Swiss State Research Articles

Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial

Postoperative hemithoracic radiotherapy has been used to treat malignant pleural mesothelioma, but it has not been assessed in a randomised trial. We assessed high-dose hemithoracic radiotherapy after neoadjuvant chemotherapy and extrapleural pneumonectomy in patients with malignant pleural mesothelioma. We did this phase 2 trial in two parts at 14 hospitals in Switzerland, Belgium, and Germany. We enrolled patients with pathologically confirmed malignant pleural mesothelioma; resectable TNM stages T1-3 N0-2, M0; WHO performance status 0-1; age 18-70 years. In part 1, patients were given three cycles of neoadjuvant chemotherapy (cisplatin 75 mg/m(2) and pemetrexed 500 mg/m(2) on day 1 given every 3 weeks) and extrapleural pneumonectomy; the primary endpoint was complete macroscopic resection (R0-1). In part 2, participants with complete macroscopic resection were randomly assigned (1:1) to receive high-dose radiotherapy or not. The target volume for radiotherapy encompassed the entire hemithorax, the thoracotomy channel, and mediastinal nodal stations if affected by the disease or violated surgically. A boost was given to areas at high risk for locoregional relapse. The allocation was stratified by centre, histology (sarcomatoid vs epithelioid or mixed), mediastinal lymph node involvement (N0-1 vs N2), and T stage (T1-2 vs T3). The primary endpoint of part 1 was the proportion of patients achieving complete macroscopic resection (R0 and R1). The primary endpoint in part 2 was locoregional relapse-free survival, analysed by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00334594. We enrolled patients between Dec 7, 2005, and Oct 17, 2012. Overall, we analysed 151 patients receiving neoadjuvant chemotherapy, of whom 113 (75%) had extrapleural pneumonectomy. Median follow-up was 54·2 months (IQR 32-66). 52 (34%) of 151 patients achieved an objective response. The most common grade 3 or 4 toxic effects were neutropenia (21 [14%] of 151 patients), anaemia (11 [7%]), and nausea or vomiting (eight [5%]). 113 patients had extrapleural pneumonectomy, with complete macroscopic resection achieved in 96 (64%) of 151 patients. We enrolled 54 patients in part 2; 27 in each group. The main reasons for exclusion were patient refusal (n=20) and ineligibility (n=10). 25 of 27 patients completed radiotherapy. Median total radiotherapy dose was 55·9 Gy (IQR 46·8-56·0). Median locoregional relapse-free survival from surgery, was 7·6 months (95% CI 4·5-10·7) in the no radiotherapy group and 9·4 months (6·5-11·9) in the radiotherapy group. The most common grade 3 or higher toxic effects related to radiotherapy were nausea or vomiting (three [11%] of 27 patients), oesophagitis (two [7%]), and pneumonitis (two [7%]). One patient died of pneumonitis. We recorded no toxic effects data for the control group. Our findings do not support the routine use of hemithoracic radiotherapy for malignant pleural mesothelioma after neoadjuvant chemotherapy and extrapleural pneumonectomy. Swiss Group for Clinical Cancer Research, Swiss State Secretariat for Education, Research and Innovation, Eli Lilly.

Health in police officers: Role of risk factor clusters and police divisions

ObjectiveLaw enforcement is a stressful occupation associated with significant health problems. To date, most studies have focused on one specific factor or one domain of risk factors (e.g., organizational, personal). However, it is more likely that specific combinations of risk factors are differentially health relevant and further, depend on the area of police work. MethodsA self-selected group of officers from the criminal, community, and emergency division (N = 84) of a Swiss state police department answered questionnaires assessing personal and organizational risk factors as well as mental and physical health indicators. ResultsIn general, few differences were observed across divisions in terms of risk factors or health indicators. Cluster analysis of all risk factors established a high-risk and a low-risk cluster with significant links to all mental health outcomes. Risk cluster-by-division interactions revealed that, in the high-risk cluster, Emergency officers reported fewer physical symptoms, while community officers reported more posttraumatic stress symptoms. Criminal officers in the high-risk cluster tended to perceived more stress. Finally, perceived stress did not mediate the relationship between risk clusters and posttraumatic stress symptoms. ConclusionIn summary, our results support the notion that police officers are a heterogeneous population in terms of processes linking risk factors and health indicators. This heterogeneity thereby appeared to be more dependent on personal factors and individuals' perception of their own work conditions than division-specific work environments. Our findings further suggest that stress-reduction interventions that do not target job-relevant sources of stress may only show limited effectiveness in reducing health risks associated with police work.

Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial

One of the standard options in the treatment of stage IIIA/N2 non-small-cell lung cancer is neoadjuvant chemotherapy and surgery. We did a randomised trial to investigate whether the addition of neoadjuvant radiotherapy improves outcomes. We enrolled patients in 23 centres in Switzerland, Germany and Serbia. Eligible patients had pathologically proven, stage IIIA/N2 non-small-cell lung cancer and were randomly assigned to treatment groups in a 1:1 ratio. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (100 mg/m(2) cisplatin and 85 mg/m(2) docetaxel) followed by radiotherapy with 44 Gy in 22 fractions over 3 weeks, and those in the control group received neoadjuvant chemotherapy alone. All patients were scheduled to undergo surgery. Randomisation was stratified by centre, mediastinal bulk (less than 5 cm vs 5 cm or more), and weight loss (5% or more vs less than 5% in the previous 6 months). The primary endpoint was event-free survival. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00030771. From 2001 to 2012, 232 patients were enrolled, of whom 117 were allocated to the chemoradiotherapy group and 115 to the chemotherapy group. Median event-free survival was similar in the two groups at 12·8 months (95% CI 9·7-22·9) in the chemoradiotherapy group and 11·6 months (8·4-15·2) in the chemotherapy group (p=0·67). Median overall survival was 37·1 months (95% CI 22·6-50·0) with radiotherapy, compared with 26·2 months (19·9-52·1) in the control group. Chemotherapy-related toxic effects were reported in most patients, but 91% of patients completed three cycles of chemotherapy. Radiotherapy-induced grade 3 dysphagia was seen in seven (7%) patients. Three patients died in the control group within 30 days after surgery. Radiotherapy did not add any benefit to induction chemotherapy followed by surgery. We suggest that one definitive local treatment modality combined with neoadjuvant chemotherapy is adequate to treat resectable stage IIIA/N2 non-small-cell lung cancer. Swiss State Secretariat for Education, Research and Innovation (SERI), Swiss Cancer League, and Sanofi.

The spectacle of the hunger-stricken body: a German–Italian terrorist, Swiss prisons and the (ir)rational body politic

In Central Europe, terrorist attacks by Communist and anarchist groups were a common occurrence in the 1970s. Many of them existed ‘underground’, robbing banks and carrying out bombings of symbolic places, as well as kidnapping high-profile public figures. Arguably some of the most publicised terrorist acts happened in prison. In Switzerland, it was the hunger strikes of Italian-German anarchist Petra Krause that unsettled the Swiss state and its citizens. Not only did her prison resistance manage to confound the gendered power relations between the rational, sane body politic and the unsavoury, emaciated body of the irrational hunger striker, she also upturned the gendered differentiation between the masculine perpetrator and the feminine victim. Finally, her hunger strikes garnered much attention and support among the radical Left and feminists alike. Her body politics thus point to the vulnerability of the citizen-subject, and more importantly, to weaknesses of the state. Indeed, imagery of the prisoners' feminised bodies broke out of the confines of the prison to cause more than just a public spectacle.

Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial

The role of bleomycin and dacarbazine in the ABVD regimen (ie, doxorubicin, bleomycin, vinblastine, and dacarbazine) has been questioned, especially for treatment of early-stage favourable Hodgkin's lymphoma, because of the drugs' toxicity. We aimed to investigate whether omission of either bleomycin or dacarbazine, or both, from ABVD reduced the efficacy of this regimen in treatment of Hodgkin's lymphoma. In this open-label, randomised, multicentre trial (HD13) we compared two cycles of ABVD with two cycles of the reduced-intensity regimen variants ABV (doxorubicin, bleomycin, and vinblastine), AVD (doxorubicin, vinblastine, and dacarbazine), and AV (doxorubicin and vinblastine), in patients with newly diagnosed, histologically proven, classic or nodular, lymphocyte predominant Hodgkin's lymphoma. In each treatment group, 30 Gy involved-field radiotherapy (IFRT) was given after both cycles of chemotherapy were completed. From Jan 28, 2003, patients were centrally randomly assigned (1:1:1:1) with a minimisation method to the four groups. Because of high event rates, assignment to the AV and ABV groups stopped early, on Sept 30, 2005, and Feb 10, 2006; assignment to ABVD and AVD continued (1:1) until Sept 30, 2009. Our primary objective was to show non-inferiority of the experimental variants compared with ABVD in terms of freedom from treatment failure (FFTF), by excluding a difference of 6% after 5 years corresponding to a hazard ratio (HR) of 1.72, via a 95% CI. Analyses reported here include qualified patients only, and between-group comparisons include only patients recruited during the same period. The trial was registered, number ISRCTN63474366. Of 1502 qualified patients, 566, 198, 571, and 167 were randomly assigned to receive ABVD, ABV, AVD, or AV, respectively. 5 year FFTF was 93.1%, 81.4%, 89.2%, and 77.1% with ABVD, ABV, AVD, and AV, respectively. Compared with ABVD, inferiority of the dacarbazine-deleted variants was detected with 5 year differences of -11.5% (95% CI -18.3 to -4.7; HR 2.06 [1.21 to 3.52]) for ABV and -15.2% (-23.0 to -7.4; HR 2.57 [1.51 to 4.40]) for AV. Non-inferiority of AVD compared with ABVD could also not be detected (5 year difference -3.9%, -7.7 to -0·1; HR 1.50, 1.00 to 2.26). 178 (33%) of 544 patients given ABVD had WHO grade III or IV toxicity, compared with 53 (28%) of 187 given ABV, 142 (26%) of 539 given AVD, and 40 (26%) of 151 given AV. Leucopenia was the most common event, and highest in the groups given bleomycin. Dacarbazine cannot be omitted from ABVD without a substantial loss of efficacy. With respect to our predefined non-inferiority margin, bleomycin cannot be safely omitted either, and the standard of care for patients with early-stage favourable Hodgkin's lymphoma should remain ABVD followed by IFRT. Deutsche Krebshilfe and Swiss State Secretariat for Education and Research.

Payment schemes and cost efficiency: evidence from Swiss public hospitals.

This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

L’émigration illégale des Italiens en France et en Suisse après la Deuxième Guerre mondiale

The Illegal Immigration of Italians to France and Switzerland after the Second World War: Differences and Similarities of French and Swiss Immigration Policies The great size of the black labour market and the restrictive legal immigration policies of both the French and the Swiss State were the main causes for the illegal immigration of Italians to France and Switzerland after the Second World War. While the French State actively controlled and encouraged the immigration of foreign workers by promoting settlement services to immigrants and their families, the Swiss immigration policy was characterized rather by reluctance and even hostility towards the reunification of immigrant families. In both countries, the restrictive nature of immigration policy was designed to reduce the number of foreign workers during economic crises. However, it also complicated the recruitment of foreign workers during phases of economic growth. Illegal immigration enabled both the French and the Swiss State to add the necessary flexibility to this rigid framework.

Does an Active Use of Mechanisms of Direct Democracy Impact Electoral Participation? Evidence from the U.S. States and the Swiss Cantons

This article investigates the consequences that frequent uses of mechanisms of direct democracy have on electoral turnout, contrasting evidence from the Swiss cantons and states in the United States. It contributes to the existing literature in two senses. First, it constitutes the very first cross-national comparative study on the topic and, therefore, it allows for examination of hypotheses the literature previously advanced for single cases (mostly, but not wholly, confined to the U.S. and Switzerland). Second, in contrast to previous research, it delves into the world of direct democracy and shows that not all MDDs are the same, nor do they have the same political effects in terms of electoral participation. I demonstrate that the previous U.S.-based knowledge does not resist empirical testing when contrasted with Swiss evidence: active use of citizen-driven initiatives have no statistically significant effects on turnout. Nonetheless, voter turnout rates are significantly lower in states and cantons with more top-down measures on the ballot.

