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Rebuilding Zimbabwe's Economy: Emmerson Mnangagwa’s Immediate Priorities

Rebuilding Zimbabwe's Economy: Emmerson Mnangagwa’s Immediate Priorities Expert comment sysadmin 13 December 2017

Zimbabwe cannot expect to rebuild in the same economic model that brought previous prosperity.

Emmerson Mnangagwa is sworn in as president on 24 November. Photo: Getty Images.

Returning to Harare as Zimbabwe’s president-designate Emmerson Mnangagwa declared, ‘We want to grow our economy, we want peace, we want jobs, jobs, jobs.’

Robert Mugabe leaves a legacy of an independent Zimbabwe in a deep economic crisis. Much remains uncertain as to what a new government in Zimbabwe will look like, and there is sure to be continuity as well as considerable change.

What is clear is that a new administration under Mnangagwa will need to turn the economy around to garner support and legitimacy from the Zimbabwean people. Zimbabwe’s economic output halved over the period 1997–2008, and it has not recovered. With more than 80 per cent of Zimbabweans in the informal economy, and with social and economic resilience undermined by previous crises and decades of mismanagement, the stakes for the new leader are very high.

Reform will be difficult particularly because politically connected elites have acquired businesses through uncompetitive means. They will be reluctant to see significantly more competition. But they will also want an improved economic environment. And there is scope for the people of Zimbabwe to benefit from this.

An important change will be in the prioritization of economic stability. Mugabe demonstrated that he was willing to make political decisions irrespective of the economic consequences. Mnangagwa is thought to be less ideological and more of a pragmatist. For him, delivering economic recovery will be crucial to building political support.

The most pressing fiscal priority is the public wage bill. Employment costs account for over 80 per cent of government expenditure, crowding out spending on social programmes, health and education. But the fragility of the economy means that reform cannot be fast-tracked. The public wage bill accounts for over 20 per cent of GDP and is an essential driver of demand. Public sector workers are also politically influential. Another further priority is the reform of state-owned enterprises that are pressuring the fiscus.

A new administration will need to rebuild confidence. Policymakers have been operating in a low-confidence environment for a long time, but for any meaningful change to take root there has to be trust between the government, businesses and the people of Zimbabwe. Businesses and citizens will want to see a plan of action for remonetizing the economy. Zimbabwe faces an acute liquidity crisis. A shortage of US dollars and a lack of confidence in government-issued bond notes are testing resilience.

The financial system has recovered from a crisis of nonperforming loans – triggered by high debt amassed during the post-dollarization boom, and weak corporate governance. But the system remains highly fragile and swamped with government debt. Hard cash US dollar deposits fell from 49 per cent ($582 million) in 2009 to just six per cent ($269 million) in 2016. In 2015, industrial utilization stood at just 34.3 per cent of installed capacity, and it was estimated that just five per cent of the country’s businesses were viable.

The crux of the Zimbabwean economy is the linkage between agriculture and manufacturing. Commercial agriculture contributes approximately 12 per cent of the country’s GDP, and more than 60 per cent of inputs into the manufacturing sector. Tobacco in particular is a vital earner of much needed foreign exchange. Policies to support mid-scale farmers will have multiplier effects. They drive agricultural growth and generate jobs throughout the supply chain.

Zimbabwe also has world-class natural resource endowments including ferrochrome, gold, copper, iron ore, lithium, diamonds and platinum group metals. But longer investment-gestation periods and industry risk adversity will mean that payoffs from fresh investments in this sector will take longer to materialize.

Domestic finance will need to be mobilized to generate recovery, and this will need to be supported by international investment. But international investors entering the country must be cognizant of Zimbabwean’s expectations and also historical perceptions – especially around the scepticism of neoliberal economics as a result of failed structural adjustment programmes in the 1990s.

Zimbabweans have high social expectations for international investors. Educated, tech-savvy, internationally connected youth are at the core of the consumer class that investors will be targeting, to both sell products to but also to staff offices in country. But this cohort also has a greater expectation of international companies to adhere to the norms and standards that they abide by at home and not take advantage of weak governance or poor regulation to exploit citizens.

Investors in Zimbabwe must also recognize that behind the controversial Mugabe policies of land reform and indigenization – the empowerment of local citizens through shared ownership – was a popular desire for postcolonial economic transformation. This sentiment remains. Working in partnership with local entities and communicating the economic contribution made to society will be necessary to build a long-term presence in Zimbabwe, and reap the dividend of what many hope to be a new start for the country.

Fresh thinking is required from domestic policymakers and international partners. A skilled population and estimated 3-5 million-strong diaspora will bring international experience and make a considerable contribution to this process. Some of this thinking has been done. The Lima process of re-engagement with international financial institutions that was agreed at the end of 2015 has laid some of the groundwork, especially around international expectations regarding both economic and governance reform – the substance of which was analysed in a 2016 Chatham House paper. The implementation of recommendations of the well-regarded auditor-general’s report on SOE reform will also be a key prerequisite for long-term reform.

Zimbabweans are not alone in processing what has happened and how to react. Investors have long been poised to capitalize on what is perceived to be one of the continent’s best long-term prospects. A lot will remain unchanged following the transition. But significantly, for the first time in decades, there is a real opportunity to effect positive change and improve the livelihoods of millions of Zimbabweans.

This article was originally published at the Huffington Post.




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Tsvangirai Leaves an Important Political Legacy in Southern Africa

Tsvangirai Leaves an Important Political Legacy in Southern Africa Expert comment sysadmin 21 February 2018

The story of Zimbabwe’s ‘people’s champion’ offers a powerful example to a region in need of new political compromises.

Supporters hold up a poster of Morgan Tsvangirai during a memorial service in Harare. Photo: Getty Images.

The death of Movement for Democratic Change (MDC) leader Morgan Tsvangirai is a loss for Zimbabwe. In nearly three decades of speaking truth to power, Tsvangirai helped to change his nation and the region.

Southern Africa’s new politics

His death marks a period of transition for regional governments and opposition parties alike. The Zuma era has ended in South Africa while Mozambique, Namibia and Angola have also seen political transitions, pushing modernization agendas to appeal to young citizenries that increasingly see politics in separate terms from the liberationist struggles of the previous generation.

