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Hickling hailed for sterling contribution to mental health

The Senate on Friday paid tribute to distinguished consultant psychiatrist, Frederick Hickling, for his tremendous contribution to persons with intellectual disabilities. Hickling died on Thursday. Senator Dr Saphire Longmore remembered Professor...




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Trinidad denies breaking US sanctions, shipping oil to Venezuela

PORT OF SPAIN, Trinidad, CMC – Prime Minister Dr Keith Rowley Saturday dismissed as a “dishonest last gasp and gamble of a dangerously delusional woman” a statement by Opposition Leader Kamla Persad Bissessar calling for him...




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Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses




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Why can’t vehicle registration be renewed online?

THE EDITOR, Madam: I arrived at the Constant Spring tax office at 6:05 a.m. on Monday, May 4 to renew my vehicle registration. At that hour, there were already 30 persons ahead of me. Persons related horror stories of spending up to five hours in...




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Give children love and appreciation

THE EDITOR, Madam May is Child Month, and we, as parents, would show love and appreciation by taking out our kids for recreation, but instead, we have to keep them indoors because of a bush tiger called coronavirus. Every year at this time, I...




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Safeguard against virus being blamed for everything

THE EDITOR, Madam: COVID-19 can be made to be the blame bearer for every ill, unless careful disaggregation is done to separate what is truly attributable to both its real scope and the understandable ripple effects of the virus. The quality of...




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Tribute to Prof Fred Hickling

THE EDITOR, Madam: Words cannot describe my feeling of loss on hearing that prominent psychiatrist Professor Fred Hickling has died. Professor Hickling was one of Jamaica’s treasures through his work in the field of community mental health. His...




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This week’s shutterbugs




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A refreshing look at personal development and success

At the outset, author Ivy Slater shares the existential crisis that spurred her to change careers. Slater’s psychosocial experience after the passing of her father and the stagnation she experienced at her printing business proved exhaustively...




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This week’s shutterbugs




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A walk down St Catherine’s history

Parish Histories of Jamaica Project, a publication by the JN Foundation in collaboration with the Department of History and Archaeology at The University of the West Indies, Mona, was launched recently. Jenny Jemmott of Department of History and...




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Curating the history of a people

Redlining a Holocaust is a rigorously researched oeuvre that establishes Dòwòti Désir as one of the most important figures in contemporary African thought. Redlining is an imaginative and monumental undertaking, a literary, visual, and oratorical...




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This week’s Shutterbugs




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Mitochondrial Proton Leak Regulated by Cyclophilin D Elevates Insulin Secretion in Islets at Nonstimulatory Glucose Levels

Fasting hyperinsulinemia precedes the development of type 2 diabetes. However, it is unclear whether fasting insulin hypersecretion is a primary driver of insulin resistance or a consequence of the progressive increase in fasting glycemia induced by insulin resistance in the prediabetic state. Herein, we have discovered a mechanism that specifically regulates non–glucose-stimulated insulin secretion (NGSIS) in pancreatic islets that is activated by nonesterified free fatty acids, the major fuel used by β-cells during fasting. We show that the mitochondrial permeability transition pore regulator cyclophilin D (CypD) promotes NGSIS, but not glucose-stimulated insulin secretion, by increasing mitochondrial proton leak. Islets from prediabetic obese mice show significantly higher CypD-dependent proton leak and NGSIS compared with lean mice. Proton leak–mediated NGSIS is conserved in human islets and is stimulated by exposure to nonesterified free fatty acids at concentrations observed in obese subjects. Mechanistically, proton leak activates islet NGSIS independently of mitochondrial ATP synthesis but ultimately requires closure of the KATP channel. In summary, we have described a novel nonesterified free fatty acid–stimulated pathway that selectively drives pancreatic islet NGSIS, which may be therapeutically exploited as an alternative way to halt fasting hyperinsulinemia and the progression of type 2 diabetes.




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Inhibition of NFAT Signaling Restores Microvascular Endothelial Function in Diabetic Mice

Central to the development of diabetic macro- and microvascular disease is endothelial dysfunction, which appears well before any clinical sign but, importantly, is potentially reversible. We previously demonstrated that hyperglycemia activates nuclear factor of activated T cells (NFAT) in conduit and medium-sized resistance arteries and that NFAT blockade abolishes diabetes-driven aggravation of atherosclerosis. In this study, we test whether NFAT plays a role in the development of endothelial dysfunction in diabetes. NFAT-dependent transcriptional activity was elevated in skin microvessels of diabetic Akita (Ins2+/–) mice when compared with nondiabetic littermates. Treatment of diabetic mice with the NFAT blocker A-285222 reduced NFATc3 nuclear accumulation and NFAT-luciferase transcriptional activity in skin microvessels, resulting in improved microvascular function, as assessed by laser Doppler imaging and iontophoresis of acetylcholine and localized heating. This improvement was abolished by pretreatment with the nitric oxide (NO) synthase inhibitor l-NG-nitro-l-arginine methyl ester, while iontophoresis of the NO donor sodium nitroprusside eliminated the observed differences. A-285222 treatment enhanced dermis endothelial NO synthase expression and plasma NO levels of diabetic mice. It also prevented induction of inflammatory cytokines interleukin-6 and osteopontin, lowered plasma endothelin-1 and blood pressure, and improved mouse survival without affecting blood glucose. In vivo inhibition of NFAT may represent a novel therapeutic modality to preserve endothelial function in diabetes.




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Methodology for Estimating Levels of Illegal Timber- and Paper-sector Imports: Estimates for China, France, Japan, the Netherlands, the UK, the US and Vietnam

25 November 2014

This paper accompanies a series of assessments on China, France, Japan, the Netherlands, the UK, the US and Vietnam, providing details on how the estimates of the level of illegality of imports of wood-based products into those countries were derived.

