sm Engage China to Uphold Multilateralism – But Not at Any Cost By feedproxy.google.com Published On :: Thu, 23 May 2019 11:14:05 +0000 12 June 2019 Harriet Moynihan Senior Research Fellow, International Law Programme @HarrietMoyniha9 Where China’s interests align with those of the international community, there are opportunities for the country’s influence and economic power to strengthen the rules-based international order. Where they do not, states that traditionally support that order should join together to push back. 2019-02-01-China.jpg Students holding Chinese national flags watch the live broadcast of the 40th anniversary celebration of China's reform and opening-up at Huaibei Normal University on 18 December. Photo: Getty Images. China’s adherence to the rules-based international system is selective, prioritizing certain rules in favour of others. States supportive of that ‘system’ – or, as some argue, systems[1] – should identify areas of mutual strategic interest so that they can draw China further into the global rules-based order and leverage China as a constructive player that potentially also contributes to improvements in such areas. This is particularly apposite at a time when the US is in retreat from multilateralism and Russia seems bent on disrupting the rules-based international order.Supportive playerThere are many reasons for actively engaging with China on mutual areas of interest. China is a committed multilateralist in many areas, recognizing that often international cooperation and frameworks hold the key to its domestic problems, for example in the fields of environmental sustainability and financial regulation.China’s economic power is valuable in upholding international institutions: China is the UN’s third-largest donor (after the US and Japan) at a time when the UN is facing budgetary shortfalls. China is also the second-highest contributor to the UN peacekeeping budget, and the largest contributor of peacekeeping forces among the five permanent members of the UN Security Council.China also has a valuable role to play in the settlement of international disputes over trade and investment. China is a big supporter of the World Trade Organization (WTO)’s dispute settlement mechanism, and one of its most active participants;[2] China is currently playing an active role in negotiations to save the WTO’s appellate mechanism from folding in the wake of the US’s refusal to nominate new judges.The last 15 years have also seen a major shift in Chinese attitudes to investment arbitration, from a general suspicion and limitation of arbitration rights to broad acceptance and incorporation of such rights in China’s trade and investment treaties. China is actively engaged in multilateral negotiations through the UN Commission on International Trade Law (UNCITRAL) on reforms to investor–state dispute settlement.China has shown leadership on global climate change diplomacy, urging nations to remain committed to the Paris Agreement in the wake of the US decision to pull out, and has been an important interlocutor with the UK and the EU on these issues. As a strong supporter of the Paris Agreement, but also as the world’s top emitter of carbon dioxide, China has a crucial role to play in pushing forward implementation of the Paris targets. Despite its high emissions, China remains one of the few major economies on track to meet its targets,[3] giving it greater leverage to peer review other parties’ efforts.A recent report by the UK parliament’s Foreign Affairs Committee (FAC), on China and the rules-based international order, noted that where a body of trust and goodwill is developed with China, there is the possibility of discovering interests that coincide and the ability to work together on issues mutually regarded as of global importance. The report refers to a number of success stories from UK partnership with China in multilateral forums, including in counterproliferation and global health.[4]Developing areas of global governanceAs well as working with the current system, China is increasingly involved in the shaping of newer areas of international law – whether it be submissions to the International Tribunal for the Law of the Sea (ITLOS) on procedural rules for the emerging deep-sea mining regime or pitching for a greater role in Arctic governance.[5]This enthusiasm should be harnessed to promote the international rule of law, but at the same time there needs to be recognition of the strategic goals that drive China’s engagement. China’s interest in the Arctic, while including the desire to protect its ecology and environment, is also about access to marine resources, as well as about the Arctic’s strategic potential for China’s military.China’s submissions to ITLOS on the rules of procedure for deep-sea mining are constructive, but also reflect an ambition to secure first-mover advantage when commercial mining eventually takes place. Like other major powers working in this policy area, China’s actions are guided by self-interest, but that doesn’t mean its goals can’t be pursued through multilateral rules.China is also interested in creating new international structures and instruments that further its strategic aims. For example, with Russia (through the Shanghai Cooperation Organisation) it has proposed an International Code of Conduct for Information Security in the UN.[6]China is also pondering an array of options for dispute-resolution mechanisms for its Belt and Road projects, including the possibility of an Asian version of the international Convention on the Settlement of Investment Disputes, which might sit under the auspices of the Asian Infrastructure Investment Bank (AIIB).[7]The creation of new instruments and institutions need not be a threat to the rules-based international order in itself. We have already seen a combination of the creation of parallel complementary regimes alongside the reform of existing institutions, for example in development financing through the AIIB or the New Development Bank (often referred to as the ‘BRICS Bank’); these two banks are relatively conventionally structured along the lines of Western-dominated institutions, albeit with greater Chinese control. Based on these examples, selective adaptation seems more likely than a hostile ‘Eastphalian’ takeover.