Regional opposition movements also face winds of change: the longstanding opposition leader in the Democratic Republic of the Congo, Etienne Tshekedi, passed away in 2017, and Mozambique’s Afonso Dhlakama and Kenya’s Raila Odinga are both aging. These movements similarly need to appeal to a younger audience or risk losing relevance.

From trade unionist to opposition leader

Tsvangirai’s career is an eloquent illustration of these challenges. Born in Buhera in rural eastern Zimbabwe, Tsvangirai worked in textiles and mining before politics – diverse experience which gave him crucial exposure to the lives of ordinary people across the country. In his early years, he also worked for ZANU-PF, before leaving to forge his own political path. He became increasingly active in mining politics, rising to the executive of the National Mineworker’s Union and, in 1989, to secretary-general of the powerful Zimbabwe Congress of Trade Unions.

In the late 1990’s, Zimbabwe was riven by questions over land, war veterans, the Congo conflict, a shrinking economy and growing doubts about ZANU-PF itself. Opposition leaders of the time could not answer them; those such as Edgar Tekere and Margaret Dongo struggled to win support beyond their local constituencies, and liberation leader Joshua Nkomo’s ZAPU had been merged with ZANU-PF in the 1987 Unity Accord.

But in 2000, Zimbabwe’s ‘perfect storm’ of a divisive constitutional referendum, land redistribution and a June election made Tsvangirai and the newly minted MDC, formed in 1999, a national rival to ZANU-PF. Through subsequent national elections in 2002, 2005, 2008 and 2013, Zimbabwe remained polarized between competing visions of Zimbabwe future: ZANU-PF’s powerful black liberationist politics of identity and the opposition’s equally compelling liberal democracy agenda.

Tsvangirai’s achievement was to provide a credible alternative to liberation icon Robert Mugabe. Tsvangirai also resuscitated Zimbabwe’s tradition of urban nationalism, and was a successor to Benjamin Burombo and other mid-century Zimbabwean urban leaders. Tsvangirai would in turn be a touchstone for contemporary urban activists Evans Mawarire, Linda Masarira and others.

From opposition to coalition

The political struggle for Zimbabwe became global, with Mugabe and Tsvangirai both winning support from rival international power blocs. In March 2007, pictures of a beaten and bloodied Tsvangirai helped to galvanize support for the MDC in the 2008 elections. But the disputed result and violent subsequent run-off between Tsvangirai and Mugabe led the regional community to push both men into a coalition government, with Tsvangirai as prime minister.

Despite continuous ructions, the Government of National Unity (GNU) held, and stabilized Zimbabwe’s collapsed economy, until 2013. Although often politically out-manoeuvred by Mugabe, Tsvangirai deserves credit for getting the opposition a share of political power and for holding his nerve against many who wanted to collapse the GNU.

Tsvangirai was no saint; his complicated love life, and tacit approval of violent attacks on party dissenters, do him no credit. More importantly, the MDC neglected its grassroots supporters during the GNU, and paid the price in its comprehensive 2013 electoral defeat. But although diminished, Tsvangirai remained Zimbabwe’s most popular opposition politician, and the MDC’s new leaders will have quite a task ahead of them, even if they have been planning since his courageous 2016 public admission of colon cancer.

The MDC after Tsvangirai

Nelson Chamisa, one of the three MDC vice presidents, has now been appointed as acting president by the party’s national committee. Chamisa inherits a fractured and fractious party, and one which has also fallen out with the Tsvangirai family. The other two vice presidents, Thokozani Khupe and Elias Mudzuri, have also set their sights on party leadership.

At 40, Chamisa, an orator with grassroots appeal, has a huge task. With general elections due by July, he has to unite the party, counter Zimbabwe’s rising ethno-politics, prove himself as leader of a broader opposition coalition and take on a resurgent President Emmerson Mnangagwa and ZANU-PF.

Electorally, the opposition’s strongest card has always been the urban vote and the economy. But Mnangagwa has fast forwarded a comprehensive economic reform and internationalist agenda. This, and Mugabe’s exit, have forced Chamisa, Joice Mujuru and other opposition leaders to play catch-up. Zimbabwe’s elections, the first since 2000 without Mugabe and Tsvangirai as contenders, will be of global interest as the country navigates the new political dynamics.

The people’s champion

Morgan Tsvangirai’s resilience earned him respect from friends and foes alike, with Zimbabwe’s President Mnangagwa and Vice President Constantino Chiwenga visiting him at home a few weeks ago. A former nominee for the Nobel Peace Prize, Tsvangirai, popularly known by his totem of ‘Save’ and also called mudhara [the old man] deserves national hero status. He will certainly be remembered as the ‘people’s champion’, and a pioneer in bridging the generational and ideological fissures that have shaped Southern Africa’s politics.

With their leader now gone, the turbulent MDC will undoubtedly be hoping for a ‘remembrance vote’ in his memory to carry them through the elections. But beyond that, his story offers a powerful example to a region in need of new political compromises.




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Mine Action in Angola: Clearing the Legacies of Conflict to Harness the Potential of Peace

Mine Action in Angola: Clearing the Legacies of Conflict to Harness the Potential of Peace Other resource sysadmin 14 June 2019

This publication draws on and updates the briefing note published following a meeting of the All- Party Parliamentary Group (APPG) on Angola on 26 April 2017. It also incorporates insights from a Chatham House Africa Programme conference session on the legacies of the Angolan Civil War, held on 23 March 2018; and draws on the Africa Programme’s research into conservation-driven development models in Southern Africa.

A mine clearance specialist in Angola preparing equipment used to look for unexploded ordnance, May 2012. Photo: Eye Ubiquitous/Contributor/Getty Images.

Almost two decades after the end of its civil war, Angola remains one of the most heavily landmine-contaminated countries in the world. The Angolan government has committed to clearing its landmines by 2025, and there is constructive collaboration between the government and mine clearing agencies in this endeavour, but the target will be achievable only if a decline in funding from international donors is reversed. International funding for mine clearance in Angola fell by more than 80 per cent between 2005 and 2017, and this sharp drop in external support has compounded the impact on domestic funding for national clearance efforts as a result of the downturn in prices for Angola’s main export commodities.

