Pelvic lymph node dissection in the context of radical cystectomy: a thorough insight into the connection between patient, surgeon, pathologist and treating institution

Pelvic lymph node dissection (PLND) in patients with bladder cancer varies widely in extent, technique employed, and pathological workup of specimens. The present paper provides an overview of the existing evidence regarding the effectiveness of PLND and elucidates the interactions between patient, surgeon, pathologist, and treating institution as well as their cumulative impact on the final postoperative lymph node (LN) staging. Bladder cancer patients undergoing radical cystectomy with extended PLND appear to have better oncologic outcomes compared to patients undergoing radical cystectomy and limited PLND. Attempts have been made to define and assess the quality of PLND according to the number of lymph nodes identified. However, lymph node counts depend on multiple factors such as patient characteristics, surgical template, pathological workup, and institutional policies; hence, meticulous PLND within a defined and uniformly applied extended template appears to be a better assurance of quality than absolute lymph node counts. Nevertheless, the prognosis of the patients can be partially predicted with findings from the histopathological evaluation of the PLND specimen, such as the number of positive lymph nodes, extracapsular extension, and size of the largest LN metastases. Therefore, particular prognostic parameters should be addressed within the pathological report to guide the urologist in terms of patient counseling.

Enquiry into the Notion of Cultural Protectionism in the Media and its Dimensions in Cyberspace

Cultural protectionism has been an element of national and foreign policies, as an extension of state sovereignty expressed both in a defensive and offensive manner. While the generic protectionist formula in the sense of restraining trade between states through measures such as import tariffs or quotas and through privileging domestic production has somewhat disintegrated over time under the rationale for free trade and the strong practical evidence of its benefits, the particular case of cultural protectionism has persevered. As we reveal in this paper, however, it has been modified, or at least its rhetoric has changed. The enquiry into the notion of cultural protectionism or cultural diversity, as the current political jargon would have it, is but one of the paper’s objectives. Its second and certainly more ambitious goal is the search for the normative dimensions of cultural diversity policies in the global digital space, asking what adjustments are needed and how feasible the entire project of diversity regulation in this environment may be. Taking into account the specificities of cyberspace and in a forward-looking manner, we propose some adjustments to current media policy practices that could better serve the goal of a sustainably diverse cultural environment.

The Protection and Promotion of Cultural Diversity in a Digital Networked Environment : Mapping Possible Advances to Coherence

The present paper is the result of a four-year-long project examining the concept and the policies of cultural diversity and the impact of digital media upon the regulatory environment where the goal of cultural diversity is to be achieved. The focus of the project was primarily on the international level and in particular on the World Trade Organization (WTO) and the United Nations Educational Scientific and Cultural Organization (UNESCO), which also epitomise the often framed as opposing pair of trade and culture. In the broad context of the project, we sought to pinpoint the essential elements of an international trade-and-culture conducive framework that can also overcome the existing fragmentation in the field of international law and move towards more coherent solutions. In a narrower context, we sketched some possible improvements to the WTO law that can make it more suitable to the digital networked environment and to the objective of diverse media that some states aspire. . Our key messages are: (1) Neither the WTO nor UNESCO currently offers appropriate solutions to the trade and culture predicament and allows for efficient protection and promotion of cultural diversity; (2) The trade and culture discourse is overly politicised and due to the related path dependencies, a number of feasible solutions appears presently blocked; (3) The digital networked environment has profoundly changed the ways cultural content is created, distributed, accessed and consumed, and may thus offer good reasons to reassess and readjust the present models of governance; (4) Access to information appears to be the most appropriate focus of the discussions with view to protecting and promoting cultural diversity in the new digital media setting, both in local and global contexts; (5) This new focal point demands also broadening and interconnecting the policy discussions, which should go beyond the narrow scope of audiovisual media services, but cautiously account for the developments at the network and applications levels, as well as in other domains, such as most notably intellectual property rights protection; (6) There are various ways in which the WTO can be made more conducive to cultural policy considerations and these include, among others, improved and updated services classifications; enhanced legal certainty with regard to digitally transferred goods and services; incorporation of rules on subsidies for services and on competition.