Alison Hoare

Senior Research Fellow, Energy, Environment and Resources Programme

This paper accompanies a series of Chatham House assessments on China, France, Japan, the Netherlands, the UK, the US and Vietnam and provides details on how the estimates of the level of illegality of imports of wood-based products into those countries were derived. The assessments are part of a research project that monitored levels of illegal logging and related trade in selected consumer, producer and processing countries in order to evaluate the effectiveness of efforts to tackle this problem.

The paper describes the methodology for estimating the levels of wood-based products at high risk of illegality that are being imported into consumer and processing countries. The methodology was developed in order to provide quantitative estimates of the scale of such imports and to assess how they have changed over time. The figures adopted for the assessments are based on the best available evidence; but, given the challenges of quantifying levels of illegal logging and the limited information available for some countries, they should not be regarded as definitive. Rather, they indicate the likely levels of illegality and, perhaps more important, how they may have changed over time.




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Trade in Illegal Timber: The Response in China

10 December 2014

Although the Chinese government and private sector have taken action to tackle illegal logging and associated trade, there is evidence to suggest illegal trade remains a significant problem.

Laura Wellesley

Research Fellow, Energy, Environment and Resources Programme

20141210IllegalTimberChinaWellesley.jpg

Two plantation workers at the lumber storage yard in Yanbian Korean Autonomous Prefecture, Jilin Province, China. Photo by Getty Images.

This paper is part of a broader Chatham House study which assesses illegal logging and the associated trade. The Chinese government has made notable progress in its efforts to tackle illegal logging and the associated trade. This has included the development of a draft national timber legality verification system (TLVS) and its active engagement with a number of consumer countries. The government’s plans to establish bilateral trade agreements with producer countries are also encouraging, although no formalized commitments have yet been made. Reflecting the growing awareness of the impact of Chinese companies overseas, the government has also been developing further guidance to promote sustainable forest products trade and investment.

The private sector is also taking action, with continued growth in the uptake of chain-of-custody (CoC) certification. Industry associations have been promoting legal and sustainable sourcing, and they will have an important role to play in testing the draft TLVS.

These steps are likely to have had an impact on the volume of illegal wood-based products being imported into China. However, trade data discrepancies and analysis of trade flows both indicate that illegal trade remains a significant problem. While imports of high-risk products are estimated to have declined since 2000, these are reckoned to comprise 17 per cent of the total by volume in 2013. This proportion is high compared with other timber-importing countries examined in this assessment.

In order to build on its response to illegal logging and related trade, the Chinese government should establish binding regulations and stringent controls on the import and export of illegal wood-based products. The draft TLVS should be further developed, including through pilot projects with timber-exporting countries and effective consultation with industry, civil society and other consumer-country governments. The government’s procurement policy should be strengthened through the clarification of its legality and sustainability requirements, the inclusion of a wider range of products within its scope, and the development of a robust mechanism to monitor compliance. 

Increased training for the private sector on due diligence, market regulations and legality requirements in consumer countries is required to stimulate further action by industry, and the work to elaborate further guidelines for companies operating overseas in the forest products trade should be continued. Awareness-raising initiatives for Chinese consumers should also be extended, in order to increase demand for verified legal wood-based products.




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The Role of Resource Politics in China-US Relations

Research Event

16 January 2015 - 12:00pm to 1:00pm

Chatham House, London

Event participants

Dr David Zweig, Chair Professor, Division of Social Science, Hong Kong University of Science and Technology
Chair: Dr Michal Meidan, Associate Fellow, Asia Programme, Chatham House

China’s resource diplomacy transpires in a world still dominated by the United States. Drawing on extensive research on global energy politics, the speaker will argue that despite Chinese claims that the US is instrumentalizing energy to contain its rise, there is little evidence to suggest that the latter intends to use the ‘oil weapon’.

Department/project

Joshua Webb

+44 (0)20 7314 3678




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Navigating the New Normal: China and Global Resource Governance

28 January 2016

How China responds to the challenges of resource security and sustainability, working with others, will help define its reputation as a responsible actor on the world stage in the next decade, according to a new paper.

Felix Preston

Former Senior Research Fellow and Deputy Research Director, Energy, Environment and Resources

Rob Bailey

Former Research Director, Energy, Environment and Resources

Siân Bradley

Research Fellow, Energy, Environment and Resources Programme

Dr Wei Jigang, Senior Research Fellow, Department of Industrial Economy, Development Research Center of the State Council (DRC)
Dr Zhao Changwen, Director, Department of Industrial Economy, Development Research Center of the State Council (DRC)

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Qingdao, China. Photo: Getty Images.
  • It is time to upgrade global resource governance
  • Meaningful progress cannot be achieved without China
  • China will need to be both innovative and pragmatic in its approach
  • New modes of cooperation are needed
  • Changes in China’s economy present opportunities and risks

Executive summary

China’s new role in the global governance of natural resources is coming to the fore against a backdrop of profound uncertainty, driven by the convergence of three interlinked trends. At home, China’s leaders are navigating the structural shift to slower but higher-quality growth, a phase of development referred to as the ‘new normal’, while facing considerable environmental and resource security challenges. Globally, the slowdown in China’s economy has sent reverberations through commodity markets, pulling the plug on the decade-long commodities ‘super cycle’. Meanwhile, China is taking on a growing role in global governance, from the G20 and multilateral development banks, to its regional partnerships in Latin America and Africa.

During the resources boom of the last decade, policy-makers and businesses in consumer countries were focused on high and volatile resource prices. The risks posed by resource nationalism in producer countries were seen in the proliferation of export restrictions and the increase in investment disputes. Today, the tables have turned, leaving producer countries facing economic pressure from falling revenues and investments. Many organizations have called on governments to phase out subsidies for fossil fuels and other natural resources while prices are low. The international policy debate is shifting to the immediate challenges presented by a massive oversupply of many energy and mineral commodities, and the longer-term risk of ‘stranded assets’.