The national mine action agency, the Comissão Nacional Intersectorial de Desminagem e Assistência Humanitária (CNIDAH), is supported by the Mines Advisory Group (MAG), Norwegian People’s Aid (NPA) and the HALO Trust. By 2017, 15 years after the end of the civil war, these organizations had collectively helped clear 56 per cent of known landmine-contaminated land. State-led demining has focused principally on clearing areas designated for infrastructure projects. Now, it is critical that humanitarian demining in largely agricultural and conservation areas is prioritized to bring to an end the daily threat to Angola’s rural poor – as well as to the country’s livestock and wildlife – of injury or death as a result of landmine accidents.

Angola has some of the world’s most important remaining wilderness, including the tributary system for the unique Okavango Delta, and the country has the potential to host one of the most diverse wildlife populations on the continent. However, the presence of landmines and other remnants of the civil war render large areas of the country unsafe both for wildlife and for the local people, whose ability to derive a sustainable livelihood from their natural environment is fundamental to its protection.

Wildlife and tourism provide important economic opportunities for diversification beyond an oil-dominated economy. Critically, Angola’s economic diversification and development objectives can only be achieved if the landmines that prohibit access to land for agriculture, mining, tourism and wildlife are cleared.

There are economic opportunities for released land in the most heavily mined provinces of Cuando Cubango and Moxico. Already, some new funding for mine action in Angola, if upscaled or matched by international donors, could be transformative for its people, and for the conservation of the region’s vital biodiversity.




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Zimbabwe After Mugabe

Zimbabwe After Mugabe Expert comment sysadmin 12 September 2019

He was the founding father of modern Zimbabwe, but he leaves behind a contested legacy and a country at a crossroads.

Children stand beside a mural of former Zimbabwe president Robert Mugabe in Harare. Photo: Getty Images.

Robert Mugabe’s death at age 95, after nearly 60 years at the helm of Zimbabwe’s liberation and post-independence politics, is a momentous occasion. Mugabe was the founding father of modern Zimbabwe, with all its stunning successes and grievous failures. As he moves into national legend, contestations over his legacy demonstrate that, in death as in life, the man known as Gushungo (from his family lineage) still continues to polarize opinion.

His failings are well known, including the mass murders of more than 30,000 civilians in Matabeleland during the 1980s Gukurahundi campaigns, and the killings and torture of opposition activists in the 2000s and 2010s.

The land reform process, although necessary, was handled in a haphazard way, contributing to the economic crash and 2008’s ‘year zero’, when Zimbabwe was plagued with a worthless currency, no food in the shops, unsafe drinking water and the spread of cholera and typhoid.

Nevertheless, Mugabe is genuinely mourned by millions in Zimbabwe and beyond. Partly this is for what he achieved in building Zimbabwe’s education, health and economy, and for giving land – however haphazardly – to millions of Zimbabweans.

But it was his assertion of black and African identity and pride which made Mugabe connect with millions. I grew up in Ian Smith’s Rhodesia, where being a black African was, by law, a cardinal sin and, at times, a capital offence. Mugabe helped to make being black not just acceptable but also a cause for celebration.

What now for the country?

Mugabe continues to shape Zimbabwe’s politics. Emmerson Mnangagwa’s government has tried to differentiate itself from Mugabe’s administrations, avoiding his radical and ideologically driven language and policies. But Zimbabwe’s military, which played a critical role in Mugabe’s 2017 removal, remains influential over government policy.

Mnangagwa wants to be seen as a moderate, accessible for regular meetings with private sector and international investors through the Presidential Advisory Commission, the Tripartite Negotiating Forum, investment meetings and other forums.

Politically, Zimbabwe’s bipartisan Parliamentary Portfolio Committees have emerged over the past year as key institutions able to effectively hold the government and other institutions to account. Contentious Mugabe-era legislation such as the Public Order and Security Act has been revised in line with Zimbabwe’s constitution. And the ongoing multiparty dialogue is a useful start towards a much-needed national political dialogue.

Through its Transitional Stabilization Programme, the Mnangagwa administration has outlined an ambitious economic reform agenda. There has been some progress; in January, the government reported a $113 million budget surplus, and publicly available audits of state-owned enterprises by Public Auditor Mildred Chiri have exposed the rot at the heart of institutions such as the National Social Security Authority.

The government has streamlined bureaucracy and legislation to improve Zimbabwe’s business climate; and the newly empowered Zimbabwe Anti-Corruption Commission has begun probing some high-profile fraud cases.

Zimbabwe’s global re-engagement with international financial institutions, a process which had stalled in Mugabe’s later years, is now making some progress, with Zimbabwe joining the Staff Monitored Programme with the IMF in mid-2019. The introduction of a new currency in February was designed to end the chaos of multiple US-dollar exchange rates and the dominance of the black market, but has had limited results.

Hardship

But the Mnangagwa administration’s attempts to stabilize the Zimbabwean economy have also included deep cuts in government spending, and the resulting austerity has brought severe hardship for ordinary Zimbabweans. Massive fuel, power and water shortages and the sky-rocketing cost of living are all reminiscent of the Mugabe era, damaging the credibility of the government’s promise of an economic dividend.

Shortages have also hit tourism, which had rebounded in recent years, and the new national currency initiative has pushed inflation to an official 180%. Violent urban protests took place in 2018 and 2019.

While government is right to commit to reforms, and has taken steps, such as cost-of-living allowances, to help mitigate the worst impacts, many Zimbabweans view the official ‘austerity for prosperity’ message with deep scepticism, and the current state of the economy has encouraged more young Zimbabweans to leave the country. Government and the business community need to prioritize people over statistics, and put social protection, anti-poverty programmes and economic democracy at the forefront of economic reform.

Getting public services working again will also require a broad national economic consensus and could look to capitalize on diaspora-led initiatives in education, agriculture, health and other sectors.

But this will require the opposition Movement for Democratic Change to recognize Mnangagwa’s legitimacy in return for substantive talks between government and the opposition and strengthened outreach to Zimbabwe’s nearly 5-million strong global diaspora, many in the United Kingdom, unsure of what tomorrow will bring, and an increasingly troubled South Africa.

The future

Robert Mugabe’s funeral will bring together the great and the good, not just from Zimbabwe but from all over the world. Robert Mugabe was always a voice and never an echo, and his passing, as with those of other Zimbabwean change-makers of all races and backgrounds, is an opportunity to reflect on the legacy of the liberation era.

But more importantly, it is also an opportunity to think about what lies ahead. Zimbabweans have proved to be resilient and innovative; but it will require a collective effort and a national re-engagement to ensure that Zimbabwe’s future is not its past. And with Mugabe now gone, the Zimbabwe government must prove that it can and will do better.