[8]RisksThere is, however, a real risk that in certain areas China may promote a rival authoritarian model of governance, assisted by an opportunistic convergence with Russia on issues such as human rights, development and internet governance. In areas where China’s core interests clash with those of the rules-based international order, China has shown itself to be unbending, as in its refusal to abide by the July 2016 decision of the Permanent Court of Arbitration in its dispute with the Philippines over the South China Sea.[9]China is becoming more assertive at the UN, but while it seeks to project itself there as a responsible emerging global leader, it is promoting a vision that weakens international norms of human rights, transparency and accountability,[10] while also carrying out practices domestically that raise serious human rights concerns (not least the detention of hundreds of thousands of Uighurs in re-education camps in Xinjiang).[11]China’s increased dominance geographically and geopolitically through its Belt and Road infrastructure projects carries with it a number of social and economic risks, including smaller states becoming trapped in unsustainable financial debts to China.But at a recent Chatham House conference on Asia and international law, participants highlighted the limitations on how far China can shape an alternative governance model.[12] China currently lacks soft power, cultural power and language power, all of which are needed in order to embed an alternative model abroad. China also currently lacks capacity and confidence to build coalitions with other states in the UN.Where it has tried to get buy-in from the international community for its new institutions, such as the China International Commercial Court (CICC) announced in July 2018, there has been scepticism about the standards to be applied.[13] Unless the court can demonstrate sufficient due process, international parties are likely to prefer other centres with a strong reputation for upholding the rule of law, such as those in London, Dubai and Singapore.Where China does promote its own governance model at the expense of the rules-based international order, states are starting to push back, often in concert. EU member states so far have adopted a joined-up approach to the Belt and Road Initiative. With the exception of Italy, they have refused to sign a Memorandum of Understanding on participation unless China provides much greater transparency on its compliance with international standards.The EU also recently presented a coordinated response to China on the situation in Xinjiang.[14] Similarly, members of the so-called ‘Five Eyes’ intelligence-sharing alliance (comprising Australia, Canada, New Zealand, the UK and the US) have acted together in relation to certain incidents of cyber interference attributed to China.[15]There are also signs of pushback from smaller states closer to home in relation to challenges to national sovereignty, debt diplomacy and financial viability arising from Belt and Road projects. The Sri Lankan government recently reversed the award of a $300 million housing deal to China, instead opting for a joint venture with an Indian company.China has been downscaling its investments as a way to counter some of the backlash it has received: the most recent Belt and Road summit put forward a more modest set of aspirations. This suggests that there is some scope for states to stand up to China and use leverage to secure better deals.Many international institutions have been Western-dominated for years;[16] China, together with many emerging and middle powers, has felt for some time that the international architecture does not reflect the world we live in. Given that context, states that champion the rules-based international order should acknowledge China’s desire to update the international order to reflect greater multipolarity, globalization and technological change, while being clear-eyed about their engagement with China. This involves investing in a proper understanding of China and how it works.[17]Where possible, cooperation with China should lead to outcomes that are backed up by international standards and transparency. The above-mentioned FAC report cites evidence that the UK’s support, and that of other developed countries, had a positive impact in shaping the governance and standards of the AIIB.[18] China has brought in international experts to advise on disputes before the CIIC, which may reassure would-be litigants.China’s relationship with the rules-based international order needs to be assessed pragmatically and dynamically. China can be a valuable partner in many areas where its objectives are closely aligned with those of the international community – from trade to climate change to peacekeeping.But where the country’s core interests are at odds with those of the wider international community, an increasingly confident China will strongly resist pressure, including on the South China Sea and human rights. In these areas, states supportive of international law can most powerfully push back through alliances and by ensuring that their own core values are not compromised in the interests of economic benefits.What needs to happenChina’s rising power and selective commitment to multilateralism make it a potentially influential ally in modernizing international governance.China is increasingly involved in shaping newer areas of international law. This enthusiasm could be harnessed in the service of institutional development and reform.Other states should identify areas of mutual strategic interest where China may offer a constructive role, including dispute settlement, health and climate change.However, engagement must not ignore the strategic calculations that drive China’s agenda, or its poor record on civil and political rights, transparency and accountability.Cooperation with China should lead to outcomes that are backed up by international standards and transparency.Where China’s actions undermine the rules-based international order, coordinated action by states supportive of that order is likely to be more effective than acting individually.Notes[1] Chalmers, M. (2019), Which Rules? Why There is No Single ‘Rules-Based International System’, RUSI Occasional Paper, April 2019, London: Royal United Services Institute, https://rusi.org/occasional-papers/Which-Rules-Why-There-Is-No-Single-Rules-Based-International-System.