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Re: David Oliver: Let’s not forget care homes when covid-19 is over - What should we expect from care homes after Covid-19?




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Zika related microcephaly may appear after birth, study finds




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Trial of novel leukaemia drug is stopped for second time after two more deaths




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Chile After the October Uprising

Invitation Only Research Event

13 February 2020 - 8:00am to 9:30am

Chatham House | 10 St James's Square | London | SW1Y 4LE

Event participants

Andrés Velasco, Dean of the School of Public Policy, London School of Economics and Political Science
Robert Funk, Assistant Professor of Political Science, University of Chile; Visiting Senior Fellow at the School of Public Policy, London School of Economics and Political Science
Chair: Melissa MacEwen, Manager, Energy, Environment and Resources Programme 

The outbreak of popular discontent in Chile in October of last year caught many observers by surprise. What began as a protest against a metro fare hike has transformed into widespread rejection of the economic and political model in place since the return to democracy in 1990, accompanied with unprecedented violence which raises questions about the state's ability to maintain rule of law. 

Professor Andrés Velasco, Dean of the School of Public Policy at the LSE, and Dr Robert Funk, Assistant Professor of Political Science at the University of Chile will join us for a discussion on the causes of the current protest.

What are the prospects for reform and a return to normality? Is this the end of the much-lauded Chilean model?

Event attributes

Chatham House Rule

US and Americas Programme




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Virtual Roundtable: US Global Leadership After COVID-19

Research Event

20 April 2020 - 2:00pm to 3:00pm

Event participants

Michèle Flournoy, Co-Founder and Managing Partner, Westexec Advisors; US Under Secretary of Defense for Policy, 2009 - 12
Chair: Dr Leslie Vinjamuri, Director, US and the Americas Programme; Dean, Queen Elizabeth II Academy for Leadership in International Affairs, Chatham House

The COVID-19 pandemic highlights the absence of US global leadership. Michèle Flournoy talks with Dr Leslie Vinjamuri about the impact of COVID-19 on US domestic priorities and foreign policy commitments.

Flournoy discusses current US strategy towards China and the Middle East and how this might change under a Democratic administration.

This event is part of the Inaugural Virtual Roundtable Series on the US, Americas and the State of the World and will take place virtually only.

Department/project

US and Americas Programme




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NICE recommends implantable monitor to identify atrial fibrillation after stroke




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Covid-19: UK advisory panel members are revealed after experts set up new group




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Covid-19: South Korea relaxes social distancing after the number of new cases drops below 10 a day




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Covid-19: Nightingale hospitals set to shut down after seeing few patients




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Three Challenges for UK Peacebuilding Policy in the South Caucasus After Brexit

21 January 2020

Laurence Broers

Associate Fellow, Russia and Eurasia Programme
Building on the legacies of a long-term British investment in a peace strategy for the South Caucasus is a realistic and attainable goal.

2020-01-21-NK.jpg

A building in Nagorny Karabakh flies the flag of the self-proclaimed republic. 'Abkhazia, South Ossetia and Nagorny Karabakh have evolved into examples of what scholars call "de facto states" that, to differing degrees, control territory, provide governance and exercise internal sovereignty,' writes Laurence Broers. Photo: Getty Images.

What does Britain’s departure from the EU mean for the country’s policy towards the South Caucasus, a small region on the periphery of Europe, fractured by conflict? Although Britain is not directly involved in any of the region’s peace processes (except in the case of the Geneva International Discussions on conflicts involving Georgia, as an EU member state), it has been a significant stakeholder in South Caucasian stability since the mid-1990s.

Most obviously, Britain has been the single largest foreign investor in Caspian oil and gas. Yet beyond pipelines, Britain also has been a significant investor in long-term civil society-led strategies to build peace in the South Caucasus.

Through what was then the Global Conflict Prevention Pool, in the early 2000s the Department for International Development (DfID) pioneered large-scale peacebuilding interventions, such as the Consortium Initiative, addressing Armenian-Azerbaijani conflict, in 2003-09. These built civic networks in the South Caucasus and partnerships with British-based NGOs.

This experience left a strong intellectual legacy. British expertise on the South Caucasus, including specific expertise on its conflicts, is highly regarded in the region and across the world.

There is also a strong tradition of British scholarship on the Caucasus, and several British universities offer Caucasus-related courses. Through schemes such as the John Smith Fellowship Trust, the Robert Bosch Stiftung Academy Fellowship at Chatham House and Chevening Scholarships, significant numbers of young leaders from the South Caucasus have spent time in British institutions and built effective relationships within them.