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Webinar: Finding Solutions to Insecurity in Cabo Delgado

Webinar: Finding Solutions to Insecurity in Cabo Delgado 16 June 2020 — 3:00PM TO 4:30PM Anonymous (not verified) 9 June 2020

Since October 2017, armed attacks in Cabo Delgado, Northern Mozambique have increased in intensity and the spread has widened. Over 1,000 people are thought to have died, and an unknown number of homes and public buildings destroyed. Reports suggest that more than 100,000 people have been internally displaced by these attacks that have been attributed to an armed Islamist sect.
Yet very little is known about who the attackers are, what their strategic objectives are and on whose domestic and international support they rely. Developing multi-faceted solutions to this insecurity will require detailed understanding of the drivers of this extremism, its connection to local informal and illicit economic activity, and the social and structural roots of disenfranchisement and disenchantment.
At this online event, the speakers explore the structural causes, drivers and dynamics of the armed attacks in Cabo Delgado, including the regional and international aspects of the situation.




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Patients taking dabigatran to prevent stroke should avoid simvastatin and lovastatin, study suggests




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Who gains from artificial intelligence?

Who gains from artificial intelligence? 27 February 2023 — 5:30PM TO 6:30PM Anonymous (not verified) 6 February 2023 Chatham House and Online

What implications will AI have on fundamental rights and how can societies benefit from this technology revolution?

In recent months, the latest developments in artificial intelligence (AI) have attracted much media attention. These technologies hold a wealth of potential for a wide range of applications, for example, the recent release of OpenAI’s ChatGPT, a text generation model, has shed light on the opportunities these applications hold including to advance scientific research and discovery, enhance search engines and improve key commercial applications.

Yet, instead of generating an evidence-based public debate, this increased interest has also led to discussions on AI technologies which are often alarmist in nature, and in a lot of cases, misleading. They carry the risk of shifting public and policymakers’ attention away from critical societal and legal risks as well as concrete solutions.

This discussion, held in partnership with Microsoft and Sidley Austin LLP, provides an expert-led overview of where the technology stands in 2023. Panellists also reflect on the implications of implementing AI on fundamental rights, the enforcement of current and upcoming legislation and multi-stakeholder pathways to address relevant issues in the AI space.

More specifically, the panel explores:

  • What is the current state of the art in the AI field?
  • What are the opportunities and challenges presented by generative AI and other innovations?
  • What are some of the key, and potentially most disruptive, AI applications to monitor in the near- and mid-term? 
  • Which applications would benefit from greater public policy/governance discussions?
  • How can current and future policy frameworks ensure the protection of fundamental rights in this new era of AI?
  • What is the role of multi-stakeholder collaboration?
  • What are the pathways to achieving inclusive and responsible governance of AI?
  • How can countries around the world work together to develop frameworks for responsible AI that upholds democratic values and advance AI collaboration across borders?

As with all member events, questions from the audience drive the conversation.

Read the transcript.




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The security gap

The security gap 7 March 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 24 February 2023 Chatham House and Online

With the increasingly significant role that women play in national defence, will perceptions change or are current attitudes towards women in uniform here to stay? 

Women have been part of armed conflicts for all of human history, serving alongside men, as well as in their own distinctive units.

More recently, scores of women are involving themselves in Kurdish resistance fighting, being deployed in Syria as fighter pilots for Israel’s Armed Forces and serving on Ukrainian frontlines.

Women have been integrated into militaries around the world including in the Canadian, Swedish and Norwegian armies to name a few.

This discussion aims to tackle some of the following questions:

  • What are some of the challenges that more inclusive militaries bring and can these challenges be overcome?
  • Can more inclusive militaries help solve the human resources problems that many modern militaries face?
  • Are attitudes changing as more women serve in combat? 
  • What are the opportunities for women in militaries and in wider defence efforts?

As with all member events, questions from the audience drive the conversation.




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In conversation with Rahul Gandhi

In conversation with Rahul Gandhi 6 March 2023 — 6:00PM TO 7:00PM Anonymous (not verified) 27 February 2023 Chatham House and Online

The former president of the Indian National Congress discusses how today’s world will set the path for the world’s biggest democracy.

Soon to be the world’s largest population, and with a rapidly growing economy and an increasing presence in global affairs, India’s place in the world is changing.

Hosting the G20 this year, the New Delhi summit in September 2023 is a symbol of India’s growing might, moving from emerging to prominent player on the world stage.

However, challenges faced by the country are substantial. Frosty relations with China, ongoing tension with Pakistan, climate catastrophe, and food insecurity all represent significant global concerns to India.

Internally, the hurdles are imposing. Millions still live below the poverty line and demographic instability poses risks to the country. The state of democracy across the country is consistently questioned.

At this event, Rahul Gandhi explores key questions including:

  • How does India see the impact of the war in Ukraine?
  • Will New Delhi be able to balance relations between the West and Russia?
  • Can India offer an alternative vision for Asia that challenges China?
  • Internally, to what extent is democracy in India under strain?
  • Can India’s economy evolve to create a wide-reaching, prosperous nation in the coming years?

As with all member events, questions from the audience drive the conversation.




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If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying

I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted...




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Here we go again: Russia’s energy ‘diplomacy’ in Moldova

Here we go again: Russia’s energy ‘diplomacy’ in Moldova Expert comment LJefferson 6 December 2021

The gas crisis shows that while the new Moldovan government may wish for geopolitics to go away, they are a weapon Russia will deploy at will.

In October, Moldova came under the spotlight when Russia, its primary provider of gas, slashed supplies by a third and refused to extend the existing contract.

The crisis was resolved at the end of October when Russia and Moldova signed a new contract, in which Moscow has used Moldova’s gas dependence to extract geopolitical concessions, weaken the new pro-western Chisinau government and drive a wedge between the EU and Moldova.

A chronic failure to reform

Moldova became a classic case of state capture when political elites – including nominally pro-European political elites – engaged in massive rent-extraction.

Up until 2020, when pro-reform forces came to power, Moldovan politics offered rapid route to riches for both the nominally pro-European parties and the pro-Russian Socialist Party; each was responsible for playing up ethnic and geopolitical cleavages in the country to mobilize votes and shore up legitimacy.

These predatory elites hollowed out Moldova economically and politically by a chronic failure to reform, in particular the energy sector which became a major source of rent.