[2] See, for example, Moynihan, H. (2017), China’s Evolving Approach to International Dispute Settlement, Briefing, London: Royal Institute of International Affairs, https://www.chathamhouse.org/publication/chinas-evolving-approach-international-dispute-settlement.[3] UN Environment (2018), Emissions Gap Report 2018, p. XVII, https://www.unenvironment.org/resources/emissions-gap-report-2018.[4] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System: Sixteenth Report of Session 2017–19, p. 32, https://publications.parliament.uk/pa/cm201719/cmselect/cmfaff/612/612.pdf.[5] Moynihan, H. (2018), ‘China Expands Its Global Governance Ambitions in the Arctic’, Expert Comment, 15 October 2018, https://www.chathamhouse.org/expert/comment/china-expands-its-global-governance-ambitions-arctic.[6] Updated version proposed 9 January 2015.[7] Moynihan, H. (2018), ‘Exploring Public International Law Issues with Chinese Scholars – Part Four’, Meeting Summary, 3 June 2018, https://www.chathamhouse.org/publication/exploring-public-international-law-issues-chinese-scholars-part-four.[8] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’, conference summary, https://www.chathamhouse.org/event/security-and-prosperity-asia-pacific-role-international-law.[9] Permanent Court of Arbitration Case No. 2013-19 (Philippines v China), Award of 12 July 2016, https://pca-cpa.org/wp-content/uploads/sites/6/2016/07/PH-CN-20160712-Award.pdf.[10] Piccone, T. (2018), China’s Long Game on Human Rights at the United Nations, Washington, DC: Brookings Institution, https://www.brookings.edu/wp-content/uploads/2018/09/FP_20181009_china_human_rights.pdf.[11] Wye, R. (2018), ‘‘The entire Uyghur population is seemingly being treated as suspect’: China’s persecution of its Muslim minority’, LSE Religion and Global Society blog, 18 September 2018, https://blogs.lse.ac.uk/religionglobalsociety/2018/09/the-entire-uyghur-population-is-seemingly-being-treated-as-suspect-chinas-persecution-of-its-muslim-minority/.[12] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’.[13] Walters, M. (2018), ‘Jury is out over China’s new commercial court, say lawyers’, Law Society Gazette, 1 November 2018, https://www.lawgazette.co.uk/law/jury-is-out-over-chinas-new-commercial-court-say-lawyers/5068125.article.[14] The Economist (2019), ‘Hope remains for Western solidarity. Look at embassies in Beijing’, 17 April 2019, https://www.economist.com/china/2019/04/20/hope-remains-for-western-solidarity-look-at-embassies-in-beijing.[15] In December 2018, the Five Eyes attributed the activities of a Chinese cyber espionage group targeting intellectual property and sensitive commercial property to China’s Ministry of State Security.[16] Roberts, A. (2017), Is International Law International?, Oxford: Oxford University Press.[17] Parton, C. (2019), China–UK Relations: Where to Draw the Border Between Influence and Interference?, RUSI Occasional Paper, February 2019, London: Royal United Services Institute, p. 30, https://rusi.org/publication/occasional-papers/china-uk-relations-where-draw-border-between-influence-and.[18] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System, p. 15.This essay was produced for the 2019 edition of Chatham House Expert Perspectives – our annual survey of risks and opportunities in global affairs – in which our researchers identify areas where the current sets of rules, institutions and mechanisms for peaceful international cooperation are falling short, and present ideas for reform and modernization. Full Article
sm Yasmin Afina By feedproxy.google.com Published On :: Thu, 27 Jun 2019 09:35:12 +0000 Research Assistant, International Security Programme Biography Yasmin Afina joined Chatham House as research assistant for the International Security programme in April 2019. She formerly worked for the United Nations Institute for Disarmament Research (UNIDIR)’s Security and Technology Programme, and the United Nations Office for Disarmament Affairs (UNODA).Yasmin’s research at Chatham House covers projects related to nuclear weapons systems, strategic weapons systems, emerging technologies including cyber and artificial intelligence, and international law.In her previous capacities, Yasmin’s research included international, regional and national cybersecurity policies, the international security implications of quantum computing, and algorithmic bias in autonomous technologies and law enforcement operations.Yasmin holds an LL.M. from the Geneva Academy of International Humanitarian Law and Human Rights, an LL.B. from the University of Essex, and a French Bachelor of Laws and Postgraduate degree (Maîtrise) in International Law from the Université Toulouse I Capitole. Areas of expertise Cybersecurity of weapons systems, command control and communication systemsCybersecurity policies and governanceAutonomous technologies (incl. artificial intelligence, machine learning)International law (incl. international humanitarian law, international human rights law, jus ad bellum)Nuclear weapons policy Past experience 2018-19Programme assistant, security and technology, United Nations Institute for Disarmament Research (UNIDIR)2017-18Project assistant, emerging security issues, United Nations Institute for Disarmament Research (UNIDIR)2017Weapons of Mass Destruction Programme, United Nations Institute for Disarmament Research (UNIDIR)2017-18LL.M., Geneva Academy of International Humanitarian Law and Human Rights (CH)2016-17Maîtrise, Université Toulouse I Capitole (FR)2016Convention on Certain Conventional Weapons Implementation Support Unit, United Nations Office for Disarmament Affairs (UNODA) Geneva Branch2013-17LL.B., University of Essex (UK)2013-16Licence (Bachelor of Laws), Université Toulouse I Capitole (FR)2014Volunteer, World YWCA Email @afinayasmin LinkedIn Full Article