Eleven-year physical activity trends in a Swiss urban area

ObjectiveRegular physical activity is a major health determinant. Little is known about physical activity trends. We evaluated whether adult physical activity levels are changing in a Swiss urban state (Geneva). MethodWe analyzed 11-year trends of physical activity indicators, including 3+MET-minutes per week and physical activity outside working hours, in population representative adults (n=9320, aged 35–74years, 50% women), relating declared physical activity to socioeconomic status, lifestyle, and clinical and blood markers. ResultsCombining yearly cohorts from 1999 to 2009, we found a significant trend for increased physical activity levels. Weekly age and sex adjusted 3+MET-minutes per week increased from 3023 to 3752, between 1999 and 2009 (P=0.02). The increase also concerned physical activity outside working hours (+18kcal/day/year). There was a shift from low levels of physical activity levels towards higher activities. Physical activity indicators were associated with socioeconomic status, comorbidities, and biological and anthropometric measures. The trend for increased physical activity was more prominent over the latter 5years. ConclusionWe found that physical activity levels have increased in an urban Swiss state. The increase is significant but small, and further efforts to promote physical activity are therefore warranted.

Use of lights and siren

The objective of this study was to analyse the use of lights and siren (L&S) during transport to the hospital by the prehospital severity status of the patient and the time saved by the time of day of the mission. We searched the Public Health Services data of a Swiss state from 1 January 2010 to 31 December 2010. All primary patient transports within the state were included (24 718). The data collected were on the use of L&S, patient demographics, the time and duration of transport, the type of mission (trauma vs. nontrauma) and the severity of the condition according to the National Advisory Committee for Aeronautics (NACA) score assigned by the paramedics and/or emergency physician. We excluded 212 transports because of missing data. A total of 24 506 ambulance transports met the inclusion criteria. L&S were used 4066 times, or in 16.6% of all missions. Of these, 40% were graded NACA less than 4. Overall, the mean total transport time to return to the hospital was 11.09 min (confidence interval 10.84-11.34) with L&S and 12.84 min (confidence interval 12.72-12.96) without. The difference was 1.75 min (105 s; P<0.001). For night-time runs alone, the mean time saved using L&S was 0.17 min (10.2 s; P=0.27). At present, the use of L&S seems questionable given the severity status or NACA score of transported patients. Our results should prompt the implementation of more specific regulations for L&S use during transport to the hospital, taking into consideration certain physiological criteria of the victim as well as time of day of transport.

MARC H. LERNER. A Laboratory of Liberty: The Transformation of Political Culture in Republican Switzerland, 1750-1848.

Marc H. Lerner begins the conclusion to his excellent monograph with a glance at Switzerland's recent past. In the mid-1990s, the Swiss government, parliament, and public engaged in a fiery debate over a commemorative year, namely 1998. The question was, which anniversary would be celebrated? On the one hand, the modern, federal, and democratic Swiss state is usually held to have been born in 1848. The constitution of that year was the result of an accommodation between conservative and liberal cantons, which had taken up arms against each other in a twenty-seven-day civil conflict, the Sonderbund War, in November of the previous year. On the other hand, some members of parliament suggested that a different anniversary be celebrated: the bicentenary of the Helvetic Republic, created in 1798 after the country was occupied by an army invading from revolutionary France. There was a public outcry against this proposal. One letter to the press described it as “perverse.” The controversy raised such questions as the role of historical memory in modern Swiss political culture, but it also struck on one of the essential problems that beset Switzerland in Lerner's hundred-year period: how to shape a federal political order in a century when European states moved, not without considerable pain and stress, from basing their legitimacy on notions of historical precedent, custom, and theological authority to foundations grounded in such principles as popular sovereignty, the individual citizen, and human rights.