However, this started to change when the pro-reform forces came to power as a result of the 2020 presidential and then 2021 parliament elections. The pro-reformist Maia Sandu defeated the incumbent president Igor Dodon (58 per cent to 42 per cent) in November of that year. And then her party got 58 per cent of the vote in the parliamentary elections which followed in July 2021.

The Party of Action’s winning formula was to focus on corruption and domestic reforms – rather than playing the ‘geopolitical’ card, a favourite strategy of their predecessors.

Her Party of Action’s (PAS) winning formula was to focus on corruption and domestic reforms – rather than playing the ‘geopolitical’ card, a favourite strategy of their predecessors. As Sandu put it, the elections marked ‘the end of the reign of thieves in Moldova’.

A gas crisis is initiated  

Russia’s response to these results was to initiate a gas crisis. Up until the victory of the pro-reform forces, Russia had annually renewed a gas contract signed in 2007. However, in September 2021, Russia refused to renew the contract as it had done many times before and instead insisted on a new contract, which allowed Russia to create linkages between energy prices, debt settlement, a halt on energy market reforms and, it can be logically inferred, further integration with the EU.

Moldova’s national energy company, Moldovgaz, is 63.5 per cent de facto owned by Gazprom with the Moldovan government owning the remaining 35.5 per cent. (Moldova was forced to give Gazprom a controlling stake when faced with a cut in supplies in January 2006). It is therefore hardly surprising that no efforts were made to de-monopolise the sector and diversify energy supplies.

This lack of modernization can be explained by the somewhat surreal fact that in any negotiations and planning, Moldovagaz – majority owned by Gazprom – represents the Moldovan side in negotiations with Gazprom. So, when it came to signing of the new five-year contract in October 2021, Russia, through Gazprom, was able to institute a contract which made gas prices conditional on various geopolitical conditions.

It is noteworthy that Moldova’s original 2007 gas contract had been renewed annually despite the supposed accrual of debt. However, the very nature of this debt is suspect. While Moldova’s debt is said to be approximately $700 million, the debt of the much smaller breakaway Transnistria was around $7.3 billion.

The exact level and source of the debt remain murky. Russia appears to be making Moldova liable to repay at least some of Transnistria’s debt while only demanding the debt settlement with Moldova, but not with Transnistria.

High stakes for Moscow

Moreover, the contract is used to derail liberalisation of the energy market in line with EU’s energy market rules (through the so-called unbundling of supplies and distribution) which Moldova had committed itself to since the country joined the Energy Community in 2010.

Referring to ‘the non-application of forced reorganization and sanctions against Moldovagaz’, the new gas contract forces Moldova to postpone implementing the unbundling of supplies and distribution by making it conditional on resolving the energy debt.

Furthermore, Moldova ominously agreed to create an ‘intergovernmental commission on economic cooperation’ with Russia, which effectively blocks Moldova’s economic integration with the EU. (This demand is hardly new as Russia previously requested, and was granted, a seat at the negotiating table on a bilateral trade agreement between the EU and Ukraine. The trilateral EU-Ukraine-Russia negotiations have made it clear that Russia is seeking a veto over European integration of all neighbouring countries.)  

Targeting Moldova’s new reformist government reflects high personal stakes for Moscow. Moldova’s caretaker (kurator) in the Kremlin is Dimitrii Kozak, who in 2003 masterminded the so-called ‘Kozak Memorandum’. This sought to reintegrate breakaway Transnistria into a Moldova-Transnistria federation.

It was thwarted at the last minute but the Russian leadership has not given up on its plan. Now using his position as the deputy head of Presidential Administration, Kozak is masterminding Russia’s rehashed policy towards Moldova and has attempted to bring back his Memorandum as a political blueprint for a ‘settlement’.

Russia’s heavy-handed energy ‘diplomacy’

The new Moldovan government is caught in a crossfire of domestic expectations and Russian geopolitical demands. The gas crisis shows that while the new government may wish for geopolitics to go away, they are a weapon Russia will deploy at will.

The new Moldovan government is caught in a crossfire of domestic expectations and Russian geopolitical demands.

The Moldovan government is brand new so it has relatively little experience of dealing with Russia’s heavy-handed ‘energy diplomacy’. But the EU has been on the receiving end of this before – this is a direct replica of Russia’s strategy toward Armenia and Ukraine – and neither ended well for the target countries or for the EU.

So, Russia’s plans for Moldova are likely to have similar consequences for the EU’s latest attempts to be a convincing foreign policy actor. 




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War in Ukraine: Can the EU survive without Russian oil and gas?

War in Ukraine: Can the EU survive without Russian oil and gas? Audio NCapeling 5 May 2022

The fourth episode of our podcast mini-series examines how reliant the European Union (EU) is on Russian energy.

What would an all-out ban on Russian oil look like? Which countries would be most affected? Does this offer an opportunity for renewable energy?

Clips used: Bloomberg News

This episode was produced by Anouk Millet of Earshot Strategies on behalf of Chatham House.




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Gorbachev's complex legacy is beyond the popular belief

Gorbachev's complex legacy is beyond the popular belief Expert comment NCapeling 3 September 2022

The last major figure with a decisive Cold War role, Mikhail Gorbachev was not as bad as Putin’s Russia portrays him, but also not as heroic as the West thinks.

Arguably the worst year of the Cold War since the Cuban Missile Crisis was 1983, with three major incidents which escalated East-West tensions – and any one of them could have led to a full-scale war.

The first was the Korean Airline KAL007 being shot down by an SU15 fighter aircraft for straying into Soviet airspace, killing all 269 passengers and crew. Then came the identification of signals from Soviet satellites as being incoming US intercontinental ballistic missiles – Colonel Stanislav Petrov, going against all protocols, thankfully decided to report them as a false alarm before he could be sure.

The third was perhaps the most dangerous, being the misinterpretation of a live-fire NATO exercise which was believed by some in both East Germany and Russia to be a front for an imminent attack.

The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled

All three incidents occurred in the few months following the infamous March 1983 ‘Star Wars’ speech by US president Ronald Reagan, in which he talked about nuclear arms control and laid out the US case for a ballistic missile defence programme.

At that time Mikhail Sergeyevich Gorbachev was the youngest serving member of the USSR Politburo, known to be a favourite of Soviet leader Yuri Andropov, and it is highly likely he had been aware of these close calls and was part of discussions within Kremlin decision-making circles.

