as it is lived and experienced by elderly people. Between April to December 2013, we conducted 25 in-depth interviews. A reflective lifeworld research design, drawing on the phenomenological tradition, was used during the data gathering and data analysis. The essential meaning of the phenomenon is understood as ‘a tangle of inability and unwillingness to connect to one's actual life’, characterized by a permanently lived tension: daily experiences seem incompatible with people's expectations of life and their idea of whom they are. While feeling more and more disconnected to life, a yearning desire to end life is strengthened.

The experience is further explicated in its five constituents: 1) a sense of aching loneliness; 2) the pain of not mattering; 3) the inability to express oneself; 4) multidimensional tiredness; and 5) a sense of aversion towards feared dependence.

This article provides evocative and empathic lifeworld descriptions contributing to a deeper understanding of these elderly people and raises questions about a close association between death wishes and depression in this sample.

Noninferiority testing in clinical trials : issues and challenges

Elderly people; Assisted suicide; Assisted dying; Existential suffering; Wish to die; Self-directed death; Qualitative phenomenological research

In recent years, there has been a growing scientific interest in elderly people wishing to die without the presence of a life-threatening disease or a severe psychiatric disorder.

Several quantitative studies have been undertaken to determine prevalence rates, characteristics and risk factors associated with the development of death ideation and death wishes in elderly people who are tired of living (Harwood et al., 2001, Jorm et al., 1995 and Rurup et al., 2011a).

In addition, some qualitative studies have been conducted to understand suicidal feelings in elderly people (Crocker et al., 2006, Harwood et al., 2006, Kjølseth et al., 2009, Kjølseth et al., 2010, Rurup et al., 2011b and Rurup et al., 2011c).

Most elderly people who wish to die “will wait until time fulfils their wish” (Rurup et al., 2005) and would probably consider suicide to be unacceptable, associated with despair and mutilation.

In order to describe the phenomenon in all its richness, an in-depth interview study based on Dahlberg's reflective lifeworld approach (Dahlberg et al., 2008) was conducted.

This approach, inspired by the philosophical phenomenology, was chosen because of its primary focus on the lifeworld: the world of lived experience. Rather than giving causal, behavioural explanations and using external theories and interpretive frameworks, the focus is on giving a description of the phenomenon as it is experienced by those who are studied (Finlay, 2011).

The aim of the reflective lifeworld approach is “to illuminate the essence of the phenomenon” under research. For Dahlberg (2006), an essence refers to a common thread through the variety of participants' experiences; the essential characteristics of the phenomenon “without which it would not be that phenomenon”.

Twenty-five people over 70 years of age, who considered their life to be ‘completed’ and no longer worth living, and who strongly wished to die while not being terminally or mentally ill, participated in an in-depth interview exploring their lived experience. Persons were recruited between April and September 2013.

Elderly people who live alone can be assisted by home monitoring systems that identify risk scenarios such as falls, fatigue symptoms or burglary. Given that these systems have to manage spatiotemporal data, human intervention is required to validate automatic alarms due to the high number of false positives and the need for context interpretation. The goal of this work was to provide tools to support human action, to identify such potential risk scenarios based on spatiotemporal data visualisation.

We propose the MTA (multiple temporal axes) model, a visual representation of temporal information of the activity of a single person at different locations. The main goal of this model is to visualize the behaviour of a person in their home, facilitating the identification of health-risk scenarios and repetitive patterns. We evaluate the model's insight capacity compared with other models using a standard evaluation protocol. We also test its practical suitability of the MTA graphical model in a commercial home monitoring system. In particular, we implemented 8VISU, a visualization tool based on MTA.

MTA proved to be more than 90% accurate in identify non-risk scenarios, independently of the length of the record visualised. When the spatial complexity was increased (e.g. number of rooms) the model provided good accuracy form up to 5 rooms. Therefore, user preferences and user performance seem to be balanced. Moreover, it also gave high sensitivity levels (over 90%) for 5–8 rooms. Fall is the most recurrent incident for elderly people. The MTA model outperformed the other models considered in identifying fall scenarios (66% of correctness) and was the second best for burglary and fatigue scenarios (36% of correctness). Our experiments also confirm the hypothesis that cyclic models are the most suitable for fatigue scenarios, the Spiral and MTA models obtaining most positive identifications.

Causes of death in patients with childhood-onset type 1 diabetes receiving dialysis in Japan: Diabetes Epidemiology Research International (DERI) Mortality Study

To investigate the causes of death and how they changed over time in patients with childhood-onset type 1 diabetes who were receiving dialysis.

The leading causes of death were end-stage renal disease (ESRD) (36.3%), cardiovascular disease (CVD) (31.9%), and infections (20.3%). Among CVD, cerebral hemorrhage was the most frequent (38.9%) and showed a significant trend for an increase in the duration of dialysis (P = 0.01, the Cochran–Armitage trend test). The mortality from ESRD concentrated within 5 years of dialysis and that from CVD increased after 10 years of dialysis, while the mortality from infections peaked during 5 to 10 years from initiation of dialysis.

The leading causes of death in dialysis patients with type 1 diabetes were ESRD, CVD, and infections. As the duration of dialysis increased, however, CVD contributed more to mortality. Special attention should be paid to CVD, particularly cerebral hemorrhage, to improve the long-term prognosis of patients.