sm Virtual Roundtable: The End of Globalism? Remaining Interconnected While Under Increased Pressure to Isolate By feedproxy.google.com Published On :: Wed, 25 Mar 2020 14:30:01 +0000 Invitation Only Research Event 30 March 2020 - 1:00pm to 2:00pm Zoom Audio Call Event participants Fred Hochberg, Chairman and President, Export-Import Bank of the United States, 2009 -17Chair: Dr Leslie Vinjamuri, Director, US and the Americas Programme, Chatham House This event is part of the Chatham House Global Trade Policy Forum. We would like to take this opportunity to to thank founding partner AIG and supporting partners Clifford Chance LLP, Diageo plc and EY for their generous support of the forum. Department/project US and the Americas Programme, Global Trade Policy Forum US and Americas Programme Email Full Article
sm Trust boss gave misleading information to GMC about consultant who was unfairly dismissed By feeds.bmj.com Published On :: Tuesday, May 5, 2020 - 15:31 Full Article
sm Med Treatments India | Medical Tourism in India | Healthcare India By investing.96.lt Published On :: Thu, 24 Aug 2017 09:08:35 UTC Med Treatments India offers one stop solution for medical healthcare services and most affordable treatments facility with best hospitals & alternative treatments in India. Full Article Sports and Health
sm Smogasbord By kolembo.wordpress.com Published On :: Wed, 26 Aug 2015 18:44:12 +0000 Smogasbord, and so Health, A dashboard of delights. Supine could be; Relaxed on a hospital bed, Goose down, Luxurious but bad for your back, Foam, Sometimes current but initially, Uncomfortable, A sister healed, A discussion beyond Mum, Silver hair framing, Ice-blue eyes, Wrinkles round a mouth; Ripe fruit is determined by smell, and A mango, […] Full Article Poetry cancer death family health poetry
sm The smell of new curtains By kolembo.wordpress.com Published On :: Sun, 23 Oct 2016 20:12:31 +0000 It came from the right side like God, or a deer, a Migraine warning; Chemotherapy strikes at any time. Where am I going wrong? Under community skies and red roofed buildings, immaculate And unfinished, Holding on for next week’s rent, Even if you were alive, I’d not have listened, Missing a father to say […] Full Article Poetry cancer friendship hope internet relationships love
sm The Painting with the smudge By kolembo.wordpress.com Published On :: Sun, 09 Apr 2017 09:49:32 +0000 I remember her detail, How she looked, how she talked to her husband, I just stood on the pavement and cried, I’ll Never see her again, not here, That’s it. Whatever came, came for a moment and then left, we were Going to live forever. I don’t get in touch with anyone anymore, It scares […] Full Article Poetry cancer coping death family life poem poetry
sm Earth Observation, Risk Assessment and Global Change: Implications for the Insurance and Aerospace Sectors By feedproxy.google.com Published On :: Fri, 20 May 2011 13:17:51 +0000 Research Event 16 July 2008 - 2:00pm to 5:15pm Chatham House, London Conference Agenda: Earth Observation, Risk Assessment and Global Changepdf | 60.78 KB This event is organized by Chatham House and the Center for Strategic and International Studies (CSIS).Keynote speaker:Lindene Patton, Climate Product Officer, Zurich Financial ServicesOther speaker highlights:Alexis Livanos, Northrop GrummanSir David King, University of OxfordBarend Van Bergen, KPMGMike Keebaugh,RaytheonPeter Stott, UK Met OfficeTrevor Maynard, Lloyd'sShree Khare, Risk Management SolutionsGiovanni Rum, Group on Earth ObservationsGreg Withee, US National Oceanic and Atmospheric AdministrationMan Cheung, Marsh Ltd Full Article
sm Subscription models and small venues the future By jamaica-gleaner.com Published On :: Tue, 05 May 2020 00:06:43 -0500 AS ARTISTES and musicians try to manage the situation brought on by COVID-19’s stranglehold on the world and its economy, in the interim, many have resorted to hosting live-stream events. But that only succeeds to a point. Performers retain their... Full Article
sm 'My Boy Lollipop' singer Millie Small will be sorely missed By jamaica-gleaner.com Published On :: Wed, 06 May 2020 12:07:31 -0500 There has been an outpouring of grief following the death of legendary Jamaican singer Millicent Dolly May Small, popularly known as Millie Small. She died in the United Kingdom today at the age of 73 after suffering a stroke. The voice... Full Article
sm Singer Owen Gray remembers ‘Sugar Plum’ Millie Small By jamaica-gleaner.com Published On :: Wed, 06 May 2020 23:14:04 -0500 BEFORE MILLIE Small became the ‘lollipop girl’, she was a ‘sugar plum’. Not only is it a term of endearment, it is also the title of her first song – a duet as it was called back in 1960 – with singer Owen Gray. This collab was born out of the time... Full Article
