Suicide assisted by right-to-die associations: a population based cohort study

Background: In Switzerland, assisted suicide is legal but there is concern that vulnerable or disadvantaged groups are more likely to die in this way than other people. We examined socio-economic factors associated with assisted suicide. Methods: We linked the suicides assisted by right-to-die associations during 2003–08 to a census-based longitudinal study of the Swiss population. We used Cox and logistic regression models to examine associations with gender, age, marital status, education, religion, type of household, urbanization, neighbourhood socio-economic position and other variables. Separate analyses were done for younger (25 to 64 years) and older (65 to 94 years) people. Results: Analyses were based on 5 004 403 Swiss residents and 1301 assisted suicides (439 in the younger and 862 in the older group). In 1093 (84.0%) assisted suicides, an underlying cause was recorded; cancer was the most common cause (508, 46.5%). In both age groups, assisted suicide was more likely in women than in men, those living alone compared with those living with others and in those with no religious affiliation compared with Protestants or Catholics. The rate was also higher in more educated people, in urban compared with rural areas and in neighbourhoods of higher socio-economic position. In older people, assisted suicide was more likely in the divorced compared with the married; in younger people, having children was associated with a lower rate. Conclusions: Assisted suicide in Switzerland was associated with female gender and situations that may indicate greater vulnerability such as living alone or being divorced, but also with higher education and higher socio-economic position.

Do WTO rules improve or impair the right to food?

The global food crisis of 2007–08 seems to be forgotten. Media attention at the time focused on food riots in Haiti and Mozambique, while world leaders and more than a dozen international organizations gathered for several food summits, calling for immediate relief measures. But not a single government seems to remember its obligations under the Right to Food (R2F) which the United Nations (UN) had enshrined back in 1948. Today we have to acknowledge that the R2F still lacks an adequate response under the present multilateral rules and disciplines applying to food production and trade. This chapter examines the present rules and disciplines under the AoA and of those contemplated in the Doha Development Round. Here we find that despite claims to the contrary they contribute precious little to the R2F. Some of the present rules, or the lack thereof, can even act as disincentives for global and national food security. Various forms of production and export subsidies, food aid abuse and export restrictions, are still WTO-legal, with few remedies available to food insecure developing countries. This amounts to a violation of their R2F obligations by many WTO Members.

Two-dimensional linear-combination model fitting of magnetic resonance spectra to define the macromolecule baseline using FiTAID, a Fitting Tool for Arrays of Interrelated Datasets

To propose the determination of the macromolecular baseline (MMBL) in clinical 1H MR spectra based on T(1) and T(2) differentiation using 2D fitting in FiTAID, a general Fitting Tool for Arrays of Interrelated Datasets.

Modeling of transfer kinetics at the serum-cerebrospinal fluid barrier in rabbits with experimental meningitis: application to grepafloxacin

The goals of the present study were to model the population kinetics of in vivo influx and efflux processes of grepafloxacin at the serum-cerebrospinal fluid (CSF) barrier and to propose a simulation-based approach to optimize the design of dose-finding trials in the meningitis rabbit model. Twenty-nine rabbits with pneumococcal meningitis receiving grepafloxacin at 15 mg/kg of body weight (intravenous administration at 0 h), 30 mg/kg (at 0 h), or 50 mg/kg twice (at 0 and 4 h) were studied. A three-compartment population pharmacokinetic model was fit to the data with the program NONMEM (Nonlinear Mixed Effects Modeling). Passive diffusion clearance (CL(diff)) and active efflux clearance (CL(active)) are transfer kinetic modeling parameters. Influx clearance is assumed to be equal to CL(diff), and efflux clearance is the sum of CL(diff), CL(active), and bulk flow clearance (CL(bulk)). The average influx clearance for the population was 0.0055 ml/min (interindividual variability, 17%). Passive diffusion clearance was greater in rabbits receiving grepafloxacin at 15 mg/kg than in those treated with higher doses (0.0088 versus 0.0034 ml/min). Assuming a CL(bulk) of 0.01 ml/min, CL(active) was estimated to be 0.017 ml/min (11%), and clearance by total efflux was estimated to be 0.032 ml/min. The population kinetic model allows not only to quantify in vivo efflux and influx mechanisms at the serum-CSF barrier but also to analyze the effects of different dose regimens on transfer kinetic parameters in the rabbit meningitis model. The modeling-based approach also provides a tool for the simulation and prediction of various outcomes in which researchers might be interested, which is of great potential in designing dose-finding trials.

Uncrossed cortico-muscular projections in humans are abundant to facial muscles of the upper and lower face, but may differ between sexes

It is a popular concept in clinical neurology that muscles of the lower face receive predominantly crossed cortico-bulbar motor input, whereas muscles of the upper face receive additional ipsilateral, uncrossed input. To test this notion, we used focal transcranial magnetic brain stimulation to quantify crossed and uncrossed cortico-muscular projections to 6 different facial muscles (right and left Mm. frontalis, nasalis, and orbicularis oris) in 36 healthy right-handed volunteers (15 men, 21 women, mean age 25 years). Uncrossed input was present in 78% to 92% of the 6 examined muscles. The mean uncrossed: crossed response amplitude ratios were 0.74/0.65 in right/left frontalis, 0.73/0.59 in nasalis, and 0.54/0.71 in orbicularis oris; ANOVA p>0.05). Judged by the sizes of motor evoked potentials, the cortical representation of the 3 muscles was similar. The amount of uncrossed projections was different between men and women, since men had stronger left-to-left projections and women stronger right-to-right projections. We conclude that the amount of uncrossed pyramidal projections is not different for muscles of the upper from those of the lower face. The clinical observation that frontal muscles are often spared in central facial palsies must, therefore, be explained differently. Moreover, gender specific lateralization phenomena may not only be present for higher level behavioural functions, but may also affect simple systems on a lower level of motor hierarchy.

Headward retreat of streams in the Late Oligocene to Early Miocene Swiss Alps

This study uses the widths, the spacing and the grain-size pattern of Oligo/Miocene alluvial fan conglomerates in the central segment of the Swiss Alpine foreland to reconstruct the topographic development of the Alps. These data are analysed with models of longitudinal stream profile development, to propose that the Alpine topography evolved from an early transient state where streams adjusted to rock uplift by headward retreat, to a mature phase where any changes in rock uplift were accommodated by vertical incision. The first stage comprises the time interval between ca 31 Ma and 22 Ma, when the Alpine streams deposited many small fans with a lateral spacing of <30 km in the north Alpine foreland. As the range evolved, the streams joined and the fans coalesced into a few large depositional systems with a lateral spacing of ca 80 to 100 km at 22 Ma. The models used here suggest that the overall elevation of the Alps increased rapidly within <5 Myr. The variability in pebble size increased either due to variations in sediment supply, enhanced orographic effects, or preferentially due to a change towards a stormier palaeoclimate. By 22 Ma, only two large rivers carried material into the foreland fans, suggesting that the major Alpine streams had established themselves. This second phase of stable drainage network was maintained until ca 5 Ma, when the uplift and erosion of the Molasse started and streams were redirected both in the Alps and in the foreland. This study illustrates that sedimentological archives of foreland basins can be used to reconstruct the chronology of the topographic development of mountain belts. It is suggested that the finite elevation of mountainous landscapes is reached early during orogeny and can be maintained for millions of years, provided that erosion is efficient.