A large literature demonstrates the direct and indirect influence of health on socioeconomic attainment, and reveals the ways in which health and socioeconomic background simultaneously and dynamically affect opportunities for attainment and mobility. Despite an increasing understanding of the effects of health on social processes, research to date remains limited in its conceptualization and measurement of the temporal dimensions of health, especially in the presence of socioeconomic circumstances that covary with health over time. Guided by life course theory, we use data from the British National Child Development Study, an ongoing panel study of a cohort born in 1958, to examine the association between lifetime health trajectories and socioeconomic attainment in middle age. We apply finite mixture modeling to identify distinct trajectories of health that simultaneously account for timing, duration and stability. Moreover, we employ propensity score weighting models to account for the presence of time-varying socioeconomic factors in estimating the impact of health trajectories. We find that, when poor health is limited to the childhood years, the disadvantage in socioeconomic attainment relative to being continuously healthy is either insignificant or largely explained by time-varying socioeconomic confounders. The socioeconomic impact of continuously deteriorating health over the life course is more persistent, however. Our results suggest that accounting for the timing, duration and stability of poor health throughout both childhood and adulthood is important for understanding how health works to produce social stratification. In addition, the findings highlight the importance of distinguishing between confounding and mediating effects of time-varying socioeconomic circumstances.

1. Introduction
A growing body of sociological research reveals a strong association between early life adversity and life course patterns of inequality (Guo, 1998, Torche, 2011 and Warren et al., 2012). Childhood is a key period for understanding the relationship between socioeconomic disadvantage and its persistent effects over the life course, and substantial evidence demonstrates the effects of socioeconomic disadvantage on socioeconomic processes and health over the life course (Mackenbach et al., 2008, Smith, 2003 and Wagmiller et al., 2006). As a form of childhood adversity that is closely intertwined with both biological and social processes, recent evidence points to the role of poor health during childhood in generating social and economic inequality within and across generations (Palloni, 2006). Health is a marker of population welfare that is unequally distributed at the time of birth, remains unequally distributed with age, and has important implications for social and economic patterns observed over the life course. Evidence that health plays a role in determining social position suggests a process of “health selection” into social and economic roles. Socioeconomic background and health work simultaneously and dynamically to affect socioeconomic attainment, to the extent that socioeconomic background is a determinant of both health and socioeconomic attainment (Adler et al., 1994, Smith, 2003, Finch, 2003 and Wagmiller et al., 2006), and health at different ages has both direct and indirect effects on opportunities for socioeconomic attainment and mobility. Health selection, therefore, results from and contributes to socioeconomic disadvantage.

A wide spectrum of quantitative systems approaches such as life cycle assessment or integrated assessment models are available to assess sustainable development strategies. These methods describe certain aspects of the biophysical basis of society, which comprises in-use stocks and the processes and flows that maintain and operate these stocks. Despite this commonality, the methods are often developed and applied in isolation, which dampens scientific progress and complicates communication between scientists and decision makers. As research on socioecological systems matures, more structure and classification are needed. We argue that the concept of socioeconomic metabolism (SEM), which was developed in material flow analysis and material flow accounting, is a powerful boundary object that can serve as paradigm for studying the biophysical basis of human society. A common paradigm can facilitate model combination and integration, which can lead to more robust and comprehensive interdisciplinary assessments of sustainable development strategies. We refine the notion of SEM, clarify the relation between SEM and the economy, and provide a list of features that we believe qualifies SEM as research paradigm. We argue that SEM as paradigm can help to justify alternative economic concepts, suggest analogies that make the concept more accessible, and discuss its limitations.

On the use of structural equation models for marketing modeling

We reflect on the role of structural equation modeling (SEM) in marketing modeling and managerial decision making. We discuss some benefits provided by SEM and alert marketing modelers to several recent developments in SEM in three areas: measurement analysis, analysis of cross-sectional data, and analysis of longitudinal data.

Objectives: To investigate the determinants of self rated health (SRH) in men and women in the British Whitehall II study and the French Gazel cohort study.

Background Raising duty on alcohol across the board can reduce morbidity, mortality and other adverse consequences of alcohol use. However, effectiveness is less certain for measures that target specific types of alcohol beverage in isolation. One example from Australia was the increase in tax on alcopops favoured by young people to curb risky drinking in this demographic.

Methods We measured alcohol-related health harms in 15–29-year-olds presenting to emergency departments (EDs) in Queensland following the tax increase. These presentations were compared with following ED controls: (1) 15–29-year-olds with asthma or appendicitis; and (2) 30–49-year-olds presenting with alcohol-related harms. We analysed data over a 5-year period (April 2005–April 2010) using a time series analysis. This covered 3 years before, and 2 years after, the tax increase. We investigated both mental and behavioural consequences (F10 codes), and intentional/unintentional injuries (S and T codes).

Results We fitted an ARIMA (autoregressive integrated moving average) model to test for a change following the increased ‘alcopops’ tax in April 2008. There was no significant decrease in alcohol-related ED presentations in 15–29-year-olds compared to any of the controls. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s and ED presentations at night-time and weekends.

Methods We measured alcohol-related health harms in 15–29-year-olds presenting to emergency departments (EDs) in Queensland following the tax increase. These presentations were compared with following ED controls: (1) 15–29-year-olds with asthma or appendicitis; and (2) 30–49-year-olds presenting with alcohol-related harms. We analysed data over a 5-year period (April 2005–April 2010) using a time series analysis. This covered 3 years before, and 2 years after, the tax increase. We investigated both mental and behavioural consequences (F10 codes), and intentional/unintentional injuries (S and T codes).