sm Tacrolimus-Induced BMP/SMAD Signaling Associates With Metabolic Stress-Activated FOXO1 to Trigger {beta}-Cell Failure By diabetes.diabetesjournals.org Published On :: 2020-01-20T12:00:26-08:00 Active maintenance of β-cell identity through fine-tuned regulation of key transcription factors ensures β-cell function. Tacrolimus, a widely used immunosuppressant, accelerates onset of diabetes after organ transplantation, but underlying molecular mechanisms are unclear. Here we show that tacrolimus induces loss of human β-cell maturity and β-cell failure through activation of the BMP/SMAD signaling pathway when administered under mild metabolic stress conditions. Tacrolimus-induced phosphorylated SMAD1/5 acts in synergy with metabolic stress–activated FOXO1 through formation of a complex. This interaction is associated with reduced expression of the key β-cell transcription factor MAFA and abolished insulin secretion, both in vitro in primary human islets and in vivo in human islets transplanted into high-fat diet–fed mice. Pharmacological inhibition of BMP signaling protects human β-cells from tacrolimus-induced β-cell dysfunction in vitro. Furthermore, we confirm that BMP/SMAD signaling is activated in protocol pancreas allograft biopsies from recipients on tacrolimus. To conclude, we propose a novel mechanism underlying the diabetogenicity of tacrolimus in primary human β-cells. This insight could lead to new treatment strategies for new-onset diabetes and may have implications for other forms of diabetes. Full Article
sm Acuna set to smash records this season By mlb.mlb.com Published On :: Wed, 13 Feb 2019 17:01:48 EDT Those hoping to watch Ronald Acuna Jr. extend last season's incredible post-All-Star break production should remember that his pace would have equated to 45 homers and 33 stolen bases over 162 games. Full Article
sm Reasons for optimism for each MLB club By mlb.mlb.com Published On :: Sun, 17 Feb 2019 21:02:04 EDT On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them. Full Article
sm Reasons for optimism for each MLB club By mlb.mlb.com Published On :: Sun, 17 Feb 2019 21:02:04 EDT On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them. Full Article
sm Reasons for optimism for each MLB club By mlb.mlb.com Published On :: Sun, 17 Feb 2019 21:02:04 EDT On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them. Full Article
sm Raising HD awareness personal for Smith, wife By mlb.mlb.com Published On :: Mon, 18 Feb 2019 16:25:28 EDT They wrestled with the decision to start a family for five years. It's something most young couples discuss at some point. Timing is important, and considering their busy lives, even more so for Astros pitcher Joe Smith and his wife, TV sports reporter Allie LaForce. The issue facing the couple is far more momentous than most others have to deal with -- one that's a matter of life and death. Full Article
sm CSME needed to rescue COVID-hit economies By jamaica-gleaner.com Published On :: Fri, 08 May 2020 00:23:04 -0500 COVID-19-ravaged regional economies, including Jamaica, will need the united strength of the Caribbean Single Market and Economy (CSME) to help revive their micro, small and medium enterprise (MSME) sectors, many of which have been decimated. That... Full Article
sm Tackling racism in the NHS By feeds.bmj.com Published On :: Thu, 23 Jul 2015 10:45:44 +0000 For decades research has shown that discrimination, harassment, and exclusion are pervasive experiences for staff from black and minority ethnic (BME) backgrounds in the National Health Service. In this podcast, the authors of a recent analysis article in The BMJ talk about the evidence for discrimination, what the NHS has done and is doing, and... Full Article
sm "For the first time in 15 years the quitting rate has gone up" - ecigarettes smoking cessation By feeds.bmj.com Published On :: Thu, 27 Jul 2017 10:54:03 +0000 It’s been 10 years since electronic cigarettes hit the shelves in a big way - and since there controversy has reigned about their health effects - are they less unhealthy than smoking traditional tobacco cigarettes, and will they increase nicotine dependence? Its to that last point that new research, published on BMJ.com is looking into -... Full Article
sm Smoking one a day can't hurt, can it? By feeds.bmj.com Published On :: Thu, 25 Jan 2018 14:59:12 +0000 We know that smoking 20 cigarettes a day increases your risk of CHD and stroke - but what happens if you cut down to 1, do you have 1/20th of that risk? Allan Hackshaw, professor of epidemiology at UCL joins us to discuss a new systematic review and meta analysis published on bmj.com, examining the risk of smoking just one or two cigarettes a... Full Article
sm Unprofessionalism - "blaming other people, I put that at the top of the impact list" By feeds.bmj.com Published On :: Mon, 12 Mar 2018 12:16:34 +0000 That’s Jo Shapiro is a surgeon and manager in Brigham and Women’s hospital, she’s also director of the Center for Professionalism and Peer Support, and has written an editorial for The BMJ on tackling unprofessional behaviour. In this discussion, she and I talked about what she thinks (beyond the illegal) are the most damaging behaviours seen... Full Article
sm Did international accord on tobacco reduce smoking? By feeds.bmj.com Published On :: Thu, 20 Jun 2019 10:51:30 +0000 WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”. But is it? That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on... Full Article
sm Talk Evidence - Z drugs, subclinical hypothyroidism and Drazen's dozen By feeds.bmj.com Published On :: Tue, 25 Jun 2019 16:58:44 +0000 This week on the podcast, (2.02) a listener asks, when we suggest something to stop, should we suggest an alternative instead? (8.24) Helen tells us to stop putting people on treatment for subclinical hypothyroidism, but what does that mean for people who are already receiving thyroxine? (20.55) Carl has a black box warning about z drugs, and... Full Article
sm Talk evidence - smoking, gloves and transparency By feeds.bmj.com Published On :: Wed, 10 Jul 2019 11:11:50 +0000 This month we have some more feedback from our listeners (2.20) Carl says it's time to start smoking cessation (or stop the reduction in funding for smoking reduction) (11.40) and marvels at how pretty Richard Doll's seminal smoking paper is. It's gloves off for infection control (22.20) Andrew George, a non-executive director of the Health... Full Article
sm Yvonne Coghill is trying to fix racism in the NHS By feeds.bmj.com Published On :: Fri, 28 Feb 2020 11:59:19 +0000 In this week's special episode of Sharp Scratch, we've got something a little different for you! Last week the panel talked microaggressions, so this week we're hearing from an expert guest who is leading the work the NHS is doing to combat inequality in healthcare. If you like this special edition, let us know on Facebook, Instagram or Twitter... Full Article