These new resource realities will provide the context for China’s growing global role, as well as setting the tenor of its relations with producer countries. Over the past decade, narratives around China often focused on its real or perceived impacts from resource production overseas and consumption at home. In the next, China’s approach to resource security and sustainability will help define its reputation, and whether it is perceived as a responsible actor on the world stage and as a development partner. The collection of international narratives, norms, rules and organizations that currently guides resource production, trade and consumption – what we call ‘global resource governance' in this report – will provide the framework.

Much political leadership will be required to overcome the barriers to China assuming a more active role in global resource governance. On the one hand, there has been slow progress in expanding China’s role in organizations from the World Bank to the International Energy Agency (IEA). On the other, new instruments or processes initiated by China can be seen as a challenge to the existing rules-based order, as the US reaction to the establishment of the Asian Infrastructure Investment Bank (AIIB) demonstrated. Yet developments such as the US–China Joint Presidential Statement on Climate Change in September 2015, ahead of the Paris Climate Conference, show that it is possible to forge cooperation and boost the prospects for progress on public goods at the multilateral level, even in politically fraught areas.

China’s international role on natural resources is also closely tied to ongoing reforms at home. The introduction of ‘ecological civilization’ as a guiding principle for China’s development at the Communist Party’s 17th Congress in 2007 marked a recognition of the need not only to address China’s domestic challenges such as air quality and water scarcity but also shift to an environmentally sustainable model of economic development. In 2015 China’s leaders set out the key incentives, accountability and mechanisms to deliver the ecological civilization in China’s 13th Five-Year Plan. Central elements of this vision, such as building sustainable cities, pursuing environmentally-friendly economic growth and developing the circular economy will have major impacts on China’s future resource consumption and import needs.

Globally, the speed and scale of the economic realignments have taken most experts and policy-makers by surprise – in many respects, China’s new normal is the world’s new normal. The greatest challenge that China’s government faces is managing a shift to slower but higher-quality growth. It is clear that the ramifications of this reach far beyond the confines of the Chinese economy or global commodity markets; yet the situation remains fluid and the nature of a new equilibrium is difficult to predict. This only makes it more urgent to consider the strategic and practical options available to policy-makers, both in China and around the world.

This report is the result of two years of joint research between Chatham House and the Development Research Center of the State Council (DRC), including six expert workshops in China and conversations with international organizations. It discusses key policy areas in global resource governance as they relate to China – in light of recent falls in commodity prices, China’s shifting economic situation, and its growing global role in the ‘new normal’. The scope of the research is limited to non-renewable energy, metals and mineral resources; throughout this report, the term ‘resources’ refers to these commodities. Other traded commodities such as agricultural goods are not included, and land, water and air are discussed only in the context of their important linkages with energy and metals. 

The report considers the costs and benefits of a more active role for China in global resources governance. It recognizes that different commodities face different challenges and require different governance frameworks, and that different regions require context-specific responses. The report also considers the risks of more limited engagement of China and other new actors, which could mean declining relevance for existing processes and institutions that govern resource production, trade and consumption, and a diminished capacity to tackle longer-term challenges like climate change.




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This is the D-backs prospect to watch in camp

The countdown to pitchers and catchers reporting is down to single digits for all 30 MLB clubs, but as exciting as it is to see the return of Major League stars, it's also a time to dream about the next wave of baseball talent.




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Kelly already knows his way around ST facility

Yes, catcher Carson Kelly is new to the D-backs this spring, but this wasn't the first time he's gotten to see what the inside of Salt River Fields looks like.




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Future closer? Confidence runs high for Lopez

It was the eighth inning of a late September game against the Dodgers when D-backs right-hander Yoan Lopez showed that not only might he have the stuff to be a future closer, but also the moxie of one as well.




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Covid-19: Number of Germans infected could be 10 times higher than official estimates

The number of people in Germany infected with covid-19, could be 10 times higher than official government estimates, according to a new study by University of Bonn researchers.1The Heinsberg study is...




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First Evidence for a Dose-Response Relationship in Patients Treated with 166Ho Radioembolization: A Prospective Study

166Ho-microspheres have recently been approved for clinical use for hepatic radioembolization in the European Union. The aim of this study was to investigate the absorbed dose–response relationship and its association with overall survival for 166Ho radioembolization in patients with liver metastases. Methods: Patients treated in the HEPAR I and II studies who underwent an 18F-FDG PET/CT scan at baseline, a posttreatment 166Ho SPECT/CT scan, and another 18F-FDG PET/CT scan at the 3-mo follow-up were included for analysis. The posttreatment 166Ho-microsphere activity distributions were estimated with quantitative SPECT/CT reconstructions using a quantitative Monte Carlo–based method. The response of each tumor was based on the change in total lesion glycolysis (TLG) between baseline and follow-up and was placed into 1 of 4 categories, according to the PERCIST criteria, ranging from complete response to progressive disease. Patient-level response was grouped according to the average change in TLG per patient. The absorbed dose–response relationship was assessed using a linear mixed model to account for correlation of tumors within patients. Median overall survival was compared between patients with and without a metabolic liver response, using a log-rank test. Results: Thirty-six patients with a total of 98 tumors were included. The relation between tumor-absorbed dose and both tumor-level and patient-level response was explored. At a tumor level, a significant difference in geometric mean absorbed dose was found between complete response (232 Gy; 95% confidence interval [CI], 178–303 Gy; n = 32) and stable disease (147 Gy; 95% CI, 113–191 Gy; n = 28) (P = 0.01) and between complete response and progressive disease (117 Gy; 95% CI, 87–159 Gy; n = 21) (P = 0.0008). This constitutes a robust absorbed dose–response relationship. At a patient level, a significant difference was found between patients with complete or partial response (210 Gy; 95% CI, 161–274 Gy; n = 13) and patients with progressive disease (116 Gy; 95% CI, 81–165 Gy; n = 9) (P = 0.01). Patients were subsequently grouped according to their average change in TLG. Patients with an objective response (complete or partial) exhibited a significantly higher overall survival than nonresponding patients (stable or progressive disease) (median, 19 mo vs. 7.5 mo; log-rank, P = 0.01). Conclusion: These results confirm a significant absorbed dose–response relationship in 166Ho radioembolization. Treatment response is associated with a higher overall survival.