A changemaker both inside and outside the USSR

Following the deaths of Andropov in 1984 and his replacement Konstantin Chernenko in 1985, Gorbachev’s appointment as general secretary of the Communist Party saw him immediately begin to change the Soviet Union from within – and also change relationships with the major Western powers, especially the US, Germany, and the UK.

His policies of glasnost (openness) and perestroika (restructuring) were primarily aimed at internal reforms but translated into a major reset of international relations and international security. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US.

These included the 1986 Stockholm Accord which emanated from the Helsinki Process and allowed for the observation and inspection of large-scale military exercises, the 1985 resumption of the Strategic Arms Reduction Talks which lead to START I, and the 1987 INF Treaty in which the USSR ‘out-yessed’ the US – the most open and transparent disarmament treaty in terms of notification and verification measures ever agreed.

There was also a reciprocal moratorium on nuclear weapons tests starting from 1985 – which laid the groundwork for the 1996 CTBT – the 1991 Chemical Weapons Convention, and the 1990 Conventional Forces in Europe (CFE) Treaty.

The most dramatic moment of all was when Gorbachev and Reagan met at a summit in Reykjavik and came close to deciding to eliminate nuclear weapons – but the initiative failed to reach agreement, mainly because Reagan could not drop his commitment to ballistic missile defences and Gorbachev could not accept the offer of joint development.

Nonetheless, all these nuclear arms control treaties led the way for their descendants which have kept nuclear weapons in check ever since and are still in place in the form of the New START agreement.

During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US

But despite these outstanding achievements, Gorbachev had blind spots – such as enabling rather than destroying the USSR bioweapons programme, unlike the US which had dismantled its own bioweapons offensive capability by 1973.

And it is now known that, despite negotiating the Chemical Weapons Convention, Russia withheld information on new chemical weapons agents – Novichoks – which have since been used to lethal effect by Russia in Salisbury and against figures opposing the current regime.

His misguided faith in a Soviet future

Gorbachev was markedly different to his predecessors as secretary general. He was neither as decrepit nor as hardline, and he understood from the outset that the Soviet Union was, by the 1980s, finally dying.

Using the intellectual abilities of Aleksandr Yakovlev, he forced through the reforms which simultaneously captured the imagination of the free world and liberated his countrymen and women.

But although he built solid relationships – even friendships – with the world’s major heads of state and improved the USSR’s human rights, releasing dissidents such as Andrei Sakharov, but many – especially Ukrainian dissidents – continued to languish in camps.

The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled.

This shortcoming is especially uncomfortable as today’s Russia continues to insist it has a given right to control other former Soviet states, to the extent it is willing to destroy them if they do not concede.




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[68Ga]Ga-PSMA-11 PET/CT-Positive Hepatic Inflammatory Pseudotumor: Possible PSMA-Avid Pitfall in Nuclear Imaging




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Design, Synthesis, and Preclinical Evaluation of a High-Affinity 18F-Labeled Radioligand for Myocardial Growth Hormone Secretagogue Receptor Before and After Myocardial Infarction

The peptide hormone ghrelin is produced in cardiomyocytes and acts through the myocardial growth hormone secretagogue receptor (GHSR) to promote cardiomyocyte survival. Administration of ghrelin may have therapeutic effects on post–myocardial infarction (MI) outcomes. Therefore, there is a need to develop molecular imaging probes that can track the dynamics of GHSR in health and disease to better predict the effectiveness of ghrelin-based therapeutics. We designed a high-affinity GHSR ligand labeled with 18F for imaging by PET and characterized its in vivo properties in a canine model of MI. Methods: We rationally designed and radiolabeled with 18F a quinazolinone derivative ([18F]LCE470) with subnanomolar binding affinity to GHSR. We determined the sensitivity and in vivo and ex vivo specificity of [18F]LCE470 in a canine model of surgically induced MI using PET/MRI, which allowed for anatomic localization of tracer uptake and simultaneous determination of global cardiac function. Uptake of [18F]LCE470 was determined by time–activity curve and SUV analysis in 3 regions of the left ventricle—area of infarct, territory served by the left circumflex coronary artery, and remote myocardium—over a period of 1.5 y. Changes in cardiac perfusion were tracked by [13N]NH3 PET. Results: The receptor binding affinity of LCE470 was measured at 0.33 nM, the highest known receptor binding affinity for a radiolabeled GHSR ligand. In vivo blocking studies in healthy hounds and ex vivo blocking studies in myocardial tissue showed the specificity of [18F]LCE470, and sensitivity was demonstrated by a positive correlation between tracer uptake and GHSR abundance. Post-MI changes in [18F]LCE470 uptake occurred independently of perfusion tracer distributions and changes in global cardiac function. We found that the regional distribution of [18F]LCE470 within the left ventricle diverged significantly within 1 d after MI and remained that way throughout the 1.5-y duration of the study. Conclusion: [18F]LCE470 is a high-affinity PET tracer that can detect changes in the regional distribution of myocardial GHSR after MI. In vivo PET molecular imaging of the global dynamics of GHSR may lead to improved GHSR-based therapeutics in the treatment of post-MI remodeling.




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Molecular Imaging of p53 in Mouse Models of Cancer Using a Radiolabeled Antibody TAT Conjugate with SPECT

Mutations of p53 protein occur in over half of all cancers, with profound effects on tumor biology. We present the first—to our knowledge—method for noninvasive visualization of p53 in tumor tissue in vivo, using SPECT, in 3 different models of cancer. Methods: Anti-p53 monoclonal antibodies were conjugated to the cell-penetrating transactivator of transcription (TAT) peptide and a metal ion chelator and then radiolabeled with 111In to allow SPECT imaging. 111In-anti-p53-TAT conjugates were retained longer in cells overexpressing p53-specific than non–p53-specific 111In-mIgG (mouse IgG from murine plasma)-TAT controls, but not in null p53 cells. Results: In vivo SPECT imaging showed enhanced uptake of 111In-anti-p53-TAT, versus 111In-mIgG-TAT, in high-expression p53R175H and medium-expression wild-type p53 but not in null p53 tumor xenografts. The results were confirmed in mice bearing genetically engineered KPC mouse–derived pancreatic ductal adenocarcinoma tumors. Imaging with 111In-anti-p53-TAT was possible in KPC mice bearing spontaneous p53R172H pancreatic ductal adenocarcinoma tumors. Conclusion: We demonstrate the feasibility of noninvasive in vivo molecular imaging of p53 in tumor tissue using a radiolabeled TAT-modified monoclonal antibody.




