Should the Law Governing Maritime Areas in the Arctic Adapt to Changing Climatic Circumstances?

The legal regime of the Arctic maritime areas has for a long time remained on the backburner of international norm creating activities. This can primarily be explained by the inhospitable climate which created natural barriers for human activities and imposed limits on the usefulness of the available technology.At present, however, climate change seems to be responsible for a marked heating up, not only of the mere physical environment of the Arctic, but also of the political tensions concerning the exact legal regime to be applied in the region.This chapter provides a close examination of the present-day legal status of the Arctic. Since almost all territorial claims have been settled in the area, the present contribution will only focus on the Arctic water areas with a special emphasis on navigation. Starting from what seems to have finally become a generally accepted legal cornerstone for appreciating the legal status of these waters, namely the 1982 United Nations Convention on the Law of the Sea, the chapter will first examine how climate change impacts on this legal regime. Subsequently, the vulnerability as well as the adaptive capacity of the 1982 Convention will be examined. Before drawing some conclusions, ways and means will be looked at for this existing legal system to better meet the new challenges that climate change poses for Arctic waters

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

High surgical volume is associated with a lower rate of secondary therapy after radical prostatectomy for localized prostate cancer

OBJECTIVE To assess the relationship between surgical volume (SV), defined as the number of radical prostatectomies (RPs) within a calendar year, and the time to secondary therapy (ST) after RP, as this might represent an important determinant of cancer control. PATIENTS AND METHODS The study included 7937 men treated with RP by 130 urologists between 1989 and 2000. Radiotherapy or any form of hormonal manipulation represented ST. Univariable and multivariable Cox regression analyses was used to evaluate the time to ST after RP. RESULTS SV was an independent (P = 0.02) predictor of ST-free survival after RP, and the multivariable rate of ST sharply decreased with increasing SV. CONCLUSIONS The use of ST is inversely proportional to SV of up to 24 RPs per year. A higher annual SV might be indicative of less restrictive use of RP in high-risk patients who eventually require combined treatments

The effect of surgical volume, age and comorbidities on 30-day mortality after radical prostatectomy: a population-based analysis of 9208 consecutive cases

OBJECTIVE To examine the effect of surgical volume (SV) on 30-day mortality after radical prostatectomy (RP; reportedly 0.1-0.6% and influenced by age and comorbidities) and to explore the most informative SV, age and comorbidity thresholds to distinguish between high- and low-risk men. PATIENTS AND METHODS Between 1989 and 2000, 9208 consecutive patients were treated with RP. The effects on 30-day mortality of (either continuously coded or categorized) patient age, comorbidities (Charlson Comorbidity Index, CCI) and SV were tested in multivariable logistic regression models. The models were corrected for overfit bias using 200 bootstrap re-samples and were displayed graphically as nomograms. RESULTS The overall 30-day mortality was 0.52%; being younger ( 27 RPs, 0.07 vs 0.6% otherwise, P = 0.049) had a protective effect and represented independent predictors of 30-day mortality. After correction for overfit bias, their combined input was 72.3% accurate in predicting 30-day mortality, vs 67.1% (P 27 RPs) can accurately identify patients at negligible risk of 30-day mortality