sm The Effect of Thiazolidinediones on Plasma Adiponectin Levels in Normal, Obese, and Type 2 Diabetic Subjects By diabetes.diabetesjournals.org Published On :: 2002-10-01 Joseph G. YuOct 1, 2002; 51:2968-2974Obesity Studies Full Article
sm Intramyocellular triglyceride content is a determinant of in vivo insulin resistance in humans: a 1H-13C nuclear magnetic resonance spectroscopy assessment in offspring of type 2 diabetic parents By diabetes.diabetesjournals.org Published On :: 1999-08-01 G PerseghinAug 1, 1999; 48:1600-1606Articles Full Article
sm Mechanisms of Pancreatic {beta}-Cell Death in Type 1 and Type 2 Diabetes: Many Differences, Few Similarities By diabetes.diabetesjournals.org Published On :: 2005-12-01 Miriam CnopDec 1, 2005; 54:S97-S107Section III: Inflammation and beta-Cell Death Full Article
sm Banting Lecture 2001: Dysregulation of Fatty Acid Metabolism in the Etiology of Type 2 Diabetes By diabetes.diabetesjournals.org Published On :: 2002-01-01 J. Denis McGarryJan 1, 2002; 51:7-18Banting Lecture 2001 Full Article
sm Elevated Levels of Acute-Phase Proteins and Plasminogen Activator Inhibitor-1 Predict the Development of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study By diabetes.diabetesjournals.org Published On :: 2002-04-01 Andreas FestaApr 1, 2002; 51:1131-1137Complications Full Article
sm A Preprandial Rise in Plasma Ghrelin Levels Suggests a Role in Meal Initiation in Humans By diabetes.diabetesjournals.org Published On :: 2001-08-01 David E. CummingsAug 1, 2001; 50:1714-1719Rapid Publications Full Article
sm PPAR{gamma} Ligands Increase Expression and Plasma Concentrations of Adiponectin, an Adipose-Derived Protein By diabetes.diabetesjournals.org Published On :: 2001-09-01 Norikazu MaedaSep 1, 2001; 50:2094-2099Pathophysiology Full Article
sm The Pathobiology of Diabetic Complications: A Unifying Mechanism By diabetes.diabetesjournals.org Published On :: 2005-06-01 Michael BrownleeJun 1, 2005; 54:1615-1625Banting Lecture 2004 Full Article
sm Assessment of MTNR1B Type 2 Diabetes Genetic Risk Modification by Shift Work and Morningness-Eveningness Preference in the UK Biobank By diabetes.diabetesjournals.org Published On :: 2020-01-20T12:00:26-08:00 Night shift work, behavioral rhythms, and the common MTNR1B risk single nucleotide polymorphism (SNP), rs10830963, associate with type 2 diabetes; however, whether they exert joint effects to exacerbate type 2 diabetes risk is unknown. Among employed participants of European ancestry in the UK Biobank (N = 189,488), we aimed to test the cross-sectional independent associations and joint interaction effects of these risk factors on odds of type 2 diabetes (n = 5,042 cases) and HbA1c levels (n = 175,156). Current shift work, definite morning or evening preference, and MTNR1B rs10830963 risk allele associated with type 2 diabetes and HbA1c levels. The effect of rs10830963 was not modified by shift work schedules. While marginal evidence of interaction between self-reported morningness-eveningness preference and rs10830963 on risk of type 2 diabetes was seen, this interaction did not persist when analysis was expanded to include all participants regardless of employment status and when accelerometer-derived sleep midpoint was used as an objective measure of morningness-eveningness preference. Our findings suggest that MTNR1B risk allele carriers who carry out shift work or have more extreme morningness-eveningness preference may not have enhanced risk of type 2 diabetes. Full Article
sm PPARA Polymorphism Influences the Cardiovascular Benefit of Fenofibrate in Type 2 Diabetes: Findings From ACCORD-Lipid By diabetes.diabetesjournals.org Published On :: 2020-03-20T11:50:29-07:00 The cardiovascular benefits of fibrates have been shown to be heterogeneous and to depend on the presence of atherogenic dyslipidemia. We investigated whether genetic variability in the PPARA gene, coding for the pharmacological target of fibrates (PPAR-α), could be used to improve the selection of patients with type 2 diabetes who may derive cardiovascular benefit from addition of this treatment to statins. We identified a common variant at the PPARA locus (rs6008845, C/T) displaying a study-wide significant influence on the effect of fenofibrate on major cardiovascular events (MACE) among 3,065 self-reported white subjects treated with simvastatin and randomized to fenofibrate or placebo in the ACCORD-Lipid trial. T/T homozygotes (36% of participants) experienced a 51% MACE reduction in response to fenofibrate (hazard ratio 0.49; 95% CI 0.34–0.72), whereas no benefit was observed for other genotypes (Pinteraction = 3.7 x 10–4). The rs6008845-by-fenofibrate interaction on MACE was replicated in African Americans from ACCORD (N = 585, P = 0.02) and in external cohorts (ACCORD-BP, ORIGIN, and TRIUMPH, total N = 3059, P = 0.005). Remarkably, rs6008845 T/T homozygotes experienced a cardiovascular benefit from fibrate even in the absence of atherogenic dyslipidemia. Among these individuals, but not among carriers of other genotypes, fenofibrate treatment was associated with lower circulating levels of CCL11—a proinflammatory and atherogenic chemokine also known as eotaxin (P for rs6008845-by-fenofibrate interaction = 0.003). The GTEx data set revealed regulatory functions of rs6008845 on PPARA expression in many tissues. In summary, we have found a common PPARA regulatory variant that influences the cardiovascular effects of fenofibrate and that could be used to identify patients with type 2 diabetes who would derive benefit from fenofibrate treatment, in addition to those with atherogenic dyslipidemia. Full Article
sm Reasons for optimism for each MLB club By mlb.mlb.com Published On :: Sun, 17 Feb 2019 21:02:04 EDT On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them. Full Article
