High-Dose Benzodiazepine Dependence: A Qualitative Study of Patients' Perceptions on Initiation, Reasons for Use, and Obtainment

BACKGROUND High-dose benzodiazepine (BZD) dependence is associated with a wide variety of negative health consequences. Affected individuals are reported to suffer from severe mental disorders and are often unable to achieve long-term abstinence via recommended discontinuation strategies. Although it is increasingly understood that treatment interventions should take subjective experiences and beliefs into account, the perceptions of this group of individuals remain under-investigated. METHODS We conducted an exploratory qualitative study with 41 adult subjects meeting criteria for (high-dose) BZD-dependence, as defined by ICD-10. One-on-one in-depth interviews allowed for an exploration of this group's views on the reasons behind their initial and then continued use of BZDs, as well as their procurement strategies. Mayring's qualitative content analysis was used to evaluate our data. RESULTS In this sample, all participants had developed explanatory models for why they began using BZDs. We identified a multitude of reasons that we grouped into four broad categories, as explaining continued BZD use: (1) to cope with symptoms of psychological distress or mental disorder other than substance use, (2) to manage symptoms of physical or psychological discomfort associated with somatic disorder, (3) to alleviate symptoms of substance-related disorders, and (4) for recreational purposes, that is, sensation-seeking and other social reasons. Subjects often considered BZDs less dangerous than other substances and associated their use more often with harm reduction than as recreational. Specific obtainment strategies varied widely: the majority of participants oscillated between legal and illegal methods, often relying on the black market when faced with treatment termination. CONCLUSIONS Irrespective of comorbidity, participants expressed a clear preference for medically related explanatory models for their BZD use. We therefore suggest that clinicians consider patients' motives for long-term, high-dose BZD use when formulating treatment plans for this patient group, especially since it is known that individuals are more compliant with approaches they perceive to be manageable, tolerable, and effective.

Prospects in International Investment Law and Policy: World Trade Forum

The negotiation of a patchy but burgeoning network of international investment agreements and the increasing use to which they are put is generating a growing body of jurisprudence which, while still evolving, requires closer analytical scrutiny. Drawing on many of the most distinguished voices in investment law and policy, and offering novel, multidisciplinary perspectives on the rapidly evolving landscape shaping international investment activity and treaty-making, this book explores the most important economic, legal and policy challenges in contemporary international investment law and policy. It also examines the systemic implications flowing from frenetic recent judicial activism in investment matters and advances several innovative propositions for how best to promote greater overall coherence in rule-design, treaty use and policy making and thus offer a better balance between the rights and obligations of international investors and host states.

Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study

Background and aims Radiofrequency denervation (RF) of the lumbar facet joints has been shown to be effective in well-selected patients. However, long-term success varies between studies. We evaluated the influence of selected psychosocial and constitutional factors on the outcome of RF, expressed as the duration of pain relief. Methods This prospective observational study included 44 patients who received RF denervations at the University Hospital of Berne. Success was defined as at least 50% pain reduction 7–21 days, 6 months and 1 year after RF therapy. The Cox-regression analysis was performed to evaluate the influence of the following factors on the duration of success: age, sex, depression, work inability and previous surgery. Results Complete follow-up was available for 41 patients. The success rate 7–21 days after the denervation was 76%. It decreased to 32% at 6 months and to 22% at 1 year. The median success duration was 17 weeks (95% CI 10–26). The Cox-regression analysis showed a significant shorter duration of success for patients with depression (hazard ratio [HR] 2.97, 95% CI 1.32–6.65), previous surgery (HR 2.39, 95% CI 1.10–5.21) and number of treated joints (HR 1.95 for each increase in the number of joints, 95% CI 1.14–3.33). In bivariate analyses, only depression was kept to be significant. Conclusions Depression seems to be related with a short duration of success. Based on these findings, a comprehensive study is warranted to evaluate whether psychosocial factors have to be considered when recruiting patients for radiofrequency denervation.

Perforation of the pulmonary artery by a bronchial wall stent

Implantation of stents into the bronchial walls is a newly developed method to treat lung emphysema, which is now being tested clinically. During this procedure, a bronchoscope carrying a Doppler ultrasonography head is placed into a segmental bronchus and the blood vessels running in parallel to the bronchus are localized. Once a safe location without blood vessels is found, the bronchial wall is perforated and a stent is placed within the wall to improve the expiratory volume of these "bypasses" to the adjacent lung parenchyma. We observed a fatal complication with this method in a 60-year-old man. The bronchial wall and the pulmonary artery were perforated by one of the stents inducing massive bleeding, which could not be stopped. The patient died due to aspiration of blood in combination with massive loss of blood. The general risk to perforate the pulmonary artery during this procedure cannot be estimated from this single observation but should be considered regarding the legal and clinical aspects.