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18F-Fluorocholine PET/CT in Primary Hyperparathyroidism: Superior Diagnostic Performance to Conventional Scintigraphic Imaging for Localization of Hyperfunctioning Parathyroid Glands

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.




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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

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.




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Diagnostic Accuracy of PET Tracers for the Differentiation of Tumor Progression from Treatment-Related Changes in High-Grade Glioma: A Systematic Review and Metaanalysis

Posttreatment high-grade gliomas are usually monitored with contrast-enhanced MRI, but its diagnostic accuracy is limited as it cannot adequately distinguish between true tumor progression and treatment-related changes. According to recent Response Assessment in Neuro-Oncology recommendations, PET overcomes this limitation. However, it is currently unknown which tracer yields the best results. Therefore, a systematic review and metaanalysis were performed to compare the diagnostic accuracy of the different PET tracers in differentiating tumor progression from treatment-related changes in high-grade glioma patients. Methods: PubMed, Web of Science, and Embase were searched systematically. Study selection, data extraction, and quality assessment were performed independently by 2 authors. Metaanalysis was performed using a bivariate random-effects model when at least 5 studies were included. Results: The systematic review included 39 studies (11 tracers). 18F-FDG (12 studies, 171 lesions) showed a pooled sensitivity and specificity of 84% (95% confidence interval, 72%–92%) and 84% (95% confidence interval, 69%–93%), respectively. O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) (7 studies, 172 lesions) demonstrated a sensitivity of 90% (95% confidence interval, 81%–95%) and specificity of 85% (95% confidence interval, 71%–93%). For S-11C-methyl)-l-methionine (11C-MET) (8 studies, 151 lesions), sensitivity was 93% (95% confidence interval, 80%–98%) and specificity was 82% (95% confidence interval, 68%–91%). The numbers of included studies for the other tracers were too low to combine, but sensitivity and specificity ranged between 93%–100% and 0%–100%, respectively, for 18F-FLT; 85%–100% and 72%–100%, respectively, for 3,4-dihydroxy-6-18F-fluoro-l-phenylalanine (18F-FDOPA); and 100% and 70%–88%, respectively, for 11C-choline. Conclusion: 18F-FET and 11C-MET, both amino-acid tracers, showed a comparably higher sensitivity than 18F-FDG in the differentiation between tumor progression and treatment-related changes in high-grade glioma patients. The evidence for other tracers is limited; thus, 18F-FET and 11C-MET are preferred when available. Our results support the incorporation of amino-acid PET tracers for the treatment evaluation of high-grade gliomas.




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SNMMI Leadership Update: To the SNMMI-TS: Congratulations on 50 Years of Dedicated Service to SNMMI and Your Patients




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This Month in JNM




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A Critical Insulin TCR Contact Residue Selects High-Affinity and Pathogenic Insulin-Specific T Cells

Type 1 diabetes is an autoimmune-mediated disease that culminates in the targeted destruction of insulin-producing β-cells. CD4 responses in NOD mice are dominated by insulin epitope B:9-23 (InsB9-23) specificity, and mutation of the key T-cell receptor (TCR) contact residue within the epitope prevents diabetes development. However, it is not clear how insulin self-antigen controls the selection of autoimmune and regulatory T cells (Tregs). Here we demonstrate that mutation of insulin epitope results in escape of highly pathogenic T cells. We observe an increase in antigen reactivity, clonality, and pathogenicity of insulin-specific T cells that develop in the absence of cognate antigen. Using a single TCR system, we demonstrate that Treg development is greatly diminished in mice with the Y16A mutant epitope. Collectively, these results suggest that the tyrosine residue at position 16 is necessary to constrain TCR reactivity for InsB9-23 by both limiting the development of pathogenic T cells and supporting the selection of Tregs.




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A Hybrid Insulin Epitope Maintains High 2D Affinity for Diabetogenic T Cells in the Periphery

β-Cell antigen recognition by autoreactive T cells is essential in type 1 diabetes (T1D) pathogenesis. Recently, insulin hybrid peptides (HIPs) were identified as strong agonists for CD4 diabetogenic T cells. Here, using BDC2.5 transgenic and NOD mice, we investigated T-cell recognition of the HIP2.5 epitope, which is a fusion of insulin C-peptide and chromogranin A (ChgA) fragments, and compared it with the WE14 and ChgA29–42 epitopes. We measured in situ two-dimensional affinity on individual live T cells from thymus, spleen, pancreatic lymph nodes, and islets before and after diabetes. Although preselection BDC2.5 thymocytes possess higher affinity than splenic BDC2.5 T cells for all three epitopes, peripheral splenic T cells maintained high affinity only to the HIP2.5 epitope. In polyclonal NOD mice, a high frequency (~40%) of HIP2.5-specific islet T cells were identified at both prediabetic and diabetic stages comprising two distinct high- and low-affinity populations that differed in affinity by 100-fold. This high frequency of high- and low-affinity HIP2.5 T cells in the islets potentially represents a major risk factor in diabetes pathogenesis.




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Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017




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Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden




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Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study




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Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study




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Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study




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Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study




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Transatlantic Dialogue on China

A joint Chatham House-RUSI project that focuses on strengthening common understanding across the Atlantic and develop new ideas for how the US and Europe can better engage with and respond to China’s rise.

This will be done through examining transatlantic approaches and responses to China through the lens for four key themes (digital technology; trade and investment; governance of global commons; and climate change and the environment) that have been identified as crucial to developing effective policy responses and fostering collaboration.

The project will strengthen national, regional and international responses to the risks and opportunities posed by China’s changing role within the global economy and international rules-based order.

Department contact

Pepijn Bergsen

Research Fellow, Europe Programme
020 795 75748

More on Transatlantic Dialogue on China




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Another CDU Leadership Race Begins in Merkel’s Shadow

28 February 2020

Quentin Peel

Associate Fellow, Europe Programme
The election of a new leader of the chancellor’s party will be another contest over her legacy.

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German Chancellor Angela Merkel is depicted on a float in the Rosenmontag parade in Mainz on 24 February. Photo: Getty Images.

Perhaps it will be second time lucky. At the end of April, Germany’s Christian Democratic Union (CDU) will elect a new party leader to follow in the footsteps of Angela Merkel. An emergency party congress has been summoned to do that after the surprise resignation of Annegret Kramp-Karrenbauer, Merkel’s chosen successor.

The plan is to leave the decision on who will be the CDU candidate for chancellor at the next election until after Germany’s EU presidency concludes in December. So Merkel will keep her job until 2021, and the new leader will have to learn to live with her.

The three leading candidates are Armin Laschet, Friedrich Merz and Norbert Röttgen, all from the state of North Rhine-Westphalia. Two of the three – Merz and Röttgen – were sacked by Merkel from their former jobs. They have not forgotten. Only Armin Laschet, currently CDU leader in North Rhine-Westphalia and state premier, can be described as a Merkel loyalist, true to her centrist mantra.

He is the man to beat, having teamed up with Jens Spahn, the 39-year-old health minister, who is popular with party conservatives. Spahn will run as his deputy, so the team straddles the left-right divide in the party. But the contest still seems set to be a bitter battle between pro- and anti-Merkel factions that could leave the party badly split.

After nearly 15 years as chancellor, and 18 years as CDU leader, Merkel remains the most popular politician in Germany. In spite of criticism that she lacks vision, her caution and predictability appear to be just what most German voters like.

But her term in office has also seen the steady shrinking of the centre ground in German politics, with the rise of the environmentalist Green party and the far-right Alternative for Germany (AfD) at the expense of the centre-right CDU and the centre-left Social Democratic Party (SPD).

The battle for the soul of the CDU is between those who think Merkel has been too left-wing, and want a more conservative leader to win back AfD voters, and those who believe that the CDU must stay in the centre, and prepare for a future coalition with the Greens. Merz is seen as the former, Laschet and Röttgen the latter.

Unless Laschet emerges as the clear winner in April, the leadership contest is likely to leave Germany sorely distracted by domestic politics just as it takes over the EU presidency in the second half of the year. Instead of Merkel having a triumphant international swansong on the EU stage, she could be battling to protect her inheritance at home.

The one area on which all three leadership candidates seem to agree is foreign policy: they all want Germany to take more leadership and responsibility, and for the European Union to play a bigger role in security, defence and international affairs. They are all Atlanticists, but critical of Donald Trump’s ‘America First’ stance. All are on the record criticizing the chancellor – at least tacitly – for not having a more vigorous foreign policy.

There the similarity ends.

On the right, the 64-year-old Merz is both the most conservative and the most popular with the party grassroots. He fell out with the chancellor when she took over his job as CDU leader in parliament in 2002. He quit politics to become a corporate lawyer (and a millionaire), but never lost his political ambition. He is an economic liberal but socially conservative, a strong critic of Merkel’s migration policy and her lack of clear leadership. Critics say he is a man of the past, and not a team player.

On the EU, he believes Germany is ‘leaving too much to the French’. If France and Germany cannot agree on financial matters, he said at the London School of Economics in February, they should instead forge a stronger EU industrial policy focused on creating more ‘European champions’.

Laschet, the Merkel loyalist, is four years younger, and from the left of the party. Like Merz, he is a former member of the European parliament. In 2015, he defended Merkel’s open border policy to accept refugees stranded in the Balkans. On Russia, however, he is more critical, calling for a new effort to re-engage with Vladimir Putin. Most recently, at the Munich Security Conference, he called for stronger Franco-German relations, and more support for the eurozone reforms proposed by Emmanuel Macron.

As CDU leader in North Rhine-Westphalia, Laschet has the strongest power base. He earned his political spurs there by winning the last state election in 2017, in contrast to Röttgen, who lost to the SPD and Greens five years earlier.

Röttgen, chairman of the Bundestag foreign affairs committee, is the surprise candidate. Once a Merkel favourite, they fell out when she sacked him as environment minister after he lost the North Rhine-Westphalia election. By throwing his hat in the ring, he has forced it to become an open contest. He is independent-minded and outspoken, but not as bitterly hostile to the chancellor as Merz, so he could be a compromise candidate.

Laschet is clearly the man Merkel would find it easiest to live with. The decision will be taken by a party congress, not a grassroots ballot, which gives him a better chance. But Merz is the most eloquent orator and seen as the best campaigner. The challenge for party members is whether they believe it is better to swing right and squeeze the AfD, or stick to the centre to hold onto voters tempted by the Greens, who have replaced the SPD as the second-most popular party in Germany.

The race is wide open. So is the future of the CDU. The only prediction one can make with much certainty is that as long as Merkel remains chancellor, any successor will struggle to get out of her shadow.




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Avoiding a Virus-Induced Cold War with China

17 April 2020

Robin Niblett

Director and Chief Executive, Chatham House
Managing relations with China once the COVID-19 crisis abates will be one of the biggest challenges facing political leaders in the United States and Europe – two of the areas worst-hit by the virus that originated in China.

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Chinese president Xi Jinping and US president Donald Trump in Beijing, China. Photo by Thomas Peter-Pool/Getty Images.