Vulnerability Following a Critical Life Event: Temporary Crisis or Chronic Distress? A Psychological Controversy, Methodological Considerations, and Empirical Evidence

This contribution deals with psychological vulnerability resulting from marital breakup after a long-term relationship. Despite the existing vast body of consolidated knowledge on divorce and psychological adaptation, there are still several controversies concerning the vulnerabilizing impact of marital breakup. One major issue refers to the question of whether vulnerability after marital breakup is a temporary crisis or rather a chronic strain. In this chapter we want to present two possible methodological options to tackle this question: First, comparing a sample of almost 1000 middle-aged persons, who were married on average 19 years, and who experienced a marital split within the last 5 years (4 time groups), with a group of age-matched married controls with regard to various indicators of psychological vulnerability (such as depression and hopelessness). Second, comparing within the divorced group the most vulnerable individuals (in terms of depression, hopelessness, life satisfaction) with those who were the least affected, regarding intra-personal resources (personality, resilience), divorce circumstances, post-divorce situation, and socio-economic resources. The study results underline the vulnerabilizing impact of marital breakup, but at the same time they reveal individual differences in psychological adaptation especially due to personality, new partnership, economic resources, and last but not least due to time. Furthermore our data strongly suggest that there is not a generalized psychological vulnerability after marital breakup, but that the emotional dimensions such as depression or feelings of not overcoming the loss are more affected than the more cognitive ones such as life satisfaction.

Food Security and Agri-Foreign Direct Investment in Weak States: Finding the Governance Gap to Avoid ‘Land Grab’

Food security is important. A rising world population coupled with climate change creates growing pressure on global world food supplies. States alleviate this pressure domestically by attracting agri-foreign direct investment (agri-FDI). This is a high-risk strategy for weak states: the state may gain valuable foreign currency, technology and debt-free growth; but equally, investors may fail to deliver on their commitments and exploit weak domestic legal infrastructure to ‘grab’ large areas of prime agricultural land, leaving only marginal land for domestic production. A net loss to local food security and to the national economy results. This is problematic because the state must continue to guarantee its citizens’ right to food and property. Agri-FDI needs close regulation to maximise its benefit. This article maps the multilevel system of governance covering agri-FDI. We show how this system creates asymmetric rights in favour of the investor to the detriment of the host state’s food security and how these problems might be alleviated.

Swiss Policies for more Food Security

Resource-poor yet blissful Switzerland is also one of the most food-secure countries in the world: there are abundant food supplies, relatively low retail prices in terms of purchasing power parity, with few poverty traps. Domestic production covers 70% of net domestic consumption. A vast and efficient food reserve scheme insures against import disruptions. Nonetheless, the food security contribution by the four sectoral policies involved is mutually constrained: our agriculture is protected by the world’s highest tariffs. Huge subsidies, surface payments, and some production quotas substitute market signals with rent maximisation. Moreover, these inefficiencies also prevent trade and investment policies which would keep markets open, development policies which would provide African farmers with the tools to become more competitive, and supply policies which would work against speculators. The paralysing effect of Swiss agricultural policies is exacerbated by new “food security subsidies” in the name of “food sovereignty” while two pending people’s initiatives might yet increase the splendid isolation which in effect reduce Swiss farmer competitiveness and global food security. Is there a solution? Absent a successful conclusion of the Doha Round (WTO) or a Transatlantic Trade and Investment Partnership Agreement (TTIP) further market openings and a consequent “recoupling” of taxpayer support to public goods production remain highly un-likely. To the very minimum Switzerland should resume the agricultural reform process, join other countries trying to prevent predatory behaviour of its investors in developing countries, and regionalise its food reserve.