Three challenges

This niche as a champion of long-term, strategic peacebuilding and repository of area-specific knowledge should not be lost as Britain’s relationship with the EU and regional actors evolves. This can be ensured through awareness of three challenges confronting a post-Brexit Caucasus policy.

The first challenge for London is to avoid framing a regional policy in the South Caucasus as an extension of a wider ‘Russia policy’. Deteriorating Russian-British relations in recent years strengthen a tendency to view policies in the European neighbourhood through the traditional prisms of Cold War and Russian-Western rivalries.

Yet an overwhelming focus on Russia fails to capture other important aspects of political developments in South Caucasus conflicts. Although often referred to as ‘breakaway’ or ‘occupied’ territories, Abkhazia, South Ossetia and Nagorny Karabakh are not ungoverned spaces. They have evolved into examples of what scholars call ‘de facto states’ that, to differing degrees, control territory, provide governance and exercise internal sovereignty.

Few disagree that these entities would not survive without external patronage. But neither does that patronage explain their sustainability on its own. Russia-centricity diminishes Britain’s latitude to engage on the full range of local drivers sustaining these entities, contributing instead to less effective policies predicated on competition and containment.

A second and related challenge is to maintain and develop Britain’s position on the issue of engaging populations in these entities. De facto states appear to stand outside of the international rules-based system. Yet in many cases, their civil societies are peopled by skilled and motivated activists who want their leaders to be held accountable according to international rules.

Strategies of isolation ignore these voices and contribute instead to fearful and demoralized communities less likely to engage in a transformation of adversarial relationships. Making this case with the wider international community, and facilitating the funding of local civil societies in contested territories, would be important steps in sustaining an effective British policy on the resolution of conflicts.    

The third challenge for Britain is to maintain a long-term approach to the conflicts of the South Caucasus alongside potential short-term imperatives in other policy fields, as relationships shift post-Brexit.

In this fluid international environment, the Foreign and Commonwealth Office has a role to play both as an internal champion of a long-term peacebuilding strategy and a coordinator of British efforts with those of multilateral actors engaged in the South Caucasus. These include the United Nations, the EU’s Special Representative for the South Caucasus and the Crisis in Georgia and OSCE’s Special Representative for the OSCE Chairperson-in-Office for the South Caucasus, all of which have built relationships with relevant actors on the ground.

Recommendations

Britain’s niche as a champion and advocate of a strategic approach to peaceful change can be secured post-Brexit in the following ways.  

First, in-house expertise is crucial to effective peacebuilding programming. The Foreign Office’s research analysts play a vital role in generating independent internal advice and liaising with academic and NGO communities. Their role could be supplemented by the reinstatement of a regional conflict adviser post, based in Tbilisi, tasked with strengthening Britain’s regional presence on conflict issues and coordinating policy at a regional level.

This post, with a remit to cover conflicts and build up area knowledge and relationships can contribute significantly to working closely with local civil societies, where so much expertise and knowledge resides, as well as other stakeholders.

Second, programming should build in conflict sensitivity by dissociating eligibility from contested political status. This can encourage local populations to take advantage of opportunities for funding, study, comparative learning and professional development irrespective of the status of the entity where they reside.

The Chevening Scholarships are an excellent example, whereby applicants can select ‘South Caucasus’ as their affiliated identity from a drop-down menu. This enables citizens from across the region to apply irrespective of the status of the territory in which they live.   

Finally, a holistic understanding of peace is crucial. Programming in unrecognized or partially-recognized entities should acknowledge that effective peacebuilding needs to embrace political dynamics and processes beyond cross-conflict contact and confidence building. Local actors in such entities may find peacebuilding funding streams defined exclusively in terms of cross-conflict contact more politically risky and ineffective in addressing domestic blockages to peace.

While cross-conflict dynamics remain critical, ‘single-community’ programming framed in terms of civic participation, inclusion, civil society capacity-building, minority and human rights in contested territories, and building the confidence from within to engage in constructive dialogue, are no less important.

The ’global Britain’ promised by Brexit remains a fanciful idea. Quiet, painstaking work to build on the legacies of a long-term British investment in a peace strategy for the South Caucasus, on the other hand, is a realistic and attainable goal.




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Beware Russian and Chinese Positioning for After the Pandemic

9 April 2020

Keir Giles

Senior Consulting Fellow, Russia and Eurasia Programme
Authoritarian regimes can use the COVID-19 crisis to improve their international standing, taking advantage of others’ distraction. Their aims are different, but their methods have much in common.