Science diplomacy with swissnex China: A Swiss nation brand initiative

Switzerland has a long tradition of expertise in the fields of science, research and education, with ‘science diplomacy’ (SD) now assuming an important role for innovation economies. Past experience shows that international scientific cooperation can have valuable outcomes for the involved countries and complements traditional foreign policy and diplomacy. In Switzerland, a worldwide network of science and technology (S&T) outposts under the auspices of the Swiss State Secretariat for Education and Research in cooperation with the Federal Department of Foreign Affairs was established in 2000. The very swissnex network around the world defines one of those established SD instruments. In this article, we discuss the swissnex office in China, which acts both as a physical and virtual environment to foster closer ties between Switzerland and China in S&T, innovation and culture. This case study examines the history and mission of swissnex China, its role and organizational structure, and reviews other nations’ comparable branding initiatives. The article analyzes clients and partners, as well as the main challenges for swissnex China during its 3 years of operation.

A Swiss anomaly? A relational account of national boundary-making

. This article reviews how major theorists of nationalism – from Ernest Renan to Benedict Anderson – have tried to come to grips with the puzzle that Swiss nationalism and the Swiss state present in view of the monoethnic states that surround it. I will argue that this puzzle disappears when assuming a political sociology perspective that highlights the networks of political alliances underlying nationalist movements and the power structure of recently formed nation-states. Studying an ‘outlier’ case such as Switzerland helps us to gain insight into the general processes and mechanisms at work in the rise of nationalism and the nation-state.

Switzerland as a ‘fractured nation’

This article deals with Swiss nationalism and Swiss nation-building. Its main thesis is that Switzerland cannot accurately be described as either a nation or a non-nation but is something in between, and could thus best be characterised as a 'fractured' nation. Switzerland has experienced some powerful nationalist moments, from the creation of the Swiss state in 1848 to the last few decades. Yet this recurrent nationalism among the Swiss, considered alongside their more traditional reluctance to consider themselves a nation, make Switzerland a peculiar object: a 'fractured' nation. This flawed process of nation-building in turn reveals some basic characteristics of all nations - inherent artificiality, and the tremendous efforts undertaken to hide it. Switzerland could be considered an unfinished, incomplete nation, and this is precisely why its study can be interesting for scholars of nations and nationalism.

Decentralized Taxation and the Size of Government: Evidence from Swiss State and Local Governments

According to the Leviathan Model, fiscal federalism is a binding constraint on revenue‐maximizing government. The competitive pressure of fiscal federalism reduces public sector size, as compared to unitary states. This study uses panel data of Swiss cantons from 1980 to 1998 to empirically analyze the effect of different instruments on government revenue and its structure. Because of the considerable tax autonomy of sub‐national Swiss governments, it is possible to investigate different mechanisms by which fiscal federalism may influence government size. The results indicate that tax exporting has a revenue‐expanding effect; whereas, tax competition favors a smaller size of government. Fragmentation has no robust effect on the size of government revenue for Swiss cantons. The overall effect of revenue decentralization leads to fewer tax revenues but higher user charges. Thus, revenue decentralization favors a smaller size of government revenue and shifts government revenue from taxes to user charges.

Far away and nearby: Holocaust remembrance and human rights education in Switzerland

The article considers how young people in Swiss schools are taught about the history and background of the Holocaust within the wider perspective of human rights education, as an important basis for education concerning democratic citizenship. Given the country’s specific history, for decades the Holocaust was not a matter of great interest in Swiss schools, or a topic that pupils often learned about as a part of their own history. Recently, however, sensitivity about historical incidents and the processes of the Third Reich has increased. Holocaust education has also become more important in the context of Swiss state institutional policy and non-governmental initiatives and has also become an issue in schools. This article includes an overview of relevant Swiss history and the current political situation, and a review of Swiss educational policies and especially of activities related to Holocaust remembrance and human rights education.