Linking Landscape Protection and Nature Conservation: Switzerland’s Experience with Protected Mire Landscapes

Since 1987, Switzerland’s Federal Inventory of Mire Landscapes of Particular Beauty and National Importance has provided an instrument for the integration of nature conservation and landscape protection. Mires and mire landscape protection are strictly regulated. However, research results show that neither the goals of mire protection nor those of mire landscape protection are being achieved. The reasons for this are manifold and, in particular, have to do with a lack of coordination between the various policy areas that shape mire environments and mire landscapes. There are several key challenges involving different political and administrative levels. At the national level, mechanisms must be devised that enable differentiated regional implementation of national sectoral policies. In the context of cantonal structure planning, regional nature conservation and landscape protection priorities should be established based on existing regional potentials vis-à-vis the natural environment and landscapes (including protected biotopes and landscapes). At the regional level (spanning multiple communes), integrated planning instruments and governance structures should be developed so that implementation of national and cantonal sectoral policies may be harmonized under the umbrella of regional and integrated development plans. These adjustments to Switzerland’s institutional system are necessary to enable far-reaching integration of nature conservation and landscape protection when setting regional policy priorities. This would strengthen the protection of mire landscapes and other integrative instruments such as regional nature parks of national importance.

Labour Migration, Trade and Investment: From Fragmentation to Coherence

Trade, investment and migration are strongly intertwined, being three key factors in international production. Yet, law and regulation of the three has remained highly fragmented. Trade is regulated by the WTO on the multilateral level, and through preferential trade agreements on the regional and bilateral levels – it is fragmented and complex in its own right. Investment, on the other hand, is mainly regulated through bilateral investment treaties with no strong links to the regulation of trade or migration. And, finally, migration is regulated by a web of different international, regional and bilateral agreements which focus on a variety of different aspects of migration ranging from humanitarian to economic. The problems of institutional fragmentation in international law are well known. There is no organizational forum for coherent strategy-making on the multilateral level covering all three areas. Normative regulations may thus contradict each other. Trade regulation may bring about liberalization of access for service providers, but eventually faces problems in recruiting the best people from abroad. Investors may withdraw investment without being held liable for disruptions to labour and to the livelihood and infrastructure of towns and communities affected by disinvestment. Finally, migration policies do not seem to have a significant impact as long as trade policies and investment policies are not working in a way that is conducive to reducing migration pressure, as trade and investment are simply more powerful on the regulatory level than migration. This chapter addresses the question as to how fragmentation of the three fields could be reme-died and greater coherence between these three areas of factor allocation in international economic relations and law could be achieved. It shows that migration regulation on the international level is lagging behind that on trade and investment. Stronger coordination and consideration of migration in trade and investment policy, and stronger international cooperation in migration, will provide the foundations for a coherent international architecture in the field.

The Dialectical Relationship of Preferential and Multilateral Trade Agreements

Preferentialism and multilateralism are not two independent and succinct avenues in the pur-suit of market access and regulatory policies. They historically build upon each other in a dialectical process, closely related and linked through regulatory bridges and references. They influence and direct each other in various ways. The paper mainly focuses on the evolution of international protection of intellectual property rights and of services. The multilateral regulation of the TRIPS and others derive from years of regulatory experience and high numbers of preferential agreements across the globe. The GATS and others, on the other hand, have entered the pluri- or multilateral stage early. Once regulation has reached the mul-tilateral stage, preferentialism focuses on WTO-plus and -extra commitments. Both areas, however, show close interaction. The principle of MFN ensures that multilateralism and preferentialism do not evolve independently from each other. It produces significant spill-over effects of preferential agreements. Such effects and the need to develop uniform and coherent regulatory standards have led in parallel to a number of preferential, plurilateral and multilateral regulatory initiatives. We submit that the process will eventually encourage the return to multilateralism and negotiations in international fora, in particular the WTO while traditional market access may stay with preferential relations among Nations. Such burden-sharing between different regulatory fora should be reflected in future WTO rules providing the overall backbone of the system.