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[68Ga]Ga-RAYZ-8009: A Glypican-3-Targeted Diagnostic Radiopharmaceutical for Hepatocellular Carcinoma Molecular Imaging--A First-in-Human Case Series

To date, the imaging and diagnosis of hepatocellular carcinoma (HCC) rely on CT/MRI, which have well-known limitations. Glypican-3 (GPC3) is a cell surface receptor highly expressed by HCC but not by normal or cirrhotic liver tissue. Here we report initial clinical results of GPC3-targeted PET imaging with [68Ga]Ga-DOTA-RYZ-GPC3 (RAYZ-8009), a peptide-based GPC3 ligand in patients with known or suspected HCC. Methods: [68Ga]Ga-RAYZ-8009 was obtained after labeling the peptide precursor with 68Ga from a 68Ge/68Ga generator and heating at 90°C for 10 min followed by sterile filtration. After administration of [68Ga]Ga-RAYZ-8009, a dynamic or static PET/CT scan was acquired between 45 min and 4 h after administration. Radiotracer uptake was measured by SUVs for the following tissues: suspected or actual HCC or hepatoblastoma lesions, non–tumor-bearing liver, renal cortex, blood pool in the left ventricle, and gastric fundus. Additionally, tumor–to–healthy-liver ratios (TLRs) were calculated. Results: Twenty-four patients (5 patients in the dynamic protocol; 19 patients in the static protocol) were scanned. No adverse events occurred. Two patients had no lesion detected and did not have HCC during follow-up. In total, 50 lesions were detected and analyzed. The mean SUVmax of these lesions was 19.6 (range, 2.7–95.3), and the mean SUVmean was 10.1 (range, 1.0–49.2) at approximately 60 min after administration. Uptake in non–tumor-bearing liver and blood pool rapidly decreased over time and became negligible 45 min after administration (mean SUVmean, <1.6), with a continuous decline to 4 h after administration (mean SUVmean, 1.0). The opposite was observed for HCC lesions, for which SUVs and TLRs continuously increased for up to 4 h after administration. In individual lesion analysis, TLR was the highest between 60 and 120 min after administration. Uptake in the gastric fundus gradually increased for up to 45 min (to an SUVmax of 31.3) and decreased gradually afterward. Conclusion: [68Ga]Ga-RAYZ-8009 is safe and allows for high-contrast imaging of GPC3-positive HCC, with rapid clearance from most normal organs. Thereby, [68Ga]Ga-RAYZ-8009 is promising for HCC diagnosis and staging. Further research is warranted.




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Dual Somatostatin Receptor/18F-FDG PET/CT Imaging in Patients with Well-Differentiated, Grade 2 and 3 Gastroenteropancreatic Neuroendocrine Tumors

Our purpose was to prospectively assess the distribution of NETPET scores in well-differentiated (WD) grade 2 and 3 gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) and to determine the impact of the NETPET score on clinical management. Methods: This single-arm, institutional ethics review board–approved prospective study included 40 patients with histologically proven WD GEP NETs. 68Ga-DOTATATE PET and 18F-FDG PET were performed within 21 d of each other. NETPET scores were evaluated qualitatively by 2 reviewers, with up to 10 marker lesions selected for each patient. The quantitative parameters that were evaluated included marker lesion SUVmax for each tracer; 18F-FDG/68Ga-DOTATATE SUVmax ratios; functional tumor volume (FTV) and metabolic tumor volume (MTV) on 68Ga-DOTATATE and 18F-FDG PET, respectively; and FTV/MTV ratios. The treatment plan before and after 18F-FDG PET was recorded. Results: There were 22 men and 18 women (mean age, 60.8 y) with grade 2 (n = 24) or grade 3 (n = 16) tumors and a mean Ki-67 index of 16.1%. NETPET scores of P0, P1, P2A, P2B, P3B, P4B, and P5 were documented in 2 (5%), 5 (12.5%), 5 (12.5%) 20 (50%), 2 (5%), 4 (10%), and 2 (5%) patients, respectively. No association was found between the SUVmax of target lesions on 68Ga-DOTATATE and the SUVmax of target lesions on 18F-FDG PET (P = 0.505). 18F-FDG/68Ga-DOTATATE SUVmax ratios were significantly lower for patients with low (P1–P2) primary NETPET scores than for those with high (P3–P5) primary NETPET scores (mean ± SD, 0.20 ± 0.13 and 1.68 ± 1.44, respectively; P < 0.001). MTV on 18F-FDG PET was significantly lower for low primary NETPET scores than for high ones (mean ± SD, 464 ± 601 cm3 and 66 ± 114 cm3, respectively; P = 0.005). A change in the type of management was observed in 42.5% of patients after 18F-FDG PET, with the most common being a change from systemic therapy to peptide receptor radionuclide therapy and from debulking surgery to systemic therapy. Conclusion: There was a heterogeneous distribution of NETPET scores in patients with WD grade 2 and 3 GEP NETs, with more than 1 in 5 patients having a high NETPET score and a frequent change in management after 18F-FDG PET. Quantitative parameters including 18F-FDG/68Ga-DOTATATE SUVmax ratios in target lesions and FTV/MTV ratios can discriminate between patients with high and low NETPET scores.




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Quantitative SPECT/CT Metrics in Early Prediction of [177Lu]Lu-DOTATATE Treatment Response in Gastroenteropancreatic Neuroendocrine Tumor Patients

Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [177Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. Methods: Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [177Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (TBS) and changes in normalized peak count (nPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. Results: Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in TBSsecond-first, TBSthird-first, and TBSfourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [177Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. –0.049, 0.08 vs. –0.116, and 0.109 vs. –0.123 [P = 0.023, P = 0.002, and P < 0.001], respectively). nPCsecond-first showed significant group differences (mean, –0.107 vs. –0.282; P = 0.033); nPCthird-first and nPCfourth-first did not reach statistical significance (mean, –0.122 vs. –0.312 and –0.183 vs. –0.405 [P = 0.117 and 0.067], respectively). At the optimal threshold, TBSfourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. TBSsecond-first and TBSthird-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. nPCsecond-first, nPCthird-first, and nPCfourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. Conclusion: TBS and nPC can predict [177Lu]Lu-DOTATATE response by the second treatment session.