2020-04-09-Russia-Aid-Serbia

An airlifter of the Russian Aerospace Forces prepares to fly to Serbia carrying equipment and professionals during the COVID-19 crisis. Photo by Russian Defence MinistryTASS via Getty Images.

Both Russia and China have mounted combined charm offensives and disinformation campaigns on the back of the pandemic. Shipments of ‘aid’ – reportedly of questionable utility and quality - have gone hand in hand with a concerted effort to deflect any blame from China for the early spread, and an ongoing drive by Russia to undermine states’ confidence and have sanctions lifted.

These concurrent operations have very different objectives, as Russia seeks to subvert international order while China is continuing its bid to demonstrate global leadership - but in both cases, they are seeking long-term gains by exploiting the inattention and distraction of their targets.

Both seek to present themselves as globally responsible stakeholders, but for divergent reasons – especially China which needs the rest of the world to recover and return to stability to ensure its own economic recovery. But despite this, the two campaigns appear superficially similar.

Fertile ground for disinformation

One reason lies in the unique nature of the current crisis. Unlike political issues that are local or regional in nature, COVID-19 affects everybody worldwide. The perceived lack of reliable information about the virus provides fertile ground for information and disinformation campaigns, especially feeding on fear, uncertainty and doubt. But Russia in particular would not be succeeding in its objectives without mis-steps and inattention by Western governments.

Confused reporting on Russia sending medical supplies to the United States showed Moscow taking advantage of a US administration in apparent disarray. Claims Russia was sending ’humanitarian aid’ were only belatedly countered by the US State Department pointing out it had been paid for. Meanwhile the earlier arrival of Russian military equipment in Italy also scored a propaganda victory for Russia, facilitated by curious passivity by the Italian government.

In both cases Russia also achieved secondary objectives. With the United States, Russia scored bonus points by shipping equipment produced by a subsidiary of a company under US sanctions. In the case of Italy, Russian state media made good use of misleading or heavily edited video clips to give the impression of widespread Italian acclaim for Russian aid, combined with disdain for the efforts of the EU.

Beijing’s external information campaigns have sought to deflect or defuse criticism of its early mishandling and misinformation on coronavirus and counter accusations of secrecy and falsifying data while also pursuing an opportunity to exercise soft power. For Moscow, current efforts boost a long-standing and intensive campaign to induce the lifting of sanctions, demonstrating if nothing else that sanctions are indeed an effective measure. Official and unofficial lobbying has intensified in numerous capital cities, and will inevitably find supporters.

But both the aid and the information campaigns are seriously flawed. While appropriate and useful aid for countries that are struggling should of course be welcomed, both Russian and Chinese equipment delivered to Europe has repeatedly been found to be inappropriate or defective

Russian photographs of cardboard boxes stacked loose and unsecured in a transport aircraft bound for the United States sparked alarm and disbelief among military and aviation experts - and there has still been no US statement on what exactly was purchased, and whether it was found to be fit for purpose when it arrived.

Reporting from Italy that the Russian equipment delivered there was ‘80% useless’ has not been contradicted by the Italian authorities. In fact, although the Italian sources criticizing Russia remain anonymous it is striking that - President Trump aside - no government has publicly endorsed materials and assistance received from Russia as actually being useful and helpful.

Even in Serbia, with its traditionally close ties with Russia, the only information forthcoming on the activities of the Russian Nuclear, Biological and Chemical Protection Troops and their equipment that arrived on April 3 was from Russian press releases.

Both countries’ strategic communications efforts are similarly fallible. China’s notoriously heavy-handed approach to its critics is of only limited use in the face of such a severe and immediate threat. One suggestion that the virus originated in the US – an early response to US criticism – has already been walked back by the Chinese diplomat who made it.

And Russia continues to be capable of spectacularly misjudging its targets. When investigative journalists looked more closely at the nature of the assistance to Italy, Russia’s official response was rage and personal threats, laying bare the real nature of the campaign and immediately alienating many of those whom Moscow had sought to win over.

Errors and deficiencies such as these provide opportunities to mitigate the worst side-effects of the campaigns. And actions by individuals can also mitigate much of the impact. The most effective disinformation plays on deeply emotional issues and triggers visceral rather than rational reactions.

Advocates of ’informational distancing’ as well as social distancing suggest a tactical pause to assess information calmly, instead of reacting or spreading it further unthinkingly. This approach would bolster not only calm dispassionate assessment of the real impact of Russian and Chinese actions, but also counter spreading of misinformation on the pandemic as a whole - especially when key sources of disinformation are national leaders seeking to politicize or profit from the crisis.

Limitations of Russian and Chinese altruism must be stated clearly and frankly to fill gaps in public understanding. Where help is genuine, it should of course be welcomed: but if it is the case that assistance received from Moscow or Beijing is not appropriate, not useful, or not fit for purpose, this should be acknowledged publicly.

Even without central direction or coordination with other Russian strategic communications efforts, the self-perpetuating Russian disinformation ecosystem continues to push narratives designed to undermine confidence in institutions and their ability to deal with the crisis. This too must continue to be monitored closely and countered where it matters.

In all cases, miscalculations by Russia or China that expose the true intent of their campaigns – no matter how different their objectives might be - should be watched for closely and highlighted where they occur.

Despite the enormity of the present emergency it is not a time for any government to relax its vigilance over longer-term threats. States must not lose sight of manoeuvres seeking to exploit weakness and distraction. If Russia and China emerge from the current crisis with enhanced authority and unjustifiably restored reputations, this will make it still harder to resist their respective challenges to the current rules-based international order in the future.




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After

We spend our days, Getting ready for tomorrow, Hoping the past will not catch us, The bad eating, the saccharin juices, when Now is the only moment, to Love, to Speak, Re-pack your life, forgive – Go, On an adventure or, Simply state your piece, It will be alright. We may yet, Save the climate. […]




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Sustainability After Rio+20: Working Towards Global Governance

Director's Breakfast Briefing

5 October 2012 - 8:00am to 9:15am

Chatham House, London

Event participants

James Bacchus, Chair, Global Agenda Council on Governance for Sustainability, World Economic Forum; Chair, Appellate Body, World Trade Organization (1995-2003); Chair, Global Practice, Greenberg Taurig LLP

In the aftermath of the recent Rio+20 conference, James Bacchus will discuss the potential for establishing new trade, investment and other international rules and arrangements to promote sustainable growth. In particular, he will explore the interconnections and the international arrangements relating to food, energy, water, climate and other issues affecting global sustainable development.

Attendance is strictly by invitation only. To enable as open a debate as possible, this event will be held under the Chatham House Rule.

About Director's Breakfast Briefings.




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Densil A. Williams | COVID-19 after-shocks: Is Jamaica ready?

As Jamaica signs off on Budget 2020-2021, we are still uncertain whether we will be able to withstand the economic onslaught that will accompany the crisis in the years to come. It is clear that this pandemic is like none other that we have seen...




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Insulin-Deficient Diabetic Condition Upregulates the Insulin-Secreting Capacity of Human Induced Pluripotent Stem Cell-Derived Pancreatic Endocrine Progenitor Cells After Implantation in Mice

The host environment is a crucial factor for considering the transplant of stem cell–derived immature pancreatic cells in patients with type 1 diabetes. Here, we investigated the effect of insulin (INS)-deficient diabetes on the fate of immature pancreatic endocrine cell grafts and the underlying mechanisms. Human induced pluripotent stem cell–derived pancreatic endocrine progenitor cells (EPCs), which contained a high proportion of chromogranin A+ NK6 homeobox 1+ cells and very few INS+ cells, were used. When the EPCs were implanted under the kidney capsule in immunodeficient mice, INS-deficient diabetes accelerated increase in plasma human C-peptide, a marker of graft-derived INS secretion. The acceleration was suppressed by INS infusion but not affected by partial attenuation of hyperglycemia by dapagliflozin, an INS-independent glucose-lowering agent. Immunohistochemical analyses indicated that the grafts from diabetic mice contained more endocrine cells including proliferative INS-producing cells compared with that from nondiabetic mice, despite no difference in whole graft mass between the two groups. These data suggest that INS-deficient diabetes upregulates the INS-secreting capacity of EPC grafts by increasing the number of endocrine cells including INS-producing cells without changing the graft mass. These findings provide useful insights into postoperative diabetic care for cell therapy using stem cell–derived pancreatic cells.




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After grief and injury, Gohara sets the bar high

Having seen what Luiz Gohara had done upon his introduction to the big leagues the previous September, Freddie Freeman told Alex Anthopoulos the big left-hander might immediately became an All-Star. Instead, it became a year of awakening for the young hurler, who remains fueled by last year's disappointments.




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O's Harvey feeling good after BP session

Orioles right-hander Hunter Harvey had hopped off a backfield mound at the club's Spring Training complex and exhaled. He was one of 14 pitchers scheduled to face hitters as part of the club's first full-squad workout on Monday, and now that he had, Harvey was asked to recall when was the last time he threw competitive pitches.




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Late effects of anticancer chemotherapy: It's hard to trust your body, after it's betrayed you

Lily was diagnosed at 14 years old with stage four Hodgkin's lymphoma and received six rounds of chemotherapy and two weeks of radiotherapy. She survived but now lives with the long term effects of that therapy - and joins us to discuss how it has impacted her quality of life. We're also joined by Saif Ahmad and Thankamma Ajithkumar, oncologists...




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After Grenfell

It's been just over two years since a fire broke out in Grenfell tower, in west London, claiming the lives of 72 residents. 223 people survived, thanks to the work of the fire brigade and health care. In this podcast we hear from Andrew Roe, assistant commissioner at London Fire Brigade, and Anu Mitra, consultant emergency physician at St Mary's...




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Look after yourself during covid-19

Continuing our series on wellbeing during the pandemic, in this podcast we speak to Occupational Psychologist Roxane Gervais about how doctors can look after themselves during the covid-19 pandemic. We discuss the importance of reaching out to friends and family during this difficult time, how to deal with the loss of control, as well how to...




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Fear, grief grip west Kingston after children murdered

Tears flowed yesterday down the face of Donaree Anderson, cousin of 15-year-old Nyron Taylor, one of two children shot dead in west Kingston hours apart on Wednesday. Eight-year-old Toya Brown was the other child killed just days into the month...




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#JamaicaTogether | Mother pulled back from the brink after thieves shatter hope

Latoya Rose used the last $3,000 she had to invest in 26 baby chicks and feed with the hope of turning a profit after they matured. Last Friday, as the Spaldings resident went to her coop to feed the chickens, they were all gone. “When I don’t see...




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Ronald Jackson leaves CDEMA after seven years

BRIDGETOWN, Barbados, CMC – The Barbados-based the Caribbean Disaster Emergency Management Agency (CDEMA) says its executive director, Ronald Jackson, is leaving the post after seven years “of unwavering and exemplary service to the...




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Partha Kar: What will come after the covid-19 crisis?




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Reds eye turnaround year after busy winter

Plenty of teams say they will make roster moves in the offseason to improve and then often underwhelm. No one could say that this winter about the Reds, who were arguably the busiest team during the Hot Stove season.




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Disco embraces fresh start after tough end to '18

Reds starting pitcher Anthony DeSclafani hated how his 2018 season ended and didn't need any motivation to make improvements over the winter.




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Votto aims to improve after 'frustrating' 2018

Even before the Reds underscored their determination to improve by making major offseason acquisitions for the club, first baseman Joey Votto was already working to improve his hitting and his overall game.




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Covid-19: Nightingale hospitals set to shut down after seeing few patients

The mothballing of Britain’s Nightingale hospitals, some of which have yet to treat a single covid-19 patient, has raised questions about whether resources to fight the pandemic were...




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Myocardial Blood Flow and Myocardial Flow Reserve After Cardiac Transplantation: Mistakes in Diagnostic Value and Prognosis




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Reply: Clarifying the Utility of Myocardial Blood Flow and Myocardial Flow Reserve After Cardiac Transplantation




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Appropriate Use Criteria for Imaging Evaluation of Biochemical Recurrence of Prostate Cancer After Definitive Primary Treatment




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Patient Travel Concerns After Treatment with 177Lu-DOTATATE




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Evidence of Tissue Repair in Human Donor Pancreas After Prolonged Duration of Stay in Intensive Care

M2 macrophages play an important role in tissue repair and regeneration. They have also been found to modulate β-cell replication in mouse models of pancreatic injury and disease. We previously reported that β-cell replication is strongly increased in a subgroup of human organ donors characterized by prolonged duration of stay in an intensive care unit (ICU) and increased number of leukocytes in the pancreatic tissue. In the present study we investigated the relationship between duration of stay in the ICU, M2 macrophages, vascularization, and pancreatic cell replication. Pancreatic organs from 50 donors without diabetes with different durations of stay in the ICU were analyzed by immunostaining and digital image analysis. The number of CD68+CD206+ M2 macrophages increased three- to sixfold from ≥6 days’ duration of stay in the ICU onwards. This was accompanied by a threefold increased vascular density and a four- to ninefold increase in pancreatic cells positive for the replication marker Ki67. A strong correlation was observed between the number of M2 macrophages and β-cell replication. These results show that a prolonged duration of stay in the ICU is associated with an increased M2 macrophage number, increased vascular density, and an overall increase in replication of all pancreatic cell types. Our data show evidence of marked levels of tissue repair in the human donor pancreas.




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Why We Build Walls: 30 Years After the Fall of the Berlin Wall

8 November 2019

Robin Niblett

Director and Chief Executive, Chatham House

Gitika Bhardwaj

Editor, Communications & Publishing, Chatham House
Robin Niblett talks to Gitika Bhardwaj about the physical and psychological significance of border walls and their role in politics today.

GettyImages-1184642325.jpg

Part of the Berlin Wall still standing today. 9 November marks the 30th anniversary of the fall of the Berlin Wall that soon led to the collapse of the communist East German government. Photo: Getty Images.

This year marks the 30th anniversary of the fall of the Berlin Wall. The wall, which stood between 1961 to 1989, came to symbolize the ‘Iron Curtain’ – the ideological split between East and West – that existed across Europe and between the two superpowers, the US and the Soviet Union, and their allies, during the Cold War. How significant was the Berlin Wall during the Cold War – was it more important physically or psychologically?

The Berlin Wall was important physically, as well as psychologically, because Berlin was the only city that was divided physically by the Cold War between the Soviet Union and its allies in the Eastern Bloc and the West.

Given the disparity that quickly emerged between the two sides in economic wealth, freedom of expression and so on, the fear was that, without that wall, there would've been a unification of Berlin in a way that the Soviet side would have lost.

But it was also very important psychologically because it became the symbol of the division between two ideologies that saw each other as inimical to each other.

That meant that if you wanted to visualize the Cold War, and the separation between the capitalist, democratic system of the West and the communist, command-and-control system of the East, Berlin offered a place where you could physically walk from one world, through a checkpoint, into the other. The whole Cold War could be reduced to this one nexus point.

Because of its psychological as well as its physical significance, the fall of the Berlin Wall quickly became the symbol of the collapse of the communist ideology it had shielded.

Since the fall of the Berlin Wall, European countries have reportedly built over 1,000 kilometres of walls – the equivalent of more than six times the total length of the Berlin Wall – along their borders.

Why has Europe been building more walls and how effective have they been? Have they been used more as symbols to appeal to political bases, and if so, has it worked with voters?

The walls that have been built in Europe recently have been for a very specific reason. This was the huge influx of migrants and refugees to Europe in 2015, through what was called the ‘eastern Mediterranean’ or ‘western Balkan route’, from Turkey to Greece and on through the Balkans, Serbia and Hungary to northern Europe – in what was Europe's biggest migrant and refugee crisis since the Second World War.

What’s interesting is that for Viktor Orbán and the Hungarian government, which was on the frontline of the flow of migrants and refugees, building a wall was a way of reasserting its sovereignty. 

Like many other countries along the ‘migrant route’, they resented that the rules under which people could migrate into Europe were flouted by northern European governments which were willing to accept large numbers of migrants and refugees.

By accepting them, they kept attracting more, and so Orbán was worried that, at some point, Germany might say ‘We can’t take anymore’ and they’d be left in Hungary.

It’s important to remember that the communist states of central and eastern Europe were kept in aspic by the Soviet Union – they existed in a hermetically sealed environment without immigration. As a result, they didn’t experience the rise of multicultural societies of the sort that emerged in Britain, Belgium, France and Germany, where immigration persisted throughout the Cold War period.

The countries of central and eastern Europe were delighted that the Berlin Wall collapsed because it allowed them to unify with western Europe. They had been vassal states of the Soviet Union during the Cold War, and by joining the EU, they re-discovered personal freedom and re-gained national sovereignty. They thought they had become masters of their own future again.

But they suddenly found they were on the frontline of a new movement of people that wanted to get into the same world that they’d entered some 15 years earlier. And, as hundreds of thousands of migrants and refugees began arriving, they suddenly realised they were in a union that did not respect their sovereignty.

So, for them, putting up walls was a sovereign act against a European Union that didn’t seem to take their sovereignty seriously.

Has it worked? Definitely. The flow of migrants has been reduced drastically. This is partly because the EU paid Turkey to hold back the over three million migrants based there. But the walls also acted as a physical and psychological deterrent. 

It also worked politically. It allowed Viktor Orbán and other European parties that took the sovereigntist line to strengthen their appeal to voters – voters like to know that governments can do certain things like protecting them and their borders.

What is hypocritical, however, is that many of the governments in western Europe which criticized the Hungarian government for building its wall have actually been rather grateful that they did so as it slowed down the flow of migrants to their countries.

Then there’s the additional hypocrisy of the EU criticizing Donald Trump for building his wall with Mexico when Europeans are benefitting from theirs in Hungary.

Two years before the fall of the Berlin Wall, former US president Ronald Reagan challenged Soviet leader Mikhail Gorbachev to ‘tear down this wall’ declaring ‘across Europe this wall will fall. For it cannot withstand [freedom].’

