EU trade agreements and their impacts on human rights: study commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ)

The European Union’s (EU) trade policy has a strong influence on economic development and the human rights situation in the EU’s partner countries, particularly in developing countries. The present study was commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) as a contribution to further developing appropriate methodologies for assessing human rights risks in development-related policies, an objective set in the BMZ’s 2011 strategy on human rights. The study offers guidance for stakeholders seeking to improve their knowledge of how to assess, both ex ante and ex post, the impact of Economic Partnership Agreements on poverty reduction and the right to food in ACP countries. Currently, human rights impacts are not yet systematically addressed in the trade sustainability impact assessments (trade SIAs) that the European Commission conducts when negotiating trade agreements. Nor do they focus specifically on disadvantaged groups or include other benchmarks relevant to human rights impact assessments (HRIAs). The EU itself has identified a need for action in this regard. In June 2012 it presented an Action Plan on Human Rights and Democracy that calls for the inclusion of human rights in all impact assessments and in this context explicitly refers to trade agreements. Since then, the EU has begun to slightly adapt its SIA methodology and is working to define more adequate human rights–consistent procedures. It is hoped that readers of this study will find inspiration to help contribute to this process and help improve human rights consistency of future trade options.

Cytokine induction in human mononuclear cells stimulated by IgG-coated culture surfaces and by IgG for infusion

The effect of IgG on cytokine production by human mononuclear cells (MNC) was studied. Tumor necrosis factor-alpha (TNF) was determined both by bioassay and by immunoassay. Interleukin-1 (IL1) was measured by a thymocyte costimulator assay, which was shown to be completely inhibitable by polyclonal anti-IL1. Precautions were taken to avoid inadvertent exposure of the studied cells to endotoxin. In a first model, TNF and IL1 production by adherent MNC in IgG-coated cluster plates were determined. IgG induced a strong TNF response, usually leveling off after 6 hr, and was comparable in kinetics and magnitude with an LPS-induced response. The thymocyte co-stimulatory activity response was relatively weak and peaked at 6 hr. In contrast, LPS-induced co-stimulatory activity production steadily increased over 24 hr. In a second model, MNC in suspension cultures containing autologous serum were exposed to IgG for intravenous use (IgG-IV). Cells exposed to IgG-IV produced higher amounts of cytokines than control counterparts and were primed for enhanced production of cytokines upon a second, unrelated stimulus. This implies that the effect of IgG-IV on suspended MNC resembles that of surface-adsorbed IgG and raises the possibility that cytokine release is an integral part of the mechanism of action of infused IgG. Evidence is presented suggesting that both surface IgG and IgG-IV act directly on monocytes, in a Fc-dependent manner.

Alpine Common Property Institutions under Change: Conditions for Successful and Unsuccessful Collective Action by Alpine Farmers in the Canton of Grisons, Switzerland

The protection and sustainable management of alpine summer pastures has been stated as a goal in Swiss national law since 1996, and direct payments from the state for summer pasturing have been tied to sustainability criteria since 2000. This reflects the increasing value of the alpine cultural landscape as a public good. However, provision of this public good remains in the hands of local farmers and their local common pool resource (CPR) institutions for managing alpine pastures. These institutions are increasingly struggling to maintain their institutional arrangements, particularly regarding the work needed to maintain the pastures. This paper examines two cases of local CPR institutions for managing alpine pastures in the Swiss Canton of Grisons that manifest different institutional developments in light of changing conditions. The differences in how these institutions reacted to change and the impacts this has had on the provision of the CPR are explained by focusing on relative prices, bargaining power, and ideology as drivers of institutional change that are often neglected within common property research. Key words: summer pasture management, institutional change, bargaining power, ideology

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Health-Related Quality of Life of Young Adults Treated with Recombinant Human Growth Hormone during Childhood.

