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

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

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

EXTERNAL VALIDATION OF THE UPDATED PARTIN TABLES IN A COHORT OF FRENCH AND ITALIAN MEN

Purpose: To test the discrimination and calibration properties of the newly developed 2007 Partin Tables in two European cohorts with localized prostate cancer. Methods: Data on clinical and pathologic characteristics were obtained for 1,064 men treated with radical prostatectomy at the Creteil University Health Center in France (n = 839) and at the Milan University Vita-Salute in Italy (n = 225). Overall discrimination was assessed with receiver operating characteristic curve analysis, which quantified the accuracy of stage predictions for each center. Calibration plots graphically explored the relationship between predicted and observed rates of extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion (LNI). Results: The rates of ECE, SVI, and LNI were 28%, 14%, and 2% in the Creteil cohort vs. 11%, 5%, and 5% in the Milan cohort. In the Creteil cohort, the accuracy of ECE, SVI, and LNI prediction was 61%, 71%, and 82% vs. 66%, 92% and 75% for the Milan cohort. Important departures were recorded between Partin Tables' predicted and observed rates of ECE, SVI, and LNI within both cohorts. Conclusions: The 2007 Partin Tables demonstrated worse performance in European men than they originally did in North American men. This indicates that predictive models need to be externally validated before their implementation into clinical practice. (c) 2009 Elsevier Inc