Contested implementation: the unilateral influence of member states on peacebuilding policy in Kosovo

International organizations play an important role in policy implementation. As member states do not necessarily resolve political disagreements before delegating tasks, this article focuses on how individual member states seek to influence policy implementation by international organizations. It argues that the institutional context in which delegation takes place affects the opportunities for such unilateral influence. Particularly when the agent has considerable autonomy, implementation is likely to be a contested process. The article presents evidence on the implementation of peacebuilding policy by three international organizations in Kosovo after independence in 2008. Despite the fact that the member states within the UN, OSCE and EU fundamentally disagree on the legal status of Kosovo, the organizations have deployed substantial peacebuilding missions. The UN, OSCE and EU have, however, different institutional designs: implementing agents in the UN and OSCE have, by default, more autonomy than those in the EU. We analogously observe variation in how and to what extent member states exert unilateral influence during implementation of peacebuilding policy on the ground in Kosovo

A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms:An International Multicenter Cohort Study

Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off >= 0.2 mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size >= 3.0 cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all p <0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). Conclusions: CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival