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Director’s breakfast briefing: Shifts in European foreign policy since 9/11

Director’s breakfast briefing: Shifts in European foreign policy since 9/11 14 October 2021 — 8:00AM TO 9:15AM Anonymous (not verified) 4 October 2021 Chatham House

Former MI6 chief, Sir Alex Younger, discusses shifts in European foreign policy since 9/11.

Former MI6 chief Sir Alex Younger, discusses shifts in European foreign policy since 9/11.

The dramatic events surrounding the withdrawal from Afghanistan demonstrates a profound shift in European security priorities since the beginning of the ‘war on terror’. Against the backdrop of the 20th anniversary of 9/11, former MI6 chief, Sir Alex Younger, discusses recent shifts in European foreign policy.

How has the focus on counterterrorism changed over the last two decades particularly in light of new and evolving strategic challenges? Why were many long-term objectives in Afghanistan left unachieved? Has the threat of terrorism changed across Europe? How has cooperation between security and intelligence services across the world changed particularly across the Atlantic? And, 20 years on, is the ‘war on terror’ really over?

This event is only open to Chatham House Partners and Major Corporate Members as well as selected giving circles of Chatham House. If you would like to attend, please RSVP to Linda Bedford at RSVP@chathamhouse.org.




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How do Eurasian kleptocracies earn and use their money?

How do Eurasian kleptocracies earn and use their money? 9 November 2021 — 1:00PM TO 2:30PM Anonymous (not verified) 22 October 2021 Chatham House and Online

This event explores the presence of corrupt funds from Eurasia in Western democracies, what they are used for, and how they can be constrained.

The Pandora Papers once again shone the spotlight on the UK being home to corrupt funds from kleptocracies, where the ruling elite abuse their political power for private gain.

In recent years much focus has been placed on this term, and the possible effects such money could have on Western democracies.

  • How do such states create this wealth in the first place?
  • How do these funds make their way to the UK?
  • Is the term kleptocracy appropriate for the majority of countries in Eurasia?
  • What evidence is there that such funds are ‘weaponized’ to achieve foreign policy goals?

This event discusses the term, how it can be applied, and the differences between how ’grey’ funds are used by various countries. It also highlights how the UK and the wider international community can counteract these flows, both from a legal point of view, and via other methods.




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Belarus-EU border crisis reveals wider security threat

Belarus-EU border crisis reveals wider security threat Expert comment NCapeling 8 December 2021

By engineering a crisis at the Belarus border, Lukashenka is attempting to exacerbate vulnerabilities within the EU. Securitizing migration is not the answer.

When thousands of migrants began freezing to death in the forests on the Belarus border with Poland, Belarusian leader Aliaksandr Lukashenka was forcing the European Union (EU) into a tough choice – either give in to blackmail and welcome migrants whose attempts to trespass the EU border were a result of his policy of luring them to Belarus to put pressure on the EU, or keep the borders closed and declare solidarity with Poland despite its known mistreatment and illegal pushbacks of potential asylum-seekers.

Lukashenka’s action was aptly exploiting three key pressure points of the EU – as a normative power where the human dignity of migrants is overlooked while the European border and coastguard agency Frontex stands by, as a geopolitical actor seeking to externalize its migration problem by signing readmission agreements with transit countries, and as a community of values with the EU-Poland dispute over rule of law.

Now is the time for a robust strategy aimed at preventing what is currently a rogue state from turning into an outright terrorist regime

His approach is typical ‘dictaplomacy’ and democracies which have confronted such a ‘continuation of war by other means’ in their past dealings with dictatorships know that blackmail mostly serves to divert attention away from a rogue leader’s misdemeanours towards his own population. But if this had been game of chess the EU would have been in check.

Thankfully checkmate was avoided – so far – as a compromise was found following weeks of heightened diplomatic efforts. Lukashenka was forced to back-pedal and take care of the migrants, and no humanitarian corridor was needed as the EU sent funds and took measures to support organizations providing shelter for the migrants in Belarus, while airlines and governments in the source countries were pressured to restrict flights to Minsk and started repatriating part of the migrants.

Causing a nuisance

‘Operation Gateway’ – the outline of which was allegedly drawn several years ago and tested by Russia in 2016 at its own borders with Norway and Finland – certainly caused a nuisance, but it ultimately backfired as Lukashenka now has to manage the remaining 2,000-5,000 migrants who refused to be flown back, as well as facing increased international sanctions. However, the fact that Angela Merkel had to personally call him made it look as if Lukashenka did not back down for nothing.

The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare, and to upgrade strategic assessments of the ‘Lukashenka problem’ too.

Back in June, the Belarus ministry of foreign affairs (MFA) announced its withdrawal from the Eastern Partnership and the visa facilitation and readmission agreement with the EU, while Lithuania sent early warnings about a ‘hybrid attack’ at its own border with Belarus. In August, Der Spiegel reported details of an alleged smuggling scheme whereby Tsentr Kurort – a company closely linked to the Administration of the President of Belarus with offices in the Middle East – was handling the shipping, accommodation, and relocation of migrants.

The EU and NATO, including the UK, only reacted collectively to this crisis once it was already out of hand, leaving questions over whether this experience of Lukashenka’s dictaplomacy is a wake-up call to boost resilience against rogue warfare

The smuggling of migrants was entirely predictable as Lukashenka has hinted many times Belarus could stop ‘protecting the EU from armed migrants’ seeking to enter it illegally. He has upped his rhetoric beyond notions of hybrid warfare by saying he needs Russian nuclear-capable bombers to ‘help him navigate the migrant crisis’, even hinting Belarus could station both Russian nuclear weapons and S-400 anti-aircraft missile systems. This shows Lukashenka is feeling increasingly cornered – which could lead to more unpredictable security crises.

Russia and Belarus are deepening relations

Although there is no smoking gun pointing to direct Russian involvement in orchestrating the hybrid attack at the EU’s borders, a new step in the military rapprochement between the two countries came when Putin and Lukashenka approved a new Military Doctrine of the Union-State of Russia and Belarus – a non-public document including a joint concept of migration policy. Lukashenka has also come off the fence over Crimea by openly accepting the legality of the peninsula’s integration with Russia.

Given Russia is also sabre-rattling over Ukraine, the risk of an accidental escalation into armed conflict is increasing in what feels like a return to classic Cold War logic, with the difference that the East is now offensively using the South for confronting the West. In recognition of the threat, the UK has joined the US, Canada, and the EU in the fresh sanctions on Belarus.




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How European security is changing

How European security is changing Expert comment LJefferson 10 January 2022

Although migration, economic, health, tech and climate policy are increasingly thought of in terms of security, different issues are taking place in each of these policy areas.

Since the end of the Cold War, debates about security among both academics and policymakers have shifted away from traditional military or state security towards a broader conception of what security is – including, for example, ideas such as ‘human security’.

More recently, there has been a widespread perception of a ‘return of great power competition’ and even renewed fears about great power war – in other words, a resurgence of traditional security debates that many hoped and believed were a thing of the past. At the same time, and especially since the COVID-19 pandemic began in 2020, the concept of ‘security’ has also been increasingly applied to other areas like economic and health policies.

These complex and parallel developments raise a number of difficult questions. First, does the changing way in which the concept of ‘security’ is used – and in particular the way people now increasingly speak of ‘economic security’ and ‘health security’ – reflect a changing reality or rather simply a changing perception of reality? Second, are these changes in the way we think about security helpful or not? In other words, is the redefinition of security that seems to be taking place leading to good policy responses and making citizens more secure, or is it rather unhelpfully ‘securitizing’ policy areas and possibly undermining democracy in the process?

Part of the reason that these questions are difficult to answer is that there are different developments taking place in different policy areas. This article briefly analyses developments in five policy areas: migration policy, economic and trade policy, health policy, technology policy, and climate policy.

The authors argue there are at least three separate developments taking place, though it is often quite difficult to disentangle them – and more than one development may be taking place in each policy area. The analysis focuses on developments in Europe – defined broadly as including countries such as the UK which are outside the European Union (EU) – which may be different from those taking place elsewhere.

Five policy areas, three trends

In migration policy, the clearest development that is taking place, in particular since the so-called ‘refugee crisis’ of 2015, is the militarization of borders in Europe – in particular, the militarization of the EU’s external border.

The removal of borders within Europe was once seen by some as a step towards a borderless world, but since 2015 the EU seems to have concluded that the internal removal of borders requires a much harder external border than was previously the case.

The removal of borders within Europe was once seen by some as a step towards a borderless world, but since 2015 the EU seems to have concluded that the internal removal of borders requires a much harder external border than was previously the case

In particular, since the ‘refugee crisis’, the EU has massively invested in Frontex, its border agency, which describes itself as ‘Europe’s first uniformed service’ that ‘helps guarantee free movement without internal borders checks that many of us take for granted’. In short, we are seeing an application to migration policy of military tools, including armed border guards.

Something different seems to be taking place in economic policy. For the last three or four decades since the end of the Cold War, economic policy has been dominated by (neo-)liberal assumptions. But these are now increasingly being challenged and a shift may be taking place away from this macroeconomic paradigm.

The reasons for this are complex – in part, a domestic backlash against this paradigm, particularly from the ‘losers’ or ‘left behind’ (in other words those who have suffered from the distributional consequences of the economic and especially trade policies of the last 30-40 years going back to the ‘neoliberal turn’), and in part a sense among analysts and policymakers that a different set of more protectionist policies are required in order to compete with China as a ‘systemic rival’.

These two different drivers of an economic paradigm shift have become even more tightly connected since the COVID-19 pandemic began in 2020. The pandemic led to both an increased demand for a new economic paradigm and a sense of intensified competition with China and, in the EU, to a lesser extent with the United States.

However, because the set of rules governing economic and in particular trade policy was set during the earlier period of (neo-)liberal hegemony, they restricted the ability of states to pursue what were seen as protectionist policies in order to redistribute and created exceptions only for security reasons. This has created a structural pressure on nation states to present economic policies in terms of security.

Here, however, the EU may be an outlier. During the last few decades, the EU has gone even further than the rest of the world has in creating rules around economic policy – at least internally. In particular, the EU’s fiscal rules may prevent its member states from borrowing to invest and its state aid rules may prevent them from experimenting with new kinds of industrial policy.

Therefore, the EU may be structurally constrained from making the kind of paradigm shift in economic policy that many now think is necessary. In particular, despite the rhetoric about a more ‘geopolitical’ EU, it may be limited in the extent to which it can think of economic policy in terms of security – sometimes to the regret of security establishments, as is the case for debates around 5G, for example.

The EU may be structurally constrained from making the kind of paradigm shift in economic policy that many now think is necessary

In health policy, something similar may be happening as in economic policy. During the last three or four decades, health policy has been approached in a rather liberal way. Across Europe, though to different degrees and in different ways, market principles have been introduced into health systems.

In many cases such as the UK, this has involved privatizing what were previously state functions in healthcare. But since the pandemic, there has been a renewed focus on renationalizing or, in the case of the EU, ‘re-regionalizing’ supply chains, in particular for personal protective equipment (PPE) and vaccines, which is presented in terms of ‘health security’. COVID-19 has also reinforced the need to better include pandemic preparedness in national security planning.

A similar trend seems to be taking place in technology policy, which as with health policy is now increasingly viewed in a defensive, protectionist way rather than the liberal way it was previously seen. For example, the production of semiconductors was previously viewed in economic liberal terms – in other words, they should be produced wherever they can be produced most efficiently.

Technology policy, like health policy, is now increasingly viewed in a defensive, protectionist way rather than the liberal way it was previously seen

But analysts and policymakers increasingly see technology as central to the competition between China and the United States – or even more broadly between authoritarian states and democracies. As in health policy, there is an increasing focus on a shared approach among allies and on the ‘resilience’ of supply chains for technology. A similar shift is taking place on the management of data flows and the need to think harder – and maybe, be less naive – about the security impact of our online life.

Finally, in climate policy, something different seems to be taking place. Here, there is neither an attempt to apply military tools (notwithstanding the fact some national European militaries as well as NATO are increasingly interested in climate security, for instance regarding the ability to train and fight in altered weather conditions, notably extreme heat) nor a paradigm shift away from liberalism – although some, especially on the left, do question whether it is possible to prevent catastrophic climate change unless we abandon economic liberalism and much of the debate about green investment is closely connected to debates about an economic paradigm shift.

In climate policy, something different seems to be taking place. Here, there is neither an attempt to apply military tools, nor a paradigm shift away from liberalism

Rather, what is striking is the increasing talk of a ‘climate emergency’ – with its implication of the need to suspend normal democratic decision-making – and of the need to take extraordinary measures to prevent catastrophic climate change. However, for the time being, such rhetoric on climate change is not matched by relevant extraordinary emergency measures.

Across these five policy areas, in other words, there seem to be at least three developments taking place that are reshaping how we think about security in Europe. The difficult question is whether each of these developments is a ‘good’ thing or not, i.e. whether they actually make European citizens more secure in an appropriate way.

In other words, is it a good idea to militarize the EU’s borders, to shift away from the earlier liberal paradigm in economic, health and technology policy and frame the shift in terms of ‘security’, or to invoke an emergency in order to be able to take more drastic measures to prevent climate change?

The limits of securitization theory

One way of thinking about these issues is what academics call ‘securitization’ – the situation when something is identified in rhetoric as an existential threat to some object, specifying a point of no return, that legitimizes the use of extraordinary measures and pushes the issue higher on the political and policy agenda.

The response to COVID-19 can be seen as an example of securitization – the existential threat to human beings but also healthcare systems was used to legitimize lockdowns and social distancing requirements.




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Ukraine response reveals Europe’s security is changing

Ukraine response reveals Europe’s security is changing Expert comment NCapeling 8 February 2022

Recent events regarding Ukraine show an active UK responding quickly while EU powers deliberate. But pulling ahead of the pack is not the same as leadership.

Britain’s relationship with Ukraine appears to be thriving, with Ukrainian defence journalist Illia Ponomarenko recently tweeting the ‘British are just unstoppable these days’ and that the UK finds itself ‘on the right side of history’ while one Ukrainian wine bar has started offering free drinks to British nationals.

Ponomarenko’s remarks and the wine bar offer – certainly one post-Brexit benefit of having a British passport – are down to the UK decision to send anti-tank weapons to support Ukraine’s forces against a potential Russian attack.

The UK’s quick response was praised by Ponomarenko as being ‘wise enough not to be lured into going the easiest way, which is always the fastest lane straight to hell’ and strikes a clear contrast with that of Germany, whose typically moderated approach to geopolitical tensions went down badly in Kyiv.

The chief of Germany’s navy was forced to resign after saying Russian president Vladimir Putin ‘deserved respect’ and that Ukraine will never win back annexed Crimea. The German government also sought an energy exception to proposed US sanctions, so that gas can continue to flow into Europe.

The question for leaders in Paris, Berlin, and Brussels is how to deal with an active Britain committed to Europe but under no obligation to work within EU processes

France’s response was somewhat stronger but rather confusing as Emmanuel Macron initially called for European Union (EU) member states to ‘conduct their own dialogue’ with Russia, seemingly as an alternative to supporting the US-led NATO response.

Risks of a ‘bullying’ Russia

Although positioning himself as the convener of a transatlantic response to the Ukraine crisis brings welcome respite for UK prime minister Boris Johnson from his domestic ‘partygate’ fiasco, he is also reported as saying some world leaders ‘may not appreciate the deteriorating picture on the Ukrainian border, or fully comprehend the risks posed by a bullying Russia’.

One particular image sums up the difference in approach between the UK and the EU, as a flight path shows a British RAF plane flying around Germany before taking a detour over Denmark on route to Ukraine.

Given that Germany later blocked the export of NATO ally Estonia’s weapons to Ukraine, this image gives ‘Global Britain’ advocates a strong symbol of apparent British reliability and resourcefulness in the face of supposed European deliberation and disunity.

But although the UK’s response to the Ukraine crisis has rightly been credited as swift and substantial, it also reveals deeper developments in the current European security landscape as EU countries had worried Britain might choose to become absent post-Brexit.

Losing one of its two main military powers would certainly have been a blow to Europe, particularly as Russia’s threat has grown in recent years, so there will be relief that the Ukraine crisis shows Britain is undoubtedly committed to the region. Now the question for leaders in Paris, Berlin, and Brussels is how to deal with an active Britain committed to Europe but under no obligation to work within EU processes.

The UK already has an interesting network of bilateral and mini-lateral relationships with European allies. Its Joint Expeditionary Force brings together ten European countries – including Scandinavian and Baltic states – and is well-placed to support NATO activities while also remaining flexible and independent. In the past year, the UK worked with Norway in the Arctic region, provided military engineers support to Poland, and worked directly with France and Germany through the E3 grouping – once again bypassing EU institutions.

The UK also brings a unique diplomatic, technology, and intelligence-sharing relationship with the US which is unavoidably important in dealing with the threat from Russia. As the US sees European security through a NATO lens – rather than an EU one – this makes Britain a leading player as one of the few countries meeting its NATO spending commitments.

UK must do more to win trust

But despite such creative partnerships transcending the constraints of Brexit, the UK must do more to win the trust of the EU’s biggest players France and Germany to be a permanent power in the region. And relations with France have deteriorated following disputes over fishing, a lack of cooperation on migrants, and the AUKUS defence technology agreement between the UK, US, and Australia.

When it comes to Germany, the UK must not use the Ukraine crisis as an opportunity for geopolitical point-scoring. There are good historical reasons for Germany’s cautious approach to military engagement, even if these do constrain the country’s response to this challenge.

In dealing with Russia, some members of Germany’s ruling SPD sincerely believe their party’s less confrontational posture was central to de-escalating conflict during the Cold War. And although some historians may dispute that belief, it is still a distinct and more noble motivation for ‘dovishness’ than pure economic self-interest.

Despite such creative partnerships transcending the constraints of Brexit, the UK must do more to win the trust of the EU’s biggest players France and Germany to be a permanent power in the region

Cooperation always requires some compromise on all sides. Germany must accept some level of economic risk if sanctions against Russia are to be meaningful and France has to accept the necessity of the UK and US’s involvement and that the most effective dialogue is unlikely to be achieved through EU institutions.

Meanwhile, the UK must accept some role for the two biggest EU players, particularly as the Normandy Format which includes Russia, Ukraine, France, and Germany has proved productive in the past. And the UK needs to clamp down on its own economic ties with Russia.




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Limited expectations as Scholz heads to Kyiv and Moscow

Limited expectations as Scholz heads to Kyiv and Moscow Expert comment NCapeling 14 February 2022

After heavy criticism for an initially timid response, the approach of Germany’s new government to the Ukraine crisis is improving as its position on Russia evolves.

Olaf Scholz is a famously quiet and cautious communicator and, as concerns mounted in Washington and London about the possibility of a Russian invasion of Ukraine, the new German chancellor remained silent.

This time his silence reflected the fact that his government was unprepared for its first major foreign policy test, with marked divisions between the SPD and the Greens on how to manage a rapidly deteriorating relationship with Russia.

When he did speak, Scholz caused dismay in several NATO capitals by defending the controversial Nord Stream 2 pipeline. He called it ‘a purely private economic project’ even though the company building the pipeline is a subsidiary of Russia’s state-owned Gazprom.

Scholz has prepared the ground carefully for his visits to Kyiv and Moscow, extensively coordinating with NATO allies, such as France and Poland – as part of the Weimar Triangle – and the three Baltic states

The absence of crisis management from Berlin was a stark reminder of the gap left by Angela Merkel. Her knowledge of Russia and Ukraine, and her personal experience of dealing with Vladimir Putin, were key assets in 2014 in developing a unified western response to Russia’s annexation of Crimea and its destabilization of south-eastern Ukraine.

Germany has coordinated with its allies

Scholz has prepared the ground carefully for his visits to Kyiv and Moscow, extensively coordinating with NATO allies, such as France and Poland – as part of the Weimar Triangle – and the three Baltic states. His inaugural visit to Washington helped align positions on US-EU efforts to develop an economic deterrent against further Russian intervention in Ukraine.

Scholz has also repeated Merkel’s language from 2014 to signal to Moscow that Germany and its partners are ‘united and determined’ to stand their ground. And he has spoken of Germany’s continuing double strategy of ‘clear announcements’ to Moscow of the price it would pay for further aggression accompanied by a readiness to use all possible channels of dialogue to preserve peace.

The continuation of Germany’s established policy will not surprise Moscow. But under the surface Germany’s discourse on Russia is evolving as the political class internalizes the fact that the current Russian leadership is openly threatening to use military force to impose its will on Ukraine and re-configure Europe’s security arrangements.

Despite deep concerns about Germany’s dependence on Russian gas – more than half of the gas it consumes comes from Russia – there is broad acceptance that Nord Stream 2 cannot go ahead if Russia invades Ukraine. But typically, Scholz has not yet said as much publicly, limiting himself to stating ‘all options are on the table.’

Despite its mantra that there is no alternative to the Minsk Agreements, Berlin now admits these currently offer no prospect of resolving the war in Donbas

Robert Habeck, Germany’s vice-chancellor as well as economic affairs and climate action minister, says the ‘geopolitical situation’ requires Germany to diversify its gas supplies and infrastructure for importing gas. For years, a strong pro-Russian gas lobby has dominated the thinking of the Economics Ministry and one consequence is the complete absence of facilities to import liquefied natural gas.

The German debate on Russia is shifting

A public debate has also started about weapons deliveries to Ukraine, even though this runs counter to deeply embedded pacifist tendencies in German society. Some MPs, former diplomats, and experts have begun to make the case for Germany to supply weapons to Ukraine so it can exercise its right to self-defence and deter military attack.

Christoph Heusgen, a former long-standing foreign policy adviser in the Federal Chancellery, says Berlin’s decision not to deliver arms to Ukraine to avoid endangering the Minsk peace process requires revision now Moscow has abandoned the path of negotiation.

Despite its mantra that there is no alternative to the Minsk Agreements, Berlin now admits these currently offer no prospect of resolving the war in Donbas because Russia is not prepared to implement them properly.

Other taboos are also being broken inside Germany. Heavyweight left-of-centre Die Zeit published the first results of its investigation into the SPD’s links with Russia and their place in Russia’s channels of influence in Germany. And even the SPD’s Sigmar Gabriel, an outspoken champion of Nord Stream 2 during his time as a government minister, has raised the question of Germany terminating energy imports from Russia if there is a drastic deterioration of the security situation.




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New research on 21st-century conflict

New research on 21st-century conflict 25 April 2022 — 5:00PM TO 6:00PM Anonymous (not verified) 11 April 2022 Online

This International Affairs webinar shares research on US special operations, urban warfare, and digital activism in recent conflicts.

Given the ongoing Russian invasion of Ukraine, and continuing conflicts in Myanmar, Yemen, and other countries, it is important to understand the changing nature of conflict in the 21st century.

In this webinar, authors from the March 2022 issue of International Affairs share research on the transformation of Western special forces, the impact of army size in urban warfare, and the use of social media and online activism in war.

The speakers in this event drew on the following research:

International Affairs was started at Chatham House in 1922 to communicate research to members who could not attend in person. Over the past 100 years, it has transformed into a journal that publishes academically rigorous and policy-relevant research. It is published for Chatham House by Oxford University Press. Read the latest issue here.




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Putin’s Eurasian dream may soon become a nightmare

Putin’s Eurasian dream may soon become a nightmare Expert comment NCapeling 3 May 2022

The Ukraine invasion has detrimental consequences for the Russia-led Eurasian Economic Union, a project which has been stumbling since its inception.

The Eurasian Economic Union (EAEU) – consisting of Russia with Armenia, Belarus, Kazakhstan, and Kyrgyzstan – represents the culmination of Russia’s pursuit of regional integration with its post-Soviet neighbours.

Officially, the Union has an ambitious economic goal – the creation of a market based on common rules for its five member states and their 180 million citizens – and Russia likes to portray the EAEU as an Eurasian replica of the European Union (EU).

But although a common market was placed at the heart of the EAEU as a way to appeal to member states, it is of marginal importance for the Russian economy. For Moscow, the EAEU is primarily a geopolitical tool to help re-assert its regional and global role.

In a world of evermore powerful trading blocs, Moscow wants to use the EAEU to establish its own economic power base in the new polycentric world order. But Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions.

The Kremlin has no qualms about disregarding the common rules when they clash with Russia’s own foreign policy, and it soon became evident the EAEU was a means to an end rather than an equitable institution within which Russia would accept constraints on its unilateral behaviour.

A crisis in the making

Although the EAEU has enabled some internal trade liberalization as well as the movement of people and labour to the benefit of its members reliant on labour migrant remittances, it has failed to tackle institutional barriers or promote growth and development policies.

Russia’s limited interest in the technocratic intricacies needed for the economic union to live up to its lofty proclamations exposes the real geopolitical ambitions

It has been hampered by weak common institutions and a lack of institutional capacity of its member states, while Russia’s dubious commitment is also problematic. The EAEU lacks the institutional features of a genuine common market and any attempts to address these shortcomings have been essentially empty promises.

EAEU membership does benefit the political elites of its member states, because its hub-and-spoke model relies on bilateral high-level political deals between Russia and each member state individually. And by using the enticement of security guarantees and both political and financial support, Moscow has succeeded in attracting new members to join.

But a member’s political survival – or defence against political and economic reform – is dependent on military, economic, financial, and political support from Russia. This has been evidenced by the Armenian-Azerbaijan conflict, and by Russia’s backing of the Lukashenka regime in Belarus and the Tokayev government in Kazakhstan.

The design of the EAEU ties it to Russia’s own fate, and so the impact of harsh sanctions imposed on Russia for invading Ukraine are in stark evidence across its member states. Both Kazakhstan and Kyrgyzstan are reeling from the adverse effects on their domestic currencies and remittances, and the trade bans of key commodities.

And although the ban Russia imposed on grain export to EAEU members has softened, it shows the extent to which Russia was prepared to disregard the rules and sacrifice the EAEU to rescue its own economy. Members are incurring direct economic losses from Putin’s war against Ukraine and the fluctuation of the rouble has created a major impediment to trade with Russia.

Russia seems to increasingly view the Union as a convenient tool to bypass sanctions, with massive implications for its partner countries. And the supposed advantages of EAEU membership – enhanced trade, growth, and modernization – have simply not materialized.

Due to the rapid economic decline of Russia – a fall of 10-15 per cent is anticipated for 2022 – the EAEU is even less likely to deliver the promised economic benefits, while also putting members at risk of secondary sanctions.

The Ukraine invasion has also reignited domestic sensitivities and regional tensions. In Kazakhstan, Tokayev has failed to endorse Russia’s justification for the invasion and refuses to recognize the ‘independence’ of the separatist LNR and DNR.

Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined

Meanwhile Azerbaijan has pursued territorial gains in Nagorno-Karabakh while Russia is distracted by its invasion of Ukraine, and has requested the withdrawal of Russian peacekeeping from the disputed territory.

Russia is keen for partner countries to help mitigate the economic impact of sanctions by providing alternative transit routes for imports to Russia. But the EAEU faces challenges even at its most basic level because the sharing of custom duties among member states was denominated in dollars, which Russia now wants to move away from.

No easy escape

Russia’s invasion of Ukraine clearly reduces the benefits of Eurasian integration even further than before and imposes higher cost on the partner countries than were envisaged when they joined. They have been dragged into a geopolitical calamity over which they have no control – the inability of EAEU institutions to mediate or constrain Russia’s behaviour is stark.




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Central and Eastern Europe become hawkish on China

Central and Eastern Europe become hawkish on China Expert comment LJefferson 16 September 2022

The recent withdrawal of the Baltic countries from the ‘17+1’ format displays changing perceptions of China due to its ambiguity towards the war in Ukraine.

While the Russian invasion of Ukraine only confirmed Central and Eastern Europe’s views of Russia, it is also affecting their relations with China. Although the relationship was already complicated due to unfulfilled Chinese economic promises to CEE countries and growing indications of efforts to influence their domestic politics, China’s support for Russia is pushing Central and Eastern Europeans even further away.

This shift was highlighted, and formalized, recently by several countries in the region leaving the ‘17+1’ format, through which China cooperates with a group of countries from the region. The shifting attitudes towards China will also influence the relationship between the European Union as a whole and China.

A Trojan Horse that never was

When the format was launched in 2012 between 16 CEE countries at the time and China, the countries jumping on board expected a wave of Chinese investment and an opportunity to diversify mostly west-bound trade.

These hopes never fully materialized as Chinese foreign direct investment (FDI) in CEE has been generally lower compared to the rest of Europe and China never became an important export destination for any of the countries. The growing disillusionment and concern about Chinese security threats has led to some of the countries speaking up about the perceived perils of closer cooperation.

The first to withdraw from what had become ‘17+1’ by 2021 was Lithuania, which also took an interest in strengthening ties with Taiwan and allowed it to open a Taiwanese representative office in Vilnius. This triggered a breakdown in the bilateral relations with China. As a retaliatory response, China blocked Lithuanian imports and imports from other EU states containing inputs from Lithuania, leading the EU to launch an official dispute at the WTO.

War in Ukraine

Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list.

However, the concerns and security environment that these countries face seems to be almost entirely disregarded by China. On the sidelines of the 2022 Winter Olympics in Beijing, Xi and Putin signed the joint communiqué in which China backed Moscow’s demands to reverse NATO borders to the pre-1997 situation, completely disregarding CEE’s security interests.

Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list.

China’s implicit support for Russia after the invasion has sowed deep mistrust of its respect for the sovereignty of other nations. The Chinese diplomatic apparatus clearly noticed this changing mood among CEE governments and sent a special envoy to eight capitals in April-May tasked with ‘eliminating misunderstandings regarding Russia-Ukraine conflict’.

However, the trip was not particularly successful. The delegation failed to secure high-level meetings, with the most prominent case being the Polish minister of foreign affairs declining to meet Huo Yuzhen, the Chinese Special Councilor for CEEC cooperation. Given that Andrzej Duda, President of Poland, was the only head of an EU state who attended the Beijing Olympics opening ceremony just before the Russian invasion in February, the change in attitudes is clear.

Following the envoy’s visit to the Czech Republic, the Czech parliament’s foreign affairs committee unanimously approved a resolution calling for the country to quit the ‘16+1’ format and the government is expected to act upon it in the near future. Meanwhile, Latvia and Estonia recently jointly announced that they would no longer be participating in the cooperation framework, turning it into ‘14+1’.




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Russian imperial mindset must change for real victory

Russian imperial mindset must change for real victory Expert comment NCapeling 8 December 2022

The attitude of Russia’s elite – and wider population – to the states which used to constitute the USSR needs to change in order to solve the Russia challenge.

Although the reverberations of Russia’s invasion of Ukraine clearly stretch around the globe, the strongest shocks are – and will continue to be – felt by those countries Moscow used to directly rule.

These countries struggle to shrug off a Soviet legacy as, to varying degrees – linguistically, technologically, culturally, and politically – they bear psychological and physical scars of Russia’s colonial past and its present mentality.

It does not help that these countries lack an appropriate collective descriptor. Over the years there has been ‘Newly Independent States’ – hardly appropriate after 31 years – the now-defunct ‘Commonwealth of Independent States’, the ‘post-Soviet space’ and ‘Former Soviet Union’ which both reference the past, and simply ‘Eurasia’ which is hardly appropriate for either Ukraine or Turkmenistan.

Some of these former ‘colonies’ are as badly governed and as sinister – albeit not as lethal beyond their borders – as Russia itself. Others, most notably the Baltic states, are modern, liberal, affluent societies, but Moscow’s shadow still looms.

There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all – but instead historical aberrations to be extinguished.

What is past is gone

As historian Timothy Snyder has noted, whatever the wrongs of Putin’s ‘history-based’ assertions about the ‘return of historic lands’, all historical claims are bunkum anyway. If the past brings validity, almost no land border on earth would be beyond dispute. It is agreements which count, and Russia signed away the other successor states in 1991.

There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all

The Russia and Eurasia programme at Chatham House has, for the last 31 years, always taken as a starting position that these countries are as sovereign as any other. This of course this means they can choose to be in Russia’s embrace if they wish. But none do because Russia is insufficiently attractive. Some have better relationships with Moscow than others – mainly the more autocratic ones – but no former slave goes back to their master willingly.

At the recent Chatham House conference Russia’s war: How will it shape the region’s future? (note the avoidance of a specific descriptor), the overwhelming consensus was that Russia must lose, that Ukraine must be reconstructed and planning for that must start now, and that the regional economy is convulsing.

But another key view was that, in Russia, rent seeking and buying loyalty are likely to lead to the separation of the Russian people and the regime, especially as the population ages and young men being sent to die at the front. Putin may still be popular in some places in Russia, but not in others – although popularity can rise and fall fast in Russia. However, few at the conference foresaw the disintegration of Russia any time soon.

With continued skill, determination, and more weaponry, Ukraine may well vanquish Russia on the battlefield, and this remains a necessary pre-requisite for European security. But even a Ukraine victory will not erase malign intent.

Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia

The Russian imperial itch is so deeply embedded, it must be excised not just from Russian capability but from the intention and mindset of elites and in the popular imagination. That is hard to achieve when so many believe in it as fervently as a religion – even the Russian Orthodox Church invokes a messianism in Russia’s imperial ‘rights’.