32 years later, building a wall along the US–Mexico border has become a cornerstone of the current US administration under Donald Trump who has pledged to build a ‘big beautiful wall’. How does this reflect the political evolution of the US and what effect does that have across the rest of the world?

President Reagan talked about tearing down the Berlin Wall as a symbol of the Cold War. He knew that the fall of the wall would undermine the Soviet Union. 

President Trump is way beyond the Cold War. Building a new wall is his response to the growing sense of economic dislocation that segments of America, like Britain and other parts of Europe and the developed world, have experienced on the back of the rise of globalization, which was partly the result of the end of the Cold War but also the rise of China.

The spread of globalization, the declining earning power of many workers in the West, advances in technology which have taken away many high-earning jobs, the eight years of austerity after the global financial crisis – these are all factors driving Trump’s thinking. 

Have inflows of Mexican immigrants or immigrants through the Mexico border been the principal driver of economic insecurity?  No.  What you’ve got is Trump promising to build a wall as a symbol of his administration’s determination to protect Americans.

So I’d say the US–Mexico wall is another symbolic – or psychological – wall. Trump’s wall is supposedly about stopping illegal immigration but there are still plenty of ways to come through the border posts. It’s principally an exercise in political theatre.

Construction site for a secondary border fence, following the length of the current primary border fence, separating the US and Mexico in San Diego. Photo: Getty Images.

From the Great Wall of China to Hadrian’s Wall, walls and fences of all sorts have been used throughout history for defence and security, but not all of them have been physical.

So-called ‘maritime walls’, as well as ‘virtual walls’, are also increasingly being enforced which, today, includes border forces patrolling seas and oceans, such as in the Mediterranean Sea or off the coasts of Australia, and border control systems controlling the movement of people. Politically how do these types of barriers compare to physical ones?

You could argue that the Mediterranean Sea, and the European border forces operating within it, still act as a physical wall because they constitute a physical obstacle to migrants being able to move from the South across the Mediterranean Sea into Europe. 

So I don’t see this maritime wall being much different to the physical walls that have been built to try to stop migrants – just like any other border patrol, the Italian navy is preventing NGO vessels carrying migrants, who have been stranded at sea from docking at Italian ports. 

In this sense, you could argue that the Mediterranean Sea is a larger version of the Rio Grande between the US and Mexico which also incorporates physical barriers along its shores.

I think the more interesting walls that are being built today are virtual walls such as regulatory walls to trade, or with the internet, new barriers are being built to digital communication which affect your capacity to access information. 

In the end, all these walls are manifestations of national sovereignty through which a government demonstrates it can ‘protect’ its citizens – whether they are successful in this objective or not.

The border between Ireland and Northern Ireland, and the presence of enforcement mechanisms along the border, has become a key issue in the Brexit negotiations. How much of the debate over this is about the symbolism of the border against its economic implications?

The Irish border carries great symbolic importance because it reflects the reality of the separation of two sovereign states.

On the island of Ireland, the British and Irish governments have wanted to minimize this reality to the greatest extent possible. They even went as far as removing all types of barriers as part of the Good Friday Agreement.

This is the same sort of fiction the European Union created when it removed any physical manifestations of the existence of borders between those member states in its Schengen agreement on borderless travel.

By removing physical manifestations of the border, the UK was able to reduce some of the popular support for Irish unification as well as support for the IRA’s campaign of violence and terrorism to try to force the same outcome. 

Brexit has thrown a huge spanner into this arrangement. If Brexit is going to mean the entire UK not being in the EU’s customs union then some sort of border would need to be reinstated.

The British government proposed to do all the checks behind the border somewhere. The EU’s view was, ‘Well, that’s nice for you to say, but this border will become the EU’s only land border with the UK, and you cannot guarantee that people won’t be able to smuggle things through.’

On the other hand, recreating a border of some sort, whether physical or not, would reignite the differentiation between the two nations – running counter to the spirit of the Good Friday Agreement.

The only solution available to Prime Minister Boris Johnson has been to put the border down the Irish Sea.  While this means that Northern Ireland will no longer be an obstacle to the UK signing new, post-Brexit, free trade agreements with other countries, it has betrayed the Conservative Party’s unionist allies, for whom it’s essential that the UK’s borders include and not exclude them. 

By the end of the Cold War there were just 15 walls and fences along borders around the world, but today, there are at least 70. How effective, do you think, building barriers are as a political and military strategy to defence and security issues given their financial – and human – cost?

Physical barriers can be an effective form of protection – or imprisonment. 

