‘I Will Control Your Mind’: The International Regulation of Brain-Hacking

In the near future, the use of neurotechnologies—like brain-computer interfaces and brain stimulation—could become widespread. It will not only be used to help persons with disabilities or illness, but also by members of the armed forces and in everyday life (e.g., for entertainment and gaming). However, recent studies suggested that it is possible to hack into neural devices to obtain information, inflict pain, induce mood change, or influence movements. This Article anticipates three scenarios which may be challenging in the future—i.e., brain hacking for the purpose of reading thoughts, remotely controlling someone, and inflicting pain or death—and assesses their compliance with international human rights law (i.e., the International Covenant on Civil and Political Rights and the European Convention on Human Rights) and international humanitarian law (Geneva Conventions III and IV, and the First Additional Protocol)

Incorporating Biodiversity into Biogeochemistry Models to Improve Prediction of Ecosystem Services in Temperate Grasslands: Review and Roadmap

Multi-species grasslands are reservoirs of biodiversity and provide multiple ecosystem services, including fodder production and carbon sequestration. The provision of these services depends on the control exerted on the biogeochemistry and plant diversity of the system by the interplay of biotic and abiotic factors, e.g., grazing or mowing intensity. Biogeochemical models incorporate a mechanistic view of the functioning of grasslands and provide a sound basis for studying the underlying processes. However, in these models, the simulation of biogeochemical cycles is generally not coupled to simulation of plant species dynamics, which leads to considerable uncertainty about the quality of predictions. Ecological models, on the other hand, do account for biodiversity with approaches adopted from plant demography, but without linking the dynamics of plant species to the biogeochemical processes occurring at the community level, and this hampers the models’ capacity to assess resilience against abiotic stresses such as drought and nutrient limitation. While setting out the state-of-the-art developments of biogeochemical and ecological modelling, we explore and highlight the role of plant diversity in the regulation of the ecosystem processes underlying the ecosystems services provided by multi-species grasslands. An extensive literature and model survey was carried out with an emphasis on technically advanced models reconciling biogeochemistry and biodiversity, which are readily applicable to managed grasslands in temperate latitudes. We propose a roadmap of promising developments in modelling

Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia

BACKGROUND: Antibiotic treatment of community-acquired pneumonia (CAP) in children remains mostly empirical because clinical and paraclinical findings poorly discriminate the principal causes of CAP. Fast response to beta-lactam treatment can be considered a proxy of pneumococcal aetiology. We aimed to identify the best biological predictor of response to beta-lactam therapy in children hospitalized for CAP. METHODS: A retrospective, single-centre cohort study included all consecutive patients 1 month to 16 years old hospitalized in a teaching hospital in Paris, France, because of CAP empirically treated with a beta-lactam alone from 2003 to 2010. Uni- and multivariate analyses were used to study the ability of routine biological parameters available in the Emergency Department to predict a favourable response to beta-lactam (defined as apyrexia within 48 hours of treatment onset). RESULTS: Among the 125 included patients, 85% (106) showed a favourable response to beta-lactam. In multivariate logistic regression, we found procalcitonin (PCT) the only independent predictor of apyrexia (p = 0.008). The adjusted odds ratio for the decadic logarithm of PCT was 4.3 (95% CI 1.5-12.7). At ≥ 3 ng/mL, PCT had 55.7% sensitivity (45.7-65.3), 78.9% specificity (54.4-93.9), 93.7% positive predictive value (84.5-98.2), 24.2% negative predictive value (14.2-36.7), 2.64 positive likelihood ratio (1.09-6.42) and 0.56 negative likelihood ratio (0.41-0.77). In the 4 children with a PCT level ≥ 3 ng/mL and who showed no response to beta-lactam treatment, secondary pleural effusion had developed in 3, and viral co-infection was documented in 1. CONCLUSIONS: PCT is the best independent biologic predictor of favourable response to beta-lactam therapy in children hospitalized for CAP. Thus, a high PCT level is highly suggestive of pneumococcal aetiology. However, a 3-ng/mL cut-off does not seem compatible with daily medical practice, and additional research is needed to further define the role of PCT in managing CAP in children

Neurology

The question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery). We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020. We included female patients with MS aged 18-45 years at MS onset, clinically followed up for more than 2 years, and with ≥3 Expanded Disease Status Scale (EDSS) measurements. Outcomes were the mean EDSS score at the end of follow-up and the annual probability of relapse during follow-up. Counterfactual outcomes were predicted using the longitudinal targeted maximum likelihood estimator in the entire study population. The patients exposed to at least 1 pregnancy during their follow-up were compared with the counterfactual situation in which, contrary to what was observed, they would not have been exposed to any pregnancy. Short-term and delayed effects were analyzed from the first pregnancy of early-exposed patients (who experienced it during their first 3 years of follow-up). We included 9,100 patients, with a median follow-up duration of 7.8 years, of whom 2,125 (23.4%) patients were exposed to at least 1 pregnancy. Pregnancy had no significant long-term causal effect on the mean EDSS score at 9 years (causal mean difference [95% CI] = 0.00 [-0.16 to 0.15]) or on the annual probability of relapse (causal risk ratio [95% CI] = 0.95 [0.93-1.38]). For the 1,253 early-exposed patients, pregnancy significantly decreased the probability of relapse during the perpartum year and significantly increased it during the postpartum year, but no significant delayed effect was found on the EDSS and relapse rate. Using a causal inference approach, we found no evidence of significantly deleterious or beneficial long-term effects of pregnancy on disability. The beneficial effects found in other studies were probably related to a reverse causation bias.Observatoire Français de la Sclérose en Plaque