The wider region is suffering

Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia. But, for now, the wider region will surely be looking to simply neuter Russia’s destructive capacities.




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How Russia’s war affects politics in southeast Europe

How Russia’s war affects politics in southeast Europe 4 April 2023 — 11:00AM TO 12:00PM Anonymous (not verified) 24 March 2023 Online

This event will discuss how the war on Ukraine has affected southeastern Europe.

This event will discuss how the war on Ukraine has affected southeastern Europe. How have the governments and publics responded to the war?

The panel will discuss Russia’s goals and leverage in the region, including the impact of its disinformation campaigns. Are the governments reassessing their foreign policy options?

The granting of EU candidate status to Ukraine and Moldova has brought attention to the stalled accession process in the Western Balkans. What lessons from the Western Balkans can be applied in Ukraine and Moldova? Have new linkages emerged between the two regions?




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Review: Rediscovering Milan Kundera’s European tragedy

Review: Rediscovering Milan Kundera’s European tragedy The World Today mhiggins.drupal 28 March 2023

The Czech writer’s 40-year-old essay on the roots of Russia’s empire-building, ‘A Kidnapped West’, reads all too presciently, writes Stefan Auer.

A Kidnapped West: The Tragedy of Central Europe
Milan Kundera, Faber, £10

‘In November 1956, the director of the Hungarian News Agency, shortly before his office was flattened by artillery fire, sent a telex to the entire world with a desperate message announcing that the Russian attack against Budapest had begun. The dispatch ended with these words: “We are going to die for Hungary and for Europe.”’ Thus, Milan Kundera began his 1983 essay for the French journal Le Débat, reflecting on the 1956 Hungarian Uprising.

A seminal essay

The Czech author might well have written a near-identical passage about the fraught hours immediately after Russia’s invasion of Ukraine in 2022. In the event, Russian tanks failed to occupy Kyiv, unlike Budapest in 1956. Nevertheless, Faber has chosen this moment, 40 years later, to republish Kundera’s seminal essay on Europe and Russian aggression in its original translation for the New York Review of Books by Edmund White. How salient are its observations today?

Thanks to the Cold War, the countries of Central Europe were denied their true destiny, Kundera thought, in the democratic West

The essay’s original French title, ‘Un Occident kidnappé ou la tragédie de l’Europe centrale’ (The Kidnapped West, or the Tragedy of Central Europe), described the fate of Hungary, Czechoslovakia in 1968 and, to an extent, Poland in 1980-81 at the hands of the Soviet Union. Owing to the Cold War division of Europe, the countries of Central Europe were denied their true destiny, Kundera thought, to be an integral part of the liberal, democratic West. Kundera himself fled Czechoslovakia for France in 1975.

The author of The Unbearable Lightness of Being might no longer be as well-known as he was at the height of his fame in the 1980s, but his novels and essays still deserve attention. So, it is pleasing to see Kundera’s masterpiece republished, even as it is awful to witness the enduring relevance of the questions it raises.

What did the Hungarian journalist mean when he declared his willingness to die for Europe, Kundera asked? That ‘Russians, in attacking Hungary, were attacking Europe itself. He was ready to die so that Hungary might remain Hungary and European’. The journalist did indeed die in the uprising.

It is a line that President Volodymyr Zelenskyy and his supporters abroad have echoed time and again: that Ukrainian soldiers are not just dying for their country, they are dying for Europe at large.

Kundera’s suspicion of Russia has been validated. His frustration about the indifference of the West less so

The ‘tragedy’ in Kundera’s essay was that the West didn’t care. ‘Europe hasn’t noticed the disappearance of its cultural home,’ Kundera wrote, ‘because Europe no longer perceives its unity as a cultural unity.’

In other words, as the cultural sphere in Central Europe continued to defy the political restrictions imposed by the Soviet empire, it embodied the western values of freedom and democracy more than the West itself did. The extent to which this analysis remains relevant today will prove decisive for Europe’s future.

As timely as ever

Kundera’s essay is as timely as ever but in ways that both vindicate and challenge his key arguments. His suspicion of Russia has been validated. His frustration about the indifference of the West less so. But the true tragedy of Ukraine would be if the West has not changed sufficiently. So far, the West appears to be doing enough to enable Ukraine to defend itself, but not enough to defeat the aggressor.

[A small nation] is one whose very existence can be put in question at any moment; a small nation can disappear and it knows it

Milan Kundera

Faber has made an excellent decision in combining The Tragedy of Central Europe with a lesser-known text by Kundera: his 1967 speech to the Czech Writers’ Congress given the year before the ill-fated Prague Spring. In it, Kundera addressed what was to become a lifelong preoccupation: the fate of small nations. ‘For Czechs’, Kundera wrote, ‘nothing has ever constituted an indisputable possession – neither their language nor their belonging to Europe.’

Rather than reflecting the size of its territory or population, a small nation ‘is one whose very existence can be put in question at any moment; a small nation can disappear, and it knows it.’ In this way Ukraine, Europe’s largest country, apart from Russia, is fighting to avoid the fate of Kundera’s ‘small nation’.

Historically, the ‘small’ nations of Central Europe were threatened by both Germany and Russia. But after the Second World War, the threat was from the Soviet Union, which for Kundera was indistinguishable from Russia (tacitly including Ukraine). In its expansiveness, Russia was the opposite of Central Europe. While the latter was based on the principle of ‘the greatest variety within the smallest space’, the former represented ‘the smallest variety within the greatest space’.

Kundera was criticized for observations that smack of civilizational racism, yet his bleak view of Russia remains prescient

In this sense, authoritarian communism was the fulfilment of Russian history, Kundera argued, writing that ‘Russian communism vigorously reawakened Russia’s old anti-western obsessions and turned it brutally against Europe’. Vladimir Putin’s Russia appears to build on these same pernicious impulses.

Kundera was widely criticized for observations in his essay that smack of civilizational racism (including by me) describing Russians as fundamentally different from us: ‘Russia knows another (greater) dimension of disaster, another image of space (a space so immense that entire nations are swallowed up in it), another sense of time (slow and patient), another way of laughing, living, and dying’.




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Virtual breakfast: The state of the EU in 2023

Virtual breakfast: The state of the EU in 2023 3 May 2023 — 8:30AM TO 9:30AM Anonymous (not verified) 5 April 2023 Online

In this breakfast discussion, we will explore the current state of play in the EU with one the most prominent experts on European politics.

While the European Union has come together in its response to the invasion of Ukraine, significant divisions remain on other issues. East-West tensions remain high and troublesome German-French relations are hampering the bloc’s traditional engine of integration.
 
Furthermore, the EU is pushing through legislation at breakneck speed, including in its attempts to kickstart green industrial policy with its responses to the American Inflation Reduction Act. At the same time, the main players within the EU continue to disagree on what the bloc’s fiscal rules should look like.

  • What are the implications of the recent wave of protests in France against President Macron’s pension reforms?
  • What is the outlook of EU-UK relations following the successful completion of the Windsor Framework?
  • Where are the fiscal rules likely to land and when will they be back in place?
  • Are we seeing the emergence of a new Central and Eastern European power bloc within the EU?

In short, despite having avoided an energy crisis over the winter, the EU continues to face significant challenges. In this breakfast event, we will explore the current state of play in the EU with one of the most prominent experts on European politics.




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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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The Emission of Internal Conversion Electrons Rather Than Auger Electrons Increased the Nucleus-Absorbed Dose for 161Tb Compared with 177Lu with a Higher Dose Response for [161Tb]Tb-DOTA-LM3 Than for [161Tb]Tb-DOTATATE

Preclinical data have shown that 161Tb-labeled peptides targeting the somatostatin receptor are therapeutically more effective for peptide receptor radionuclide therapy than are their 177Lu-labeled counterparts. To further substantiate this enhanced therapeutic effect, we performed cellular dosimetry to quantify the absorbed dose to the cell nucleus and compared dose–response curves to evaluate differences in relative biological effectiveness in vitro. Methods: CA20948 cell survival was assessed after treatment with [161Tb]Tb- and [177Lu]Lu-DOTATATE (agonist) and with [161Tb]Tb- and [177Lu]Lu-DOTA-LM3 (antagonist) via a clonogenic assay. Cell binding, internalization, and dissociation assays were performed up to 7 d to acquire time-integrated activity coefficients. Separate S values for each type of particle emission (Auger/internal conversion [IC] electrons and β particles) were computed via Monte Carlo simulations, while considering spheric cells. Once the absorbed dose to the cell nucleus was calculated, survival curves were fitted to the appropriate linear or linear-quadratic model and corresponding relative biological effectiveness was evaluated. Results: Although the radiopeptide uptake was independent of the radionuclide, [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 delivered a 3.6 and 3.8 times higher dose to the nucleus, respectively, than their 177Lu-labeled counterparts on saturated receptor binding. This increased nucleus-absorbed dose was mainly due to the additional emission of IC and not Auger electrons by 161Tb. When activity concentrations were considered, both [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 showed a lower survival fraction than did labeling with 177Lu. When the absorbed dose to the nucleus was considered, no significant difference could be observed between the dose–response curves for [161Tb]Tb- and [177Lu]Lu-DOTATATE. [161Tb]Tb-DOTA-LM3 showed a linear-quadratic dose response, whereas [161Tb]Tb-DOTATATE showed only a linear dose response within the observed dose range, suggesting additional cell membrane damage by Auger electrons. Conclusion: The IC, rather than Auger, electrons emitted by 161Tb resulted in a higher absorbed dose to the cell nucleus and lower clonogenic survival for [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 than for the 177Lu-labeled analogs. In contrast, [161Tb]Tb-DOTATATE showed no higher dose response than [177Lu]Lu-DOTATATE, whereas for [161Tb]Tb-DOTA-LM3 an additional quadratic response was observed. Because of this quadratic response, potentially caused by cell membrane damage, [161Tb]Tb-DOTA-LM3 is a more effective radiopeptide than [161Tb]Tb-DOTATATE for labeling with 161Tb.




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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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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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Diagnostic Accuracy of [18F]FDG PET/MRI in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Metaanalysis

This study evaluates the diagnostic utility of PET/MRI for primary, locoregional, and nodal head and neck squamous cell carcinoma (HNSCC) through systematic review and metaanalysis. Methods: A systematic search was conducted using PubMed and Scopus to identify studies on the diagnostic accuracy of PET/MRI for HNSCC. The search included specific terms and excluded nonhybrid PET/MRI studies, and those with a sample size of fewer than 10 patients were excluded. Results: In total, 15 studies encompassing 638 patients were found addressing the diagnostic test accuracy for PET/MRI within the chosen subject domain. Squamous cell carcinoma of the nasopharynx was the most observed HNSCC subtype (n = 198). The metaanalysis included 12 studies, with pooled sensitivity and specificity values of 93% and 95% per patient for primary disease evaluation, 93% and 96% for locoregional evaluation, and 89% and 98% per lesion for nodal disease detection, respectively. An examination of a subset of studies comparing PET/MRI against PET/CT or MRI alone for evaluating nodal and locoregional HNSCC found that PET/MRI may offer slightly higher accuracy than other modalities. However, this difference was not statistically significant. Conclusion: PET/MRI has excellent potential for identifying primary, locoregional, and nodal HNSCC.




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Development of 18F-Fluoromisonidazole Hypoxia PET/CT Diagnostic Interpretation Criteria and Validation of Interreader Reliability, Reproducibility, and Performance

Tumor hypoxia, an integral biomarker to guide radiotherapy, can be imaged with 18F-fluoromisonidazole (18F-FMISO) hypoxia PET. One major obstacle to its broader application is the lack of standardized interpretation criteria. We sought to develop and validate practical interpretation criteria and a dedicated training protocol for nuclear medicine physicians to interpret 18F-FMISO hypoxia PET. Methods: We randomly selected 123 patients with human papillomavirus–positive oropharyngeal cancer enrolled in a phase II trial who underwent 123 18F-FDG PET/CT and 134 18F-FMISO PET/CT scans. Four independent nuclear medicine physicians with no 18F-FMISO experience read the scans. Interpretation by a fifth nuclear medicine physician with over 2 decades of 18F-FMISO experience was the reference standard. Performance was evaluated after initial instruction and subsequent dedicated training. Scans were considered positive for hypoxia by visual assessment if 18F-FMISO uptake was greater than floor-of-mouth uptake. Additionally, SUVmax was determined to evaluate whether quantitative assessment using tumor-to-background ratios could be helpful to define hypoxia positivity. Results: Visual assessment produced a mean sensitivity and specificity of 77.3% and 80.9%, with fair interreader agreement ( = 0.34), after initial instruction. After dedicated training, mean sensitivity and specificity improved to 97.6% and 86.9%, with almost perfect agreement ( = 0.86). Quantitative assessment with an estimated best SUVmax ratio threshold of more than 1.2 to define hypoxia positivity produced a mean sensitivity and specificity of 56.8% and 95.9%, respectively, with substantial interreader agreement ( = 0.66), after initial instruction. After dedicated training, mean sensitivity improved to 89.6% whereas mean specificity remained high at 95.3%, with near-perfect interreader agreement ( = 0.86). Conclusion: Nuclear medicine physicians without 18F-FMISO hypoxia PET reading experience demonstrate much improved interreader agreement with dedicated training using specific interpretation criteria.