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Clinical Factors That Influence Repeat 68Ga-PSMA-11 PET/CT Scan Positivity in Patients with Recurrent Prostate Cancer Under Observation After a Negative 68Ga-PSMA-11 PET/CT Scan: A Single-Center Retrospective Study

This analysis aimed to identify clinical factors associated with positivity on repeat 68Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 68Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann–Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2–1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9–3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative 68Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat 68Ga-PSMA-11 PET/CT.




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Predicting Pathologic Complete Response in Locally Advanced Rectal Cancer with [68Ga]Ga-FAPI-04 PET, [18F]FDG PET, and Contrast-Enhanced MRI: Lesion-to-Lesion Comparison with Pathology

Neoadjuvant therapy in patients with locally advanced rectal cancer (LARC) has achieved good pathologic complete response (pCR) rates, potentially eliminating the need for surgical intervention. This study investigated preoperative methods for predicting pCR after neoadjuvant short-course radiotherapy (SCRT) combined with immunochemotherapy. Methods: Treatment-naïve patients with histologically confirmed LARC were enrolled from February 2023 to July 2023. Before surgery, the patients received neoadjuvant SCRT followed by 2 cycles of capecitabine and oxaliplatin plus camrelizumab. 68Ga-labeled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI-04) PET/MRI, [18F]FDG PET/CT, and contrast-enhanced MRI were performed before treatment initiation and before surgery in each patient. PET and MRI features and the size and number of lesions were also collected from each scan. Each parameter’s sensitivity, specificity, and diagnostic cutoff were derived via receiver-operating-characteristic curve analysis. Results: Twenty eligible patients (13 men, 7 women; mean age, 60.2 y) were enrolled and completed the entire trial, and all patients had proficient mismatch repair or microsatellite-stable LARC. A postoperative pCR was achieved in 9 patients (45.0%). In the visual evaluation, both [68Ga]Ga-FAPI-04 PET/MRI and [18F]FDG PET/CT were limited to forecasting pCR. Contrast-enhanced MRI had a low sensitivity of 55.56% to predict pCR. In the quantitative evaluation, [68Ga]Ga-FAPI-04 change in SULpeak percentage, where SULpeak is SUVpeak standardized by lean body mass, had the largest area under the curve (0.929) with high specificity (sensitivity, 77.78%; specificity, 100.0%; cutoff, 63.92%). Conclusion: [68Ga]Ga-FAPI-04 PET/MRI is a promising imaging modality for predicting pCR after SCRT combined with immunochemotherapy. The SULpeak decrease exceeding 63.92% may provide valuable guidance in selecting patients who can forgo surgery after neoadjuvant therapy.




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Whole-Body HER2 Heterogeneity Identified on HER2 PET in HER2-Negative, -Low, and -Positive Metastatic Breast Cancer

Understanding which patients with human epidermal growth factor receptor 2 (HER2)–negative or –low metastatic breast cancer (MBC) benefit from HER2-targeted strategies is urgently needed. We assessed the whole-body heterogeneity of HER2 expression on 89Zr-trastuzumab PET (HER2 PET) and the diagnostic performance of HER2 PET in a large series of patients, including HER2-negative and -low MBC. Methods: In the IMPACT-MBC study, patients with newly diagnosed and nonrapidly progressive MBC of all subtypes were included. Metastasis HER2 status was determined by immunohistochemistry and in situ hybridization.89Zr-trastuzumab uptake was quantified as SUVmax and SUVmean. HER2 immunohistochemistry was related to the quantitative 89Zr-trastuzumab uptake of all metastases and corresponding biopsied metastasis, uptake heterogeneity, and qualitative scan evaluation. A prediction algorithm for HER2 immunohistochemistry positivity based on uptake was developed. Results: In 200 patients, 89Zr-trastuzumab uptake was quantified in 5,163 metastases, including 186 biopsied metastases. With increasing HER2 immunohistochemistry status, uptake was higher (geometric mean SUVmax of 7.0, 7.6, 7.3, and 17.4 for a HER2 immunohistochemistry score of 0, 1, 2, or 3+, respectively; P < 0.001). High uptake exceeding 14.6 (90th percentile) was observed in one third of patients with a HER2-negative or -low metastasis biopsy. The algorithm performed best when lesion site and size were incorporated (area under the curve, 0.86; 95% CI, 0.79–0.93). Conclusion: HER2 PET had good diagnostic performance in MBC, showing considerable whole-body HER2 heterogeneity and uptake above background in HER2-negative and -low MBC. This provides novel insights into HER2-negative and -low MBC compared with standard HER2 immunohistochemistry on a single biopsy.




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Navigating the Future of Prostate Cancer Care: AI-Driven Imaging and Theranostics Through the Lens of RELAINCE




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Trump calls rumors he may sell $3.5B Trump Media stake 'illegal,' calls for investigation

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At least 56 people, including 20 children, killed in Israeli airstrikes in Lebanon and Gaza

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Bill to legalize assisted-sying introduced in British Parliament

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ISC Opens Nominations for 2025 Jack Dongarra Early Career Award in HPC

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The post ISC Opens Nominations for 2025 Jack Dongarra Early Career Award in HPC appeared first on HPCwire.




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Speed up Innovation with performance gains of up to 42% on the most powerful HPC Cloud

About This Webinar Oracle’s next generation HPC architecture with Intel compute instance based on 3rd Generation Intel® Xeon® Scalable processors, code named “Ice Lake”, changes the game for HPC in […]

The post Speed up Innovation with performance gains of up to 42% on the most powerful HPC Cloud appeared first on HPCwire.




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GIGABYTE Joins AI Accelerator Skyscraper Congress to Highlight Sustainable Supercomputing Advances

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Army investigating suspected suicides of three Fort Drum soldiers

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Why More Organizations Are Running HPC Workloads in the Cloud

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The post Why More Organizations Are Running HPC Workloads in the Cloud appeared first on HPCwire.





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Final phase for polio vaccinations resumes in northern Gaza

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Veterans Day: Harriet Tubman posthumously award rank of brigadier general

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Look: Megan Fox, Machine Gun Kelly expecting child together

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Watch: Disney+ teases 'Alien: Earth,' 'Andor' S2, 'Daredevil: Born Again' in 2025 preview

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