sm Stop mismanaging our country By jamaica-gleaner.com Published On :: Fri, 08 May 2020 00:11:36 -0500 THE EDITOR, Madam: TO THE Jamaican Government: there are no trade laws that say you have to buy poison – foreign chicken, beef, produce and other agricultural staples are poisonous. They are chock-full of hormones, antibiotics, fillers, excess... Full Article
sm Letter of the Day | Tourism won’t be ‘business as usual’ By jamaica-gleaner.com Published On :: Sat, 09 May 2020 00:06:27 -0500 THE EDITOR, Madam: With most things grinding to a halt worldwide, this pandemic has proven to be as much of an economic crisis as it is a health one. Many sectors have changed their day-to-day operations, with some allowing for greater flexibility... Full Article
sm Marte confident transition to CF will be smooth By mlb.mlb.com Published On :: Thu, 14 Feb 2019 19:16:45 EDT Ketel Marte does not lack for confidence when it comes to switching from second base/shortstop to center field, which is where he's expected to see a lot of time this season. Full Article
sm Reasons for optimism for each MLB club By mlb.mlb.com Published On :: Sun, 17 Feb 2019 21:02:04 EDT On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them. Full Article
sm Vitamin C in Human Health and Disease: Effects, Mechanisms of Action, and New Guidance on Intake By jnm.snmjournals.org Published On :: 2020-04-01T06:00:28-07:00 Full Article
sm Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT By jnm.snmjournals.org Published On :: 2020-04-01T06:00:28-07:00 We aimed to assess the value of 11C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99mTc-sestamibi imaging and neck ultrasound. Methods: Eighty-seven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUVmax and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had false-positive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUVmax was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99mTc-sestamibi imaging yield negative or discordant results. Full Article
sm 18F-Fluorocholine PET/CT in Primary Hyperparathyroidism: Superior Diagnostic Performance to Conventional Scintigraphic Imaging for Localization of Hyperfunctioning Parathyroid Glands By jnm.snmjournals.org Published On :: 2020-04-01T06:00:28-07:00 Primary hyperparathyroidism (PHPT) is a common endocrine disorder, definitive treatment usually requiring surgical removal of the offending parathyroid glands. To perform focused surgical approaches, it is necessary to localize all hyperfunctioning glands. The aim of the study was to compare the efficiency of established conventional scintigraphic imaging modalities with emerging 18F-fluorocholine PET/CT imaging in preoperative localization of hyperfunctioning parathyroid glands in a larger series of PHPT patients. Methods: In total, 103 patients with PHPT were imaged preoperatively with 18F-fluorocholine PET/CT and conventional scintigraphic imaging methods, consisting of 99mTc-sestamibi SPECT/CT, 99mTc-sestamibi/pertechnetate subtraction imaging, and 99mTc-sestamibi dual-phase imaging. The results of histologic analysis, as well as intact parathyroid hormone and serum calcium values obtained 1 d after surgery and on follow-up, served as the standard of truth for evaluation of imaging results. Results: Diagnostic performance of 18F-fluorocholine PET/CT surpassed conventional scintigraphic methods (separately or combined), with calculated sensitivity of 92% for PET/CT and 39%–56% for conventional imaging (65% for conventional methods combined) in the entire patient group. Subgroup analysis, differentiating single and multiple hyperfunctioning parathyroid glands, showed PET/CT to be most valuable in the group with multiple hyperfunctioning glands, with sensitivity of 88%, whereas conventional imaging was significantly inferior, with sensitivity of 22%–34% (44% combined). Conclusion: 18F-fluorocholine PET/CT is a diagnostic modality superior to conventional imaging methods in patients with PHPT, allowing for accurate preoperative localization. Full Article
sm Comparison of 3 Interpretation Criteria for 68Ga-PSMA11 PET Based on Inter- and Intrareader Agreement By jnm.snmjournals.org Published On :: 2020-04-01T06:00:28-07:00 PET using radiolabeled prostate-specific membrane antigen (PSMA) is now being more widely adopted as a valuable tool to evaluate patients with prostate cancer (PC). Recently, 3 different criteria for interpretation of PSMA PET were published: the European Association of Nuclear Medicine (EANM) criteria, the Prostate Cancer Molecular Imaging Standardized Evaluation criteria, and the PSMA Reporting and Data System. We compared these 3 criteria in terms of interreader, intrareader, and intercriteria agreement. Methods: Data from 104 patients prospectively enrolled in research protocols at our institution were retrospectively reviewed. The cohort consisted of 2 groups: 47 patients (mean age, 64.2 y old) who underwent Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (68Ga-PSMA11) PET/MRI for initial staging of biopsy-proven intermediate- or high-risk PC, and 57 patients (mean age, 70.5 y old) who underwent 68Ga-PSMA11 PET/CT because of biochemically recurrent PC. Three nuclear medicine physicians independently evaluated all 68Ga-PSMA11 PET/MRI and PET/CT studies according to the 3 interpretation criteria. Two of them reevaluated all studies 6 mo later in the same manner and masked to the initial reading. The Gwet agreement coefficient was calculated to evaluate interreader, intrareader, and intercriteria agreement based on the following sites: local lesion (primary tumor or prostate bed after radical prostatectomy), lymph node metastases, and other metastases. Results: In the PET/MRI group, interreader, intrareader, and intercriteria agreement ranged from substantial to almost perfect for any site according to all 3 criteria. In the PET/CT group, interreader agreement ranged from substantial to almost perfect except for judgment of distant metastases based on the PSMA Reporting and Data System (Gwet agreement coefficient, 0.57; moderate agreement), in which the most frequent cause of disagreement was lung nodules. Intrareader agreement ranged from substantial to almost perfect for any site according to all 3 criteria. Intercriteria agreement for each site was also substantial to almost perfect. Conclusion: Although the 3 published criteria have good interreader and intrareader reproducibility in evaluating 68Ga-PSMA11 PET, there are some factors causing interreader disagreement. Further work is needed to address this issue. Full Article