So far, there has been a noticeable worsening of relations that had already soured in recent years – the latest step being President Donald Trump’s suspension of US funding for the World Health Organization (WHO) in response to accusations of Chinese interference in its operations.

Should the world now simply prepare for a period of intense and extended hostility? As director of a policy institute founded 100 years ago in the shadow of the First World War, I believe we must do all in our power to avoid a return of the global strategic rivalries that blighted the 20th century.

Deepening suspicions

Of course, the outcome does not lie only in the hands of the US and Europe. In the 1930s, as much as they wanted to avoid another great war, British and French leaders were forced to respond to Germany’s aggression in central Europe. In the late 1940s, America’s instinct to disentangle itself from war-ravaged Europe was quickly tempered by the realization that the Soviet Union would impose or infiltrate Communist control as far into Europe as possible.

Today, those who warned that China - a one-party, surveillance state with a power-centralising leader - could never be treated as a global stakeholder feel vindicated. They see in COVID-19 an opportunity to harden policies towards China, starting by blocking all Chinese investment into 5G infrastructure and breaking international dependence on Chinese supply chains.

They can point to the fact that Chinese Communist Party officials in Wuhan initially prioritised sustaining economic growth and supressed reports about COVID-19’s capacity for human-to-human transmission, epitomised by their treatment of Dr Li Wenliang. They can highlight how Beijing’s obsession with denying Taiwan a voice in the WHO prevented Taiwanese input into the early analysis of the crisis. They can highlight the ways in which Beijing has instrumentalised its medical support for coronavirus-afflicted countries for diplomatic gain.

For their part, those in China who believed the US and Europe would never allow China’s return as a regional and world power see this criticism as further evidence. They can point to comments about this being the ‘Chinese virus’, a leaked biological weapon or China’s ‘Chernobyl moment’. ‘Wolf warrior’ Chinese diplomats have sought to outdo each other by challenging narratives about COVID-19, while propagating disinformation about the origins of the virus.

There are major risks if this blame game escalates, as it could in the lead-up to a fraught US presidential election. First, consciously uncoupling the US economically from China will make the post-coronavirus recovery that much harder. China already accounts for nearly 20% of world GDP but, unlike after the global financial crisis in 2008, it is fast becoming the world’s leading consumer market. Its financial stimulus measures need to be closely coordinated with the G7 and through the G20.

Second, Chinese scientists were the first to uncover the genetic code of the virus and shared it with the WHO as early as January 12, enabling the roll-out of effective testing around the world. They are now involved in the global search for a vaccine alongside American and European counterparts. While the Chinese government will remain a legitimate target for criticism, Chinese citizens and companies will contribute to many of the most important technical breakthroughs this century.

Third, if COVID-19 creates a long-term schism between China and the US, with Europeans caught on its edge, this could do deep damage to world order. China may become a less willing partner in lowering global greenhouse gas emissions and sharing renewable energy technologies; in helping African and other developing countries grow sustainably; and in helping to build a more resilient global health infrastructure.

Getting the balance right

But the COVID-19 crisis can also be the hinge point to a more coherent and self-interested transatlantic approach to China, one whose motto should be ‘beware but engage’. There should indeed be limits on state-backed Chinese investment in strategic US and European economic sectors, just as China limits Western access to its market. But the goal should be to lower barriers to trade and investment over time on a mutually beneficial and transparent basis, not to recreate an economic Cold War.

Chinese human rights violations, at home and abroad, should be called out. The dissemination of Chinese systems of citizen surveillance, which will be more popular in a post-coronavirus world, should be monitored and contested with US and European alternatives. And the extent of Chinese exports’ access to international markets should be conditional on China improving its phytosanitary standards - which protect humans, animals, and plants from diseases, pests, or contaminants - and strictly regulating unhygienic wet markets.

But to go further and try to make disengagement the dominant transatlantic policy as COVID-19 subsides will not only divide Europe and America. It will also contribute to a self-fulfilling prophecy; in which a resentful China grows apart from the US and Europe during a period where they must work together.

Given that it will likely be the world’s largest economy in 2030, how the US and Europe manage their relations with China after this crisis is a question at least as seminal as the one they faced after 1945 with the Soviet Union. In the ensuing years, the Soviet Union became a military superpower and competitor, but not an economic one. Containment was a viable, correct and, ultimately, successful strategy. The same options are not available this time. There will be no winners from a new Cold War with China.




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Towards a Low-Carbon Future: China and the European Union

1 October 2007 , Number 7

Chinese goods seem to flood western markets: computers, light bulbs, sweaters, T-shirts and bras. The instinct is to try to protect home producers. A better plan would be to work with Beijing on producing products for the next industrial revolution – the creation of a low-carbon economy. But that would take real vision and political courage.

Bernice Lee OBE

Research Director; Executive Director, Hoffmann Centre for Sustainable Resource Economy

Nick Mabey

Founding director and Chief Executive, E3G




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12th International Forum on Illegal, Unreported and Unregulated Fishing

Research Event

18 May 2020 - 2:00pm to 22 May 2020 - 3:30pm
Add to Calendar
The 12th International Forum on Illegal, Unreported and Unregulated Fishing was originally scheduled to take place 19-20 March 2020 at Chatham House in London, but was postponed due to COVID-19. We are excited to announce that we have decided to transform the 2020 conference into a series of webinars, delivering the forum discussions over the course of a week (18-22 May 2020). The foci of these exciting sessions include a discussion on the importance of international cooperation to end IUU fishing; the interplay between subsidies and IUU practices; the particular impact of IUU fishing on women and gender relations; transparency; new technologies, and a contextual exploration of IUU fishing in Southeast Asia.
 
Many of the excellent panellists confirmed for the in-person event in March have agreed to participate in this digital version of the IUU Fishing Forum. The online format also provides new opportunities; we hope to reach new, larger and more geographically diverse audiences around the world.
 