BACKGROUND Since recombinant human growth hormone (rhGH) became available in 1985, the spectrum of indications has broadened and the number of treated patients increased. However, long-term health-related quality of life (HRQoL) after childhood rhGH treatment has rarely been documented. We assessed HRQoL and its determinants in young adults treated with rhGH during childhood. METHODOLOGY/PRINCIPAL FINDINGS For this study, we retrospectively identified former rhGH patients in 11 centers of paediatric endocrinology, including university hospitals and private practices. We sent a questionnaire to all patients treated with rhGH for any diagnosis, who were older than 18 years, and who resided in Switzerland at time of the survey. Three hundred participants (58% of 514 eligible) returned the questionnaire. Mean age was 23 years; 56% were women; 43% had isolated growth hormone deficiency, or idiopathic short stature; 43% had associated diseases or syndromes, and 14% had growth hormone deficiency after childhood cancer. Swiss siblings of childhood cancer survivors and the German norm population served as comparison groups. HRQoL was assessed using the Short Form-36. We found that the Physical Component Summary of healthy patients with isolated growth hormone deficiency or idiopathic short stature resembled that of the control group (53.8 vs. 54.9). Patients with associated diseases or syndromes scored slightly lower (52.5), and former cancer patients scored lowest (42.6). The Mental Component Summary was similar for all groups. Lower Physical Component Summary was associated with lower educational level (coeff. -1.9). Final height was not associated with HRQoL. CONCLUSIONS/SIGNIFICANCE In conclusion, HRQoL after treatment with rhGH in childhood depended mainly on the underlying indication for rhGH treatment. Patients with isolated growth hormone deficiency/idiopathic short stature or patients with associated diseases or syndromes had HRQoL comparable to peers. Patients with growth hormone deficiency after childhood cancer were at high risk for lower HRQoL. This reflects the general impaired health of this vulnerable group, which needs long-term follow-up.

Achievements and Challenges 20 Years after Beijing: A View from Switzerland

Despite being one of the world’s wealthiest countries and most modern economies, in Switzerland gender equality remains an elusive challenge. Paid maternity leave, legal abortion and an increase in women’s educational attainment are some of the milestones achieved since 1995, when the country was one of 189 states to adopt the Beijing Declaration and Platform for Action at the Fourth World Conference on Women. But while legal gender equality may be nearly achieved, much remains to be done to achieve gender equality in practice. Rigid gender stereotypes, wage discrimination, women’s heavy care burden, segregation in the workplace, violence against women, under-representation of women in political and economic decision making, and structural obstacles to reconciling family duties with employment still stand in the way of gender equality. In order to realize gender equality, government, employers, politicians and civil society all need to take concrete and coordinated actions. These range from changes in the educational sector, in the labour market and in the social security system to an active foreign policy that promotes women’s human rights.

Caffeine affects the biological responses of human hematopoietic cells of myeloid lineage via downregulation of the mTOR pathway and xanthine oxidase activity.

Correction of human myeloid cell function is crucial for the prevention of inflammatory and allergic reactions as well as leukaemia progression. Caffeine, a naturally occurring food component, is known to display anti-inflammatory effects which have previously been ascribed largely to its inhibitory actions on phosphodiesterase. However, more recent studies suggest an additional role in affecting the activity of the mammalian target of rapamycin (mTOR), a master regulator of myeloid cell translational pathways, although detailed molecular events underlying its mode of action have not been elucidated. Here, we report the cellular uptake of caffeine, without metabolisation, by healthy and malignant hematopoietic myeloid cells including monocytes, basophils and primary acute myeloid leukaemia mononuclear blasts. Unmodified caffeine downregulated mTOR signalling, which affected glycolysis and the release of pro-inflammatory/pro-angiogenic cytokines as well as other inflammatory mediators. In monocytes, the effects of caffeine were potentiated by its ability to inhibit xanthine oxidase, an enzyme which plays a central role in human purine catabolism by generating uric acid. In basophils, caffeine also increased intracellular cyclic adenosine monophosphate (cAMP) levels which further enhanced its inhibitory action on mTOR. These results demonstrate an important mode of pharmacological action of caffeine with potentially wide-ranging therapeutic impact for treating non-infectious disorders of the human immune system, where it could be applied directly to inflammatory cells.