sm Head-to-Head Comparison of 68Ga-PSMA-11 with 18F-PSMA-1007 PET/CT in Staging Prostate Cancer Using Histopathology and Immunohistochemical Analysis as a Reference Standard By jnm.snmjournals.org Published On :: 2020-04-01T06:00:28-07:00 18F-PSMA-1007 is a novel prostate-specific membrane antigen (PSMA)–based radiopharmaceutical for imaging prostate cancer (PCa). The aim of this study was to compare the diagnostic accuracy of 18F-PSMA-1007 with 68Ga-PSMA-11 PET/CT in the same patients presenting with newly diagnosed intermediate- or high-risk PCa. Methods: Sixteen patients with intermediate- or high-risk PCa underwent 18F-PSMA-1007 and 68Ga-PSMA-11 PET/CT within 15 d. PET findings were compared between the 2 radiotracers and with reference-standard pathologic specimens obtained from radical prostatectomy. The Cohen -coefficient was used to assess the concordance between 18F-PSMA-1007 and 68Ga-PSMA-11 for detection of intraprostatic lesions. The McNemar test was used to assess agreement between intraprostatic PET/CT findings and histopathologic findings. Sensitivity, specificity, positive predictive value, and negative predictive value were reported for each radiotracer. SUVmax was measured for all lesions, and tumor-to-background activity was calculated. Areas under receiver-operating-characteristic curves were calculated for discriminating diseased from nondiseased prostate segments, and optimal SUV cutoffs were calculated using the Youden index for each radiotracer. Results: PSMA-avid lesions in the prostate were identified in all 16 patients with an almost perfect concordance between the 2 tracers ( ranged from 0.871 to 1). Aside from the dominant intraprostatic lesion, similarly detected by both radiotracers, a second less intense positive focus was detected in 4 patients only with 18F-PSMA-1007. Three of these secondary foci were confirmed as Gleason grade 3 lesions, whereas the fourth was shown on pathologic examination to represent chronic prostatitis. Conclusion: This pilot study showed that both 18F-PSMA-1007 and 68Ga-PSMA-11 identify all dominant prostatic lesions in patients with intermediate- or high-risk PCa at staging. 18F-PSMA-1007, however, may detect additional low-grade lesions of limited clinical relevance. Full Article
sm {beta}-Cell Stress Shapes CTL Immune Recognition of Preproinsulin Signal Peptide by Posttranscriptional Regulation of Endoplasmic Reticulum Aminopeptidase 1 By diabetes.diabetesjournals.org Published On :: 2020-03-20T11:50:28-07:00 The signal peptide of preproinsulin is a major source for HLA class I autoantigen epitopes implicated in CD8 T cell (CTL)–mediated β-cell destruction in type 1 diabetes (T1D). Among them, the 10-mer epitope located at the C-terminal end of the signal peptide was found to be the most prevalent in patients with recent-onset T1D. While the combined action of signal peptide peptidase and endoplasmic reticulum (ER) aminopeptidase 1 (ERAP1) is required for processing of the signal peptide, the mechanisms controlling signal peptide trimming and the contribution of the T1D inflammatory milieu on these mechanisms are unknown. Here, we show in human β-cells that ER stress regulates ERAP1 gene expression at posttranscriptional level via the IRE1α/miR-17-5p axis and demonstrate that inhibition of the IRE1α activity impairs processing of preproinsulin signal peptide antigen and its recognition by specific autoreactive CTLs during inflammation. These results underscore the impact of ER stress in the increased visibility of β-cells to the immune system and position the IRE1α/miR-17 pathway as a central component in β-cell destruction processes and as a potential target for the treatment of autoimmune T1D. Full Article
sm Dwayne Devonish | Smart virus testing necessary for economic reboot By jamaica-gleaner.com Published On :: Fri, 08 May 2020 00:13:10 -0500 OP-ED CONTRIBUTION: COVID-19 AND THE ECONOMY FOR MOST countries in the Caribbean, the current testing for COVID-19 has not reached levels suitable for ascertaining an accurate picture of the state of outbreak and spread of the infection. This... Full Article
sm Webinar: Labour, Foreign Policy and Internationalism By feedproxy.google.com Published On :: Mon, 23 Mar 2020 09:55:01 +0000 Members Event Webinar Online Event 25 March 2020 - 6:00pm to 6:45pm Event participants Lisa Nandy MP, Member of Parliament for WiganChair: Thomas Raines, Director, Europe Programme, Chatham House Labour leadership candidate, Lisa Nandy, reflects on the party's foreign policy priorities and makes the case for a foreign policy underpinned by internationalism.In recent years, the Labour party has struggled to reach cross-party consensus on its foreign policy agenda. While the current leadership election offers the party an opportunity to debate and redefine its position on issues such as immigration, security and Brexit, the extent to which Labour can reconcile its factionalism remains unclear. As Labour undergoes a process of reflection, what kind of foreign policy agenda should the party rally behind that will also appeal to voters outside of its traditional base?Can the Labour party be unified on its approach to international issues? Is an internationalist foreign policy an attractive choice for voters? And as Brexit tensions persist, what might the party's framework be to ensure new trade deals and partnerships align with fundamental Labour priorities such as workers' rights? Full Article