The agenda, along with the registration links for the sessions, will be published shortly.

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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Chile’s Social Unrest: Why It’s Time to Get Serious about a ‘Just’ Transition

4 November 2019

Patrick Schröder

Senior Research Fellow, Energy, Environment and Resources Programme
President Sebastián Piñera’s decision to cancel the COP25 climate negotiations, which Chile was due to host in early December, shows the importance of ensuring the transition to a sustainable world is just.

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Demonstrators march in Santiago, Chile during street protests which erupted over a now suspended hike in metro ticket prices. Photo: Getty Images.

One year ago, during the last annual Conference of Parties (COP) held in Katowice, the Polish government launched a Solidarity and Just Transition Declaration, signed by 56 governments including the UK, making the case for why the green transition must be just.

Three years earlier in 2015, the landmark Paris Agreement also included provisions for a just transition where it stated that the decarbonization process should be ‘Taking into account the imperatives of a just transition of the workforce and the creation of decent work and quality jobs in accordance with nationally defined development priorities’. In practice, however, the concept of a just transition has not yet been implemented and has not been sufficiently considered by governments or corporations around the world.

The social unrest that has erupted in Chile’s capital Santiago over the past month, which has forced the Chilean government to ask to move this year’s COP to Madrid, is a case in point. This discontent clearly shows that climate action cannot be separated from social justice concerns. There has not been a real commitment by governments to ensure a just transition based on social dialogue from the local to the national level. This was seen in France with the gilets jaunes protests in November 2018 – one month after President Emmanuel Macron ended the so-called ‘fortune tax’ and instead introduced taxes on diesel fuel as part of an effort to transition to green energy – and the current situation in Chile has some striking parallels. 

Sustainability transitions are a complex web of political choices and investment decisions which affect countries and societies in many different ways. Questions of social justice are everywhere, but in most cases, poorly understood by decision-makers. For example, although poverty has been reduced significantly over the last decade, Chile has one of the worst rates of inequality in Latin America and the highest Gini index in the OECD. The decisions taken in 2017 to power Metro de Santiago with solar photovoltaics and wind energy are commendable from a climate perspective, however, it led to students and young people protesting against rises in subway fares in October 2019.

They were joined by Chileans who are frustrated with rising living costs and by workers and trade unions struggling with low wages. As reported by the Chilean Human Rights Commission (INDH), so far more than 4,200 people have been arrested and more than 1,300 injured and hospitalized.

Climate negotiations beyond technicalities

This time there is also another important dimension to the protests: social unrest as a reaction to worsening inequality has the potential to derail multilateral cooperation on climate change and other global issues. Since tackling climate change is a race against the clock, the world faces the challenge of addressing both urgency and equity. The world cannot afford delays and needs to move fast but decision-makers need to take time for deliberation and civic participation to avoid rapid and ill-conceived transitions which eventually meet public resistance.

Many technical experts and negotiators, who often unintentionally divorce climate policy and technical discussions about emission reductions from social justice concerns, have been caught by surprise by the cancellation of the negotiations. For this year’s COP, one important focus of the official negotiations are the so-called 'Article 6 Rules' – the accounting mechanisms and modalities for a new form of international interaction on carbon markets and off-setting to ensure carbon markets can support countries in enhancing the ambitions of their stated climate action, known as Nationally Determined Contributions (NDCs). 

What is becoming much more obvious now is that just transitions are at least equally important for achieving NDCs and other long-term mitigation strategies.

In order to meet the 1.5 degree target, stated by the Intergovernmental Panel on Climate Change (IPCC), the world will have to invest an average of around $3 trillion a year over the next three decades in transforming its energy supply systems. But how can we ensure that these investments benefit low-income communities? Will they further increase everyday living costs? The climate finance related discussions focussing on commercially-oriented investments for low-carbon energy systems in most cases only consider the aspect of affordability, but not the other important principles of alternative ‘just’ energy finance, such as good governance, due process, intra-generational equity, spatial equity and financial resilience. Investments to support just transitions need to ensure investments, not only for large energy infrastructure, but also in the jobs, skills and work vital to both adaptation and mitigation.

Just transitions for a circular economy

The just transition concept is also the entry point to broader discussions about inclusive economic transformations, questioning the dominant paradigm of consumerism and ending the wasteful use of critical resources. The current linear economic model of take-make-throw away – in Chile epitomized by the linear extractive model of the mining sector that has contributed to widening inequality – the linear extractive model is not only destructive on the natural environment but also destructive for social cohesion.

In Chile, the commodity boom in copper production – the country accounts for about 30 per cent of the world’s output – and more recently lithium – which is used in batteries for mobile phones, laptops and electric cars – have generated enormous prosperity in Chile. But the wealth has been unequally distributed and has not been used to lay the foundation for raising the overall level of incomes.

A socially embedded and inclusive circular economy can, therefore, be a way forward from the current situation the Latin American country finds itself in. The circular economy was intended to feature prominently during the 25th COP and Chile’s policies – from the Ministry of Environment and Chile's Production Development Corporation (CORFO) – have played an important role in supporting the development of a circular economy, launching in 2018, the first public circular economy programme in Latin America

The government’s support for start-up companies and entrepreneurs to develop inclusive circular economy business models is the right approach to addressing the issues of waste, employment, services for low-income communities and local economic development. These are solutions that need to be scaled up having the potential to reduce Chile’s economic reliance on the dominant extractive model.

As a global community, it is necessary to address the environmental and social objectives equally as not addressing social objectives will become an obstacle in achieving climate mitigation and solving other environmental issues. 

The Chilean protests are a wake-up call and present an opportunity for the global climate change community – which includes governments – to ensure just transitions are implemented in practice.