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

L'efficacité de la Cour pénale internationale à l'épreuve de la souveraineté étatique

International audienc

Cyber-espionage in International Law

Les Etats s’espionnent depuis des siècles, soulevant des tensions. Toutefois, une régulation expresse ne peut être trouvée que dans le droit des conflits armés. Alors que les espions peuvent être capturés et punis, il est paradoxalement admis que leur envoi en temps de guerre n’est pas contraire au droit international. En revanche, aucune règle expresse ne vient réglementer l’espionnage en temps de paix. Une appréhension indirecte n’existe que par le biais de la souveraineté territoriale. En effet, en l’absence de son consentement, l’envoi d’un agent sur le sol d’un territoire étranger est illégal. Cela fait écho à la position ambivalente des Etats sur la scène internationale, qui ont toujours envoyé des espions en territoire étranger. Quand ces agents sont capturés, l’Etat peut les punir conformément à sa législation pénale, protester ou les échanger. Toutefois, l’applicabilité de ce cadre juridique est remise en question par l’émergence du cyber-espionnage, dans la mesure où la présence physique d’un agent n’est plus requise. Le fil d’Ariane de cette thèse est donc de savoir si la dématérialisation et la déterritorialisation de l’espionnage prévient l’application des règles de droit international au cyber-espionnage.La doctrine a tenté de faire face à ce manque de régulation expresse et ces changements. Les auteurs ont habituellement proposé d’appliquer les traités existants, d’examiner la légalité du cyber-espionnage à la lumière des règles de souveraineté et de non-intervention, ou essaient d’identifier de nouvelles règles coutumières. Toutefois, cette thèse perçoit de nombreux problèmes dans cette démarche. En effet, seules de rares références sont faites aux règles d’interprétation contenues dans la Convention de Vienne sur le Droit des Traités, les conclusions de la Commission de Droit International (CDI) sur l’identification du droit international coutumier, ainsi qu’à la pratique étatique. De plus, de nombreuses analogies reposent sur la supposition erronée que le territoire et le cyberespace sont similaires.Huit instruments sont analysés dans cette thèse. Afin de déterminer ce qu’ils ont à dire au sujet du cyber-espionnage, cette recherche propose de recourir aux règles officielles d’interprétation contenue dans la Convention de Vienne, les conclusions de la CDI, et d’incorporer le montant maximum de pratique étatique. Cette thèse conclut finalement que le cyber-espionnage ne viole pas les règles de souveraineté, de non-intervention, la Charte des Nations Unies, l’Accord sur les aspects des droits de propriété intellectuelle qui touchent au commerce et la Constitution de l’Union Internationale des Télécommunications. Elle révèle également que la plupart des règles applicables en temps de guerre sont inapplicables, et que ni l’espionnage ni le cyber-espionnage ne sont interdits par le droit international coutumier. Seule la surveillance des archives et documents digitaux, ainsi que la correspondance électronique et vocale violent la Convention de Vienne sur les Relations Diplomatiques.States have spied on each other for centuries, raising tensions. Yet, express regulation may only be found in the law of war. While spies may be caught and punished, it is paradoxically admitted that sending them does not breach international law. As to peacetime espionage, no similar convention exists, and it has never been expressly prohibited or authorized. An indirect regulation may nevertheless be found in the rule of territorial sovereignty, as–lacking its consent–sending an agent on the soil of another state would be illegal. This echoes states’ ambivalent position on the international stage. They have indeed always sent spies to foreign territories. When those agents were caught, the targeted states punished them in accordance with their domestic law, protested or exchanged them. However, the applicability of this framework is challenged by the emergence of cyber-espionage, as a physical intrusion by an agent is not required anymore. Thus, this thesis’ leading question is whether the dematerialization and de-territorialisation of spying prevents the application of international rules to cyber-espionage.Facing this lack of express regulation and changes, doctrine has tried to fill this loophole. Authors usually propose to apply existing treaties, examine the legality of cyber-spying in the light of sovereignty and non-intervention, or try to identify new customary rules. However, this thesis finds numerous problems in these approaches, as only sparse reference to the rules of treaty interpretation contained in the Vienna Convention on the Law of Treaties (VCLT), the draft conclusions of the International Law Commission (ILC) on the ‘Identification of customary international law’, and even state practice may be found. Then, many analogies rely on the false assumption that cyberspace and land are similar.Eight instruments are under review in this thesis. To determine what they have to say about cyber-spying, this research proposes to resort to the VCLT rules of interpretation, the ILC draft conclusions, and to systematically incorporate the maximal amount of state practice. This thesis finally concludes that cyber-espionage does not breach the rules of sovereignty, non-intervention, the Charter of the United Nations, the Agreement on Trade-Related Aspects of Intellectual Property Rights and the Constitution of the International Telecommunication Union. It also finds that most of wartime rules are inapplicable, while cyber-spying is neither authorized, nor forbidden by customary international law. The sole surveillance of electronic archives, documents and correspondence goes against the Vienna Convention on Diplomatic Relations

L'efficacité de la Cour pénale internationale à l'épreuve de la souveraineté étatique

International audienc