skeletonized drug formularies with unstable access to long‐term prescriptions, no psychiatric therapy for people immobilized by depression, and no more than fourteen days of acute hospitalization. Reimbursements may be so low that providers cannot hire qualified staff and must reduce services, close facilities, or refuse to take Medicaid altogether. Misguided efficiency policies may afflict some groups of patients as (...) well. Decisions to narrow access rights to publicly funded health care promote the perception that more broadly inclusive programs would be unwisely and unfairly generous. They also risk characterizing disability rights as “special,” confined to a narrow class of people who charitably ought not to be expected to provide for themselves. In contrast, on a philosophical view we have been exploring—one that addresses problems of justice under circumstances of injustice by pursuing rather than reducing inclusion—efforts like these are unjust. (shrink)

The capacity of visual working memory (VWM) refers to the amount of visual information that can be maintained in mind at once, readily accessible for ongoing tasks. In healthy young adults, the capacity limit of VWM corresponds to about three simple objects. While some researchers argued that VWM capacity becomes adult-like in early years of life, others claimed that the capacity of VWM continues to develop beyond middle childhood. Here we assessed whether VWM capacity reaches adult levels in adolescence. Using (...) an adaptation of the visual change detection task, we measured visual working memory capacity estimates in 13 year-olds, 16-year-olds, and young adults. We tested whether the capacity estimates observed in early or later years of adolescence were comparable to the estimates obtained from adults. Our results demonstrated that the capacity of VWM continues to develop throughout adolescence, not reaching adult levels even in 16 year-olds. These findings suggest that VWM capacity displays a prolonged development, similar to the protracted trajectories observed in various other aspects of cognition. (shrink)

This essay surveys and synthesizes the academic literature, archival sources and interviews with key policy makers regarding the emergence of community technology centers in the US. Community Technology Centers came to the fore in the late 1990s through an activist nonprofit sector combined with federal government and private sector funding. Federal data indicates that CTCs now represent the most important access points to information communications technology for the poor in the US. This essay reviews the latest arguments for and (...) against continued investment in CTCs and public access in general. In addition to providing access, which is often used beneficially for employment and education related purposes, CTCs appear to contribute to social capital as they become social gathering points. This paper concludes, that both government and nonprofits play a vital role in ensuring public access for the poor and that continued investment in CTCs is warranted. (shrink)

Background: For patients admitted to hospital both pastoral care and privacy or confidentiality are important. Rules related to each have come into conflict recently in the US. Federal laws and other rules protect confidentiality in ways that countermand hospitals’ methods for facilitating access to pastoral care. This leads to conflicts and poses an unusual type of dilemma—one of conflicting values and rights. As interests are elements necessary for establishing rights, it is important to explore patients’ interests in privacy compared (...) with their desire for attention from a cleric.Aim: To assess the willingness of patients to have their names and rooms included on a list by religion, having that information given to clergy without their consent, their sense of privacy violation if that were done and their views about patients’ privacy rights.Methods and participants: 179 patients, aged 18–92 years, admitted to hospital in an acute care setting, were interviewed and asked about their preferences for confidentiality and pastoral support.Results: Most patients did not want to be listed by religion; 58% did not think hospitals should give lists to clergy without their consent and 84% welcomed a visit by their own clergy even if triggered from a hospital list.Conclusions: Values related to confidentiality or privacy and pastoral care were found to be inconsistent and more complicated than expected. Balancing the right to privacy and the value of religious support continue to present a challenge for hospitals. Patients’ preferences support the importance of providing balance in a way that protects rights while offering comprehensive services. (shrink)

Down syndrome (Trisomy 21) is a mild to moderate intellectual disability. Historically, this condition has been a primary target for prenatal testing. However, Down syndrome has not been targeted for prenatal testing because it is an especially severe illness. The condition was just one that could be easily identified prenatally using the techniques first available decades ago. We are moving into an era in which we can prenatally test for a vast range of human traits. I argue that when we (...) can test for anything, there is no longer any reason to continue targeting Down syndrome. I present an argument based on the value of nondiscrimination. It is justified to set limits on access to prenatal information if the information is going to be used for discriminatory purposes. I use the examples of (1) prenatal testing for misogynistic fetal sex selection, and (2) homophobia-motivated prenatal testing for potential homosexuality, as compelling analogies. (shrink)

The publishing sector in India is growing at an estimated 30 per cent annually. New publishing technologies are creating opportunities for book publishers in the country. The current ebook market is said to be less than one per cent of the total book market, but expected to grow multifold in the next 2–3 years. This paper scopes out the factors that will lead to the growth of ebooks, namely, growth of literacy; internet penetration; proliferation of personal handheld devices; localization; and (...) the government’s policies and initiatives. It lists the epublishing efforts of private publishers and new enterprises in education and trade segments of the industry. The article observes that although ebook publishing is at a nascent stage with potential for remarkable growth, print runs of printed books are increasing simultaneously. A hybrid model for the book industry, of both printed books and ebooks, is suggested as a viable option for the needs of a developing country such as India, where access to digital content continues to be a significant challenge. (shrink)

Mark Schroeder reflects on nine years of leading JESP, the continuing value of and challenges for the model of university-funded full-open access publishing in philosophy, and announces new leadership of and support for the journal.