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The International Forum on Illegal, Unreported and Unregulated Fishing

The International Forum on Illegal, Unreported and Unregulated (IUU) Fishing brings together over 100 leading policymakers, researchers, industry representatives and civil society groups from across the world to discuss the latest initiatives, regulations and research in the areas of fisheries governance and trade in illegal fish products.

Department contact

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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The prospects of carbon dioxide removal in climate policymaking within the United States

Research Event

19 November 2019 - 9:00am to 5:00pm

School of Law, University of California, Davis

This meeting formed part of a programme of work which investigates the role of negative emissions technologies (NETs) in achieving the Paris Agreement climate targets. Previous meetings held in London and Brussels have looked at integrating negative emissions into EU policy-making, the implications and degree to which NETs, and in particular bioenergy with carbon capture storage (BECCS), can be an effective climate mitigation tool. This meeting focused on the possible deployment pathways of NETs and alternatives to BECCS for the US in particular, in the context of geographical constraints and socioenvironmental implications, the role of the private sector, and appropriate governance and finance mechanisms. 

Melissa MacEwen

Project Manager, Energy, Environment and Resources Programme




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UK-China Cooperation on Climate Change Risk Assessment

The project purpose is to ensure emissions reduction and resilience strategies, policies and decision-making - both in China and globally - are better informed by an evidence-based perspective on climate-change risks.

Avoiding the worst economic, social and environmental risks of climate change requires a better understanding of what those risks may be. Decision-makers need information on the full range of risks that climate change poses, across the full spectrum of probabilities. Monitoring the nature and severity of these risks is essential if decision-makers are to make the right choices about effective mitigation and adaptation responses.

To meet this need, international scientists and policy analysts in the UK (including at Chatham House) and China have been engaged in a multi-year, multi-disciplinary, and collaborative research process. This has deepened understandings of how these complex, interconnected first, second and third-order risks can be better assessed and tracked.

Phase one, culminating in 2015 and involving experts, demonstrated how general principles of risk assessment could be applied in relation to climate change.

Phase two (culminating in 2019) was a bilateral cooperation between the UK and China that was agreed during President Xi Jinping’s state visit to the UK in 2015. It addressed a specific recommendation from phase one - that risk assessments need to be made on a regular and consistent basis - by providing a proof of concept indicator framework.

Substantive project funding for phases 1 and 2 was provided by the UK Foreign and Commonwealth Office, with additional contributions and in-kind support from the China Expert Panel on Climate Change, the UK Government Office for Science, the Skoll Global Threats Fund, the Global Challenges Foundation, the UK Institute and Faculty of Actuaries, and Willis Research Network (phase 1); and Chatham House, China Expert Panel on Climate Change, UK Committee on Climate Change, International Energy Agency, Willis Towers Watson (phase 2).

Many institutions contributed to the project under phases 1 and 2 (see reports for full list of contributors).

Chatham House now leads a third phase of this project (2020 to 2022), funded by the Prosperity Fund of the UK Foreign and Commonwealth Office. The purpose is to help ensure emissions reduction and resilience strategies, policies and decision-making - both in China and globally - are better informed by an evidence-based perspective on climate-change risks.

Under the guidance of the China Expert Committee on Climate Change and the UK Committee on Climate Change, the programme is building on the risk indicator and risk assessment work developed in Phase 1 and 2.

This phase of work has four complementary workstreams looking at emissions risks, direct climate risks, systemic climate risks and the integration of climate risks into Chinese and international governance frameworks. Embedded throughout the project is considerations of gender and inclusion(G&I) which are fundamental to achieve climate-compatible development.

The programme is delivered through a cohort of partner organisations based in both China and the UK, including Chatham House, E3G (Third Generation Environmentalism), Hubei University of Economics, National Climate Centre of China, Tsinghua University and the University of Reading.

Department contact

Jiangwen Guo

Senior Research Fellow, Energy, Environment and Resources Programme




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Thiago H. K. Uehara

Research Fellow, Energy, Environment and Resources Programme

Biography

Thiago Uehara, political ecologist, is a research fellow at Chatham House. Before joining its Energy, Environment and Resources programme in 2019, Thiago served as technical adviser to the Brazilian Presidency, consultant to the Intergovernmental Panel on Climate Change (IPCC), and senior consultant to Fundação Getulio Vargas (FGV), to name a few.

Thiago is a policy analyst and environmental social scientist working with public policy, rural development and sustainability since 2006. He holds degrees in Geographical Research (University of Cambridge), Public Administration (FGV), Environmental Science (University of São Paulo Institute of Energy), Environmental Management (University of São Paulo School of Agriculture), and Music (Villa-Lobos Institute).

He also studied at the Institute of Development Studies/STEPS Centre, at AgroParistech-Engref, and is completing his PhD at Imperial College London’s Centre for Environmental Policy on the politics of retrenchment and the impacts of austerity for peasant livelihoods in the Amazon and in São Paulo.

He is a founder member of the Brazilian Research Network on Food Sovereignty, Nutrition and Food Security, and advises students at Imperial College London. Languages: PT, EN, FR, ES.

Areas of expertise

  • Sustainable livelihoods, rural development, food sovereignty
  • Environmental policy and management; nature-base solutions; forest restoration
  • Public procurement; sustainable procurement
  • Wellbeing economies and just transformations to sustainability
  • International development; Global South; Brazil

Past experience

2016-2019Consultant, IPCC WG3 Supervisor and research postgraduate, Imperial College London
2012-2019Technical adviser, Presidency of Brazil
2012-2019Lecturer, National School of Public Administration
2012-2019Environmental specialist, Ministry of the Environment, Brazil
2010-2012Researcher, FGV Centre for Sustainability Studies
2010-2012Senior consultant, FGV Centre for Public Administration
2007-2010Environmental manager, São Paulo Environmental Agency




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Generics have a chequered recent history




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Covid-19’s impact on US medical research—shifting money, easing rules




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Covid-19 is no worse in immunocompromised children, says NICE