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Association Between CA 15-3 and 18F-FDG PET/CT Findings in Recurrent Breast Cancer Patients at a Tertiary Referral Hospital in Kenya

The tumor marker cancer antigen 15-3 (CA 15-3) is that most commonly used to monitor metastatic breast cancer during active therapy and surveillance for disease recurrence after treatment. The association of CA 15-3 and 18F-FDG PET/CT findings can be considered complementary, since any significant rise may indicate the presence of disease and imaging is able to map the tumor sites. Although current guidelines do not recommend the routine performance of CA 15-3 in asymptomatic patients being followed up after definitive breast cancer treatment, most oncologists perform serial assessment of the tumor markers as part of routine follow-up of patients. The aim of this study was to evaluate the correlation between CA 15-3 levels and 18F-FDG PET/CT scan findings in patients with recurrent breast cancer. Methods: This was a cross-sectional study with data collected retrospectively. Patients being evaluated for breast cancer recurrence with 18F-FDG PET/CT imaging and CA 15-3 level were included. Evaluation of the association between CA 15-3 levels and 18F-FDG PET/CT scan findings was then done. Results: In total, 154 cases were included in this study; 62 patients had recurrence (positive) on the 18F-FDG PET/CT scans, whereas 92 patients had normal (negative) findings on follow-up 18F-FDG PET/CT scans. There was an association between CA 15-3 levels and the presence or absence of recurrence on 18F-FDG PET/CT scans, with 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT and 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT as well as a correlation with the burden of metastases. Most patients with disease recurrence on 18F-FDG PET/CT, however, had normal CA 15-3 levels. Conclusion: Higher CA 15-3 levels correlate with breast cancer recurrence on 18F-FDG PET/CT as well as with burden of metastasis. Notably, CA 15-3 levels within the reference range do not exclude breast cancer disease recurrence since more than half of patients with recurrence had normal CA 15-3 levels. 18F-FDG PET/CT should therefore be considered in patients with suspected breast cancer recurrence but normal CA 15-3 levels.




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1,090 Publications and 5 Years Later: Is FAP-Targeted Theranostics Really Happening?




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Nuclear Imaging of Bispecific Antibodies on the Rise

Bispecific antibodies (bsAbs) are engineered to target 2 different epitopes simultaneously. About 75% of the 16 clinically approved bsAbs have entered the clinic internationally since 2022. Hence, research on biomedical imaging of various radiolabeled bsAb scaffolds may serve to improve patient selection for bsAb therapy. Here, we provide a comprehensive overview of recent advances in radiolabeled bsAbs for imaging via PET or SPECT. We compare direct targeting and pretargeting approaches in preclinical and clinical studies in oncologic research. Furthermore, we show preclinical applications of imaging bsAbs in neurodegenerative diseases. Finally, we offer perspectives on the future directions of imaging bsAbs based on their challenges and opportunities.




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How to Explain Turkey's Early Elections

How to Explain Turkey's Early Elections 14 June 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 29 May 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE

On 24 June 2018 Turkey will go to the polls to vote in early presidential and parliamentary elections. Following a constitutional referendum last spring and against the backdrop of Turkey’s continued intervention in Syria and rising economic problems, President Erdogan has argued that an early election would help reduce uncertainty and set the country on a course to greater prosperity. The elections, likely to be held under the state of emergency in place since the attempted coup in July 2016, will also mark the country’s transformation from a parliamentary democracy to one with a powerful executive presidency.

In this session, the speaker will discuss what other factors led President Erdogan to call for an early election, what the state of the opposition is and what we can expect from Turkey should Erdogan win another term.

Attendance at this event is by invitation only.




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Turkey's Foreign Policy in the Middle East

Turkey's Foreign Policy in the Middle East 14 May 2019 — 12:30PM TO 1:30PM Anonymous (not verified) 29 April 2019 Chatham House | 10 St James's Square | London | SW1Y 4LE

Turkey is cooperating closely with Russia to secure its border with Syria and to encourage a long-term political resolution to the Syrian conflict. Its efforts have staved off a humanitarian catastrophe in the northern Syrian province of Idlib and initiated the trilateral ‘Astana Process’ with Russia and Iran as the primary framework to settle the future of Syria.

By contrast, Turkey and the US disagree on a range of important issues including Turkey’s purchase of the Russian-made S-400 air missile defence systems and American support for the PKK-affiliated Peoples’ Protection Units (YPG) in Syria.

In this session, the speaker will outline Turkey’s foreign policy priorities in the Middle East and share his country’s perspectives on the US and Russian policies in that region.

Attendance at this event is by invitation only.




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Turkey in 2020 and Beyond: What Lies Ahead for Turkish Politics?

Turkey in 2020 and Beyond: What Lies Ahead for Turkish Politics? 25 November 2019 — 12:30PM TO 1:30PM Anonymous (not verified) 6 November 2019 Chatham House | 10 St James's Square | London | SW1Y 4LE

Turkey witnessed some major developments over the last year. In August 2018, the dramatic Lira devaluation caused the Turkish economy to go into recession. In the 2019 local elections, which took place during the economic downturn, the Republican Peoples’ Party (CHP) mayoral candidates took control of Ankara and Istanbul after 25 years of dominance by the ruling Justice and Development Party (AKP).

The election results might lead to a rethink of the AKP leadership and consequences on Turkish politics will depend on Erdoğan’s interpretation of this reversal of his political fortune.

Will this affect the long-standing alliance between AKP and MHP that has characterised Turkish foreign policy for the past few years? What impact will this have on both the domestic and international level? Finally, will Turkey’s recent incursion into Syria have lasting effect on the country’s alliances with other powers and its standing?

In this context, the speaker will analyse the significance of these changes and the future trajectory of Turkish politics, economics and foreign policy.




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Turkey’s foreign and domestic policy: A story of mutual creation?

Turkey’s foreign and domestic policy: A story of mutual creation? 1 November 2022 — 2:00PM TO 3:00PM Anonymous (not verified) 12 October 2022 Online

Panellists discuss the link between Turkey’s domestic and foreign policies under President Erdoğan.

From Turkey’s ongoing rapprochement with its erstwhile Middle Eastern antagonists to its Syria policy and earlier approach towards the West, there has been extensive discussion on the domestic drivers behind Ankara’s foreign policy.

Less discussed but no less important is how Turkish foreign affairs have shaped its internal politics. Under the rule of the Justice and Development Party (AKP) government and President Recep Tayyip Erdoğan, Turkey’s foreign and domestic policies have mutually reshaped each other.

In this webinar, launching Gönül Tol’s new book Erdoğan’s War: A Strongman’s Struggle at Home and in Syria, panellists will take stock of how Turkey’s domestic and foreign policies under the leadership of President Erdoğan have influenced and shaped each other. Speakers will also discuss the internal drivers behind Turkey’s current reset in relations with the Middle East, and examine how Ankara’s foreign affairs play into the country’s political and identity fault lines.

The event will be held on the record and will be live-streamed on the MENA Programme’s Facebook page.




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