Jurisdiction and Management of Arctic Marine Transportation

Although the United States and Canada have different views regarding jurisdiction over the waters surrounding arctic islands, both countries nevertheless share many concerns about marine transportation in high latitudes. Among these concerns are environmental protection, safety, impacts of development on northern peoples and third party transit of arctic waters. These common concerns suggest that there is much potential for cooperative activity and problem solving in the Arctic. Specific suggestions are made regarding possibilities for coordination of transit management activities. A range of options is presented for both the jurisdiction and management elements of a transit regime for the Arctic. It is the thesis of this article that, despite jurisdictional disagreements, the U.S. and Canada can develop a transit regime that satisfies the interests and concerns of both.Key words: Arctic, jurisdiction, management, marine transportation, regimeMots clés: Arctique, juridiction, gestion, transport maritime, régim

Revue des connaissances et technologies utilisées pour restaurer et créer des habitats côtiers

Les habitats côtiers font partie des systèmes les plus productifs et les plus sensibles de la planète. Ils sont aussi soumis à de très grandes pressions des activités humaines qui continuent à s'étendre. En conséquence, de nombreux habitats côtiers naturels ont disparu ou ont été sérieusement dégradés. Reconnaissant l'importance de la bonne santé des habitats côtiers pour des fonctions naturelles et des besoins humains, ce rapport fait l'inventaire des méthodes et des technologies généralement utilisées pour restaurer ou recréer ces habitats importants. On s'intéressera tout particulièrement aux technologies pour restaurer les zones humides, les habitats côtiers peu profonds, les plages et les dunes. La restauration de certains habitats tropicaux, tels que les mangroves et les récifs coralliens, n'est que brièvement évoquée. Les méthodes et technologies présentées ici pour la restauration des zones humides côtières comprennent l'utilisation de matériaux de dragage, la gestion de l'avancée ou du recul des marais côtiers, la modification des conditions hydrologiques et la plantation de végétaux. Les chapitres sur les habitats infra-littoraux traitent des méthodes de restauration des herbiers, l'utilisation de récifs artificiels et la construction de bennes. La partie sur la restauration des dunes et des plages se focalise sur la gestion dynamique de la dune, sur l'alimentation artificielle des plages et la reconstruction d'îles "barrières". Dans tous les cas, les méthodes et technologies sont illustrées de quelques exemples. Ceux-ci sont tirés de projets récents aux États-Unis, au Royaume-Uni, aux Pays-Bas et en Italie. Les autres thèmes développés brièvement comprennent des considérations de planning de restauration, une discussion sur l'utilisation de la bioremédiation pour réhabiliter les biotopes côtiers contaminés, et une discussion sur l'usage de la télédétection et des SIG pour la gestion des projets de restauration

Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial.

ImportanceLess than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant.ObjectiveTo determine the relative effectiveness and safety of 3 common alternate treatments for MDD.Design, setting, and participantsFrom December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks.InterventionsSwitch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase).Main outcomes and measuresThe primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C16] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects.ResultsAmong 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain.Conclusions and relevanceAmong a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach.Trial registrationclinicaltrials.gov Identifier: NCT01421342