How Do Electoral Systems Affect Fiscal Policy? Evidence from State and Local Governments, 1890 to 2005

Using a new data set on Swiss state and local governments from 1890 to today, we analyze how the adoption of proportional representation affects fiscal policy. We show that proportional systems shift spending toward broad goods (e.g. education and welfare benefits) but decrease spending on targetable goods (e.g. roads and agricultural subsidies). Our evidence does not suggest that proportional representation increases the overall size of government. We provide new evidence on the mechanism behind these estimates. We show that proportional elections lead to better political representation of left-wing parties, which are associated with more spending. Furthermore, proportional elections lead to higher political fragmentation. However, since political fragmentation increases spending in a plurality system only, proportional elections reduce spending through its more moderate effects of fractionalized parliaments.

Switzerland's nation branding initiative to foster science and technology, higher education and innovation: A case study

This article presents a case study about Switzerland's initiative to promote its science and technology, higher education and innovation environment. This is accomplished through a worldwide network of science and technology outposts run by the Swiss State Secretariat for Education and Research in cooperation with the Federal Department of Foreign Affairs. In this article, we specifically discuss the outpost located in Boston. swissnex Boston acts as a physical and virtual environment to foster closer ties between Switzerland and the Boston region in various fields of interest to academia, industry, business and society. We present the history and mission of swissnex Boston, its role and organizational structure, and a benchmarking analysis of other nations’ initiatives. We further discuss the required leadership and performance measurement of swissnex Boston and the main challenges it has surmounted in its 10 years of operation.

The World of Organic Agriculture: Statistics and Emerging Trends 2008

The 17th edition of The World of Organic Agriculture, published by the Research Institute of Organic Agriculture (FiBL) and IFOAM – Organics International, provides a comprehensive review of recent developments in global organic agriculture. It includes contributions from representatives of the organic sector from throughout the world and provides comprehensive organic farming statistics that cover area under organic management, specific information about land use in organic systems, numbers of farms and other operator types as well as selected market data. The book also contains information on the global market for organic food, information on standards and regulations, organic policy, as well as insights into current and emerging trends in organic agriculture in Africa, Asia, Europe, Latin America and the Caribbean, North America and Oceania. In addition, the volume contains reports about the organic sector in Australia, Canada, the Pacific Islands, Thailand, and the United States of America, as well as brief updates for various countries in Asia as well as Latin America and the Caribbean. New additions to this edition are an article on organic cotton from the Textile Exchange and a chapter reviewing eight key commodities certified by selected Voluntary Sustainability Standards (VSS). This book has been produced with the support of the International Trade Centre (ITC), the Swiss State Secretariat for Economic Affairs (SECO) and NurnbergMesse.

The World of Organic Agriculture: Statistics and Emerging Trends 2008

Organic agriculture is practiced in 186 countries, and 71.5 million hectares of agricultural land are managed organically by approximately 2.8 million farmers. The global sales of organic food and drink reached more than 96 million euros in 2018. The 21st edition of The World of Organic Agriculture, published by the Research Institute of Organic Agriculture (FiBL) and IFOAM – Organics International, provides a comprehensive review of recent developments in global organic agriculture. It includes contributions from representatives of the organic sector around the world and presents detailed organic farming statistics that cover the area under organic management, specific information about land use in organic systems, the number of farms and other operator types, and selected market data. The book also contains information about the global market for organic food, information on standards and regulations, organic policy, and insights into current and emerging trends in organic agriculture in Africa, Asia, Europe, the Mediterranean, Latin America and the Caribbean, North America, and Oceania. In addition, the volume includes reports about the organic sector in Australia, Canada, the Pacific Islands, and the United States of America and brief updates for various countries in Asia. This book has been produced with the support of the International Trade Centre (ITC), the Swiss State Secretariat for Economic Affairs (SECO), the Coop Sustainability Fund of Coop, and NurnbergMesse. The views expressed herein can in no way be taken to reflect the official opinions of ITC, SECO, or NurnbergMesse. +++ Affiliates of IFOAM – Organics International order the book at a reduced price directly from IFOAM – Organics International . Tel. +49 (0)228 926 50-10+49 (0)228 926 50-10; HeadOffice@ifoam.bio; www.ifoam.bio