Critical Essays on "Causation & Responsibility"

Due to its scope and depth, Moore’s Causation and Responsibility is probably the most important publication in the philosophy of law since the publication of Hart’s and Honoré’s Causation in the Law in 1959. This volume offers, for the first time, a detailed exchange between legal and philosophical scholars over Moore’s most recent work. In particular, it pioneers the dialogue between English-speaking and German philosophy of law on a broad range of pressing foundational questions concerning causation in the law. It thereby fulfills the need for a comprehensive, international and critical discussion of Moore’s influential arguments. The 15 contributors to the proposed volume span the whole interdisciplinary field from law and morals to metaphysics, and the authors include distinguished criminal and tort lawyers, as well as prominent theoretical and practical philosophers from four nations. In addition, young researchers take brand-new approaches in the field. The collection is essential reading for anyone interested in legal and moral theory.

The UNESCO Convention on Cultural Diversity: An Appraisal Five Years after Its Entry into Force

The United Nations Educational Scientific and Cultural Organization (UNESCO) adopted in 2005 the first legally binding international instrument on culture. The Convention on the Protection and Promotion of the Diversity of Cultural Expressions was agreed upon with an overwhelming majority and after the swiftest ratification process in the history of the UNESCO entered into force on 18 March 2007. Now, five years later and with some 125 Members committed to implementing the Convention, not only observers with a particular interest in the topic but also the broader public may be eager to know what has happened and in how far has the implementation progress advanced. This is the question that animates this paper and which it seeks to answer by giving a brief background to the UNESCO Convention, clarifying its legal and political status and impact, as well as by looking at the current implementation activities in the domestic and international contexts.

The UNESCO Convention on Cultural Diversity : An Appraisal Five Years after its Entry into Force

The United Nations Educational Scientific and Cultural Organization (UNESCO) adopted in 2005 the first legally binding international instrument on culture. The Convention on the Protection and Promotion of the Diversity of Cultural Expressions was agreed upon with an overwhelming majority and after the swiftest ratification process in the history of the UNESCO entered into force on 18 March 2007. Now, five years later and with some 125 Members committed to implementing the Convention, not only observers with a particular interest in the topic but also the broader public may be eager to know what has happened and in how far has the implementation progress advanced. This is the question that animates this paper and which it seeks to answer by giving a brief background to the UNESCO Convention, clarifying its legal and political status and impact, as well as by looking at the current implementation activities in the domestic and international contexts.

The story of Community preference for food security

"Préférence communautaire" is an in-built notion of the CAP since its inception with the Treaty of Rome (1957). Its’ simple objective laid down at the Stresa Conference in 1958 is to prefer community produce over imports wherever possible, while at the same time promoting agricultural exports and FDI (“vocation exportatrice de l’Europe”). Does this contrast or correlate with the notion of “food sovereignty” which originated in 1996 as a notion of small farmer self-sufficiency (Via Campesina), and which now has found its way into the official EC discourse? Recent CAP reforms indeed seem to continue banking on border protection and on the occasional export subsidy. Nonetheless, coming together with claims to mitigate climate change, “food sovereignty” à la CAP fails to acknowledge efficiency losses at home and negative spillover effects on the right to food of food exporting developing countries. This chapter asks whether new non-tariff and domestic support measures are just new wine in the old cask of fortress Europe, together with the FDI promotion instruments of the FED and others. Might the increasing dynamics and new challenges of agricultural trade and investment lead to lower market and production shares for European farms? It concludes that in the medium term the WTO Green Box has the only legal and effective tools to promote EU agriculture and food.

Veil: Mirror of Identity

The Islamic headscarf has become the subject of heated legal and political debate. France and Germany have legislated against it, and even the UK, long a champion of multiculturalism, has recently restricted the veil proper. Ever since home-grown Islamic terrorism struck Europe, these debates have become even more prominent, impassioned and wide-ranging, with vital global importance. In this concise and beautifully written introduction to the politics of the veil in modern societies, Christian Joppke examines why a piece of clothing could have led to such controversy. He dissects the multiple meanings of the Islamic headscarf, and explores its links with the global rise of Islam, Muslim integration, and the retreat from multiculturalism. He argues that the headscarf functions as a mirror of identity, but one in which national and liberal identities overlap, exposing the paradox that while it may be an affront to liberal values, its suppression is equally illiberal.