The separation wall between Israel and the Palestinian territories has reduced the level of terrorist violence being perpetrated in Israel, but the cost has been the impoverishment of many Palestinians, and is another nail in the coffin of a two-state solution.

Yet many Israelis are saying that, maybe, being entirely separate is the best way to achieve peace between the two sides.

However, the walls around the Gaza Strip have not prevented, for various reasons, the Hamas government from developing rockets and firing them into Israel.   

You could argue that the border between China and North Korea, which is severely patrolled, has been a tool of continued political control protecting the Kim Jong-un regime from collapse – as has its virtual border preventing internet penetration.

Similarly, the virtual border the Chinese government has created around its own internet, the ‘great firewall’, has been very effective both economically – allowing Chinese internet platforms to develop without the threat of competition – and also as a form of political control that helps the Chinese Communist Party retain its monopoly on power. 

So walls in all of their shapes and forms can work. They are like sanctions – sanctions are easy to impose but difficult to remove. Walls are easy to build but they’re difficult to break down. 

But my view would be that they still only work temporarily. In the end, walls serve their particular purpose for a particular period, like the Berlin Wall, they end up outliving their purpose.

You have to be alive to the fact that, whether that purpose was a good or bad purpose, there will be a moment when walls end up protecting the interests of an ever-narrower number of people inside the wall, while they cease serving, if they ever did, the interests of the growing number on both sides. 

It’s ironic that the fall of the Berlin Wall in November 1989 was not the main marker of the end of the Cold War. It began earlier that year, with the intensification of people protesting in Poland, Hungary and Czechoslovakia.

Once Hungarian troops dismantled the fence separating them from Austria in May 1989, thousands of Hungarian citizens simply walked out of their country, because by then, the wall between the East and West only existed in their minds.

Then, once East Germans also realized that Mikhail Gorbachev and the Soviet regime had lost its willingness to defend the Berlin Wall, it collapsed. 

So it is interesting that we’re marking the end of the Cold War with this anniversary of the fall of the Berlin Wall, which of course, did divide two halves of one country, making its fall all the more poignant and powerful. But the end of the Cold War really began with the fall of the invisible wall in people’s minds.




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After 6 More Months, 31 Million New Domestic Violence Cases, Warns U.N.

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Late Relapse of Diabetes After Bariatric Surgery: Not Rare, but Not a Failure

OBJECTIVE

To characterize the status of cardiometabolic risk factors after late relapse of type 2 diabetes mellitus (T2DM) and to identify factors predicting relapse after initial diabetes remission following bariatric surgery to construct prediction models for clinical practice.

RESEARCH DESIGN AND METHODS

Outcomes of 736 patients with T2DM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at an academic center (2004–2012) and had ≥5 years’ glycemic follow-up were assessed. Of 736 patients, 425 (58%) experienced diabetes remission (HbA1c <6.5% [48 mmol/mol] with patients off medications) in the 1st year after surgery. These 425 patients were followed for a median of 8 years (range 5–14) to characterize late relapse of diabetes.

RESULTS

In 136 (32%) patients who experienced late relapse, a statistically significant improvement in glycemic control, number of diabetes medications including insulin use, blood pressure, and lipid profile was still observed at long-term. Independent baseline predictors of late relapse were preoperative number of diabetes medications, duration of T2DM before surgery, and SG versus RYGB. Furthermore, patients who relapsed lost less weight during the 1st year after surgery and regained more weight afterward. Prediction models were constructed and externally validated.

CONCLUSIONS

While late relapse of T2DM is a real phenomenon (one-third of our cohort), it should not be considered a failure, as the trajectory of the disease and its related cardiometabolic risk factors is changed favorably after bariatric surgery. Earlier surgical intervention, RYGB (compared with SG) and more weight loss (less late weight regain) are associated with less diabetes relapse in the long-term.




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Targeting CXCR1/2 Does Not Improve Insulin Secretion After Pancreatic Islet Transplantation: A Phase 3, Double-Blind, Randomized, Placebo-Controlled Trial in Type 1 Diabetes

OBJECTIVE

Reparixin is an inhibitor of CXCR1/2 chemokine receptor shown to be an effective anti-inflammatory adjuvant in a pilot clinical trial in allotransplant recipients.

RESEARCH DESIGN AND METHODS

A phase 3, multicenter, randomized, double-blind, parallel-assignment study (NCT01817959) was conducted in recipients of islet allotransplants randomized (2:1) to reparixin or placebo in addition to immunosuppression. Primary outcome was the area under the curve (AUC) for C-peptide during the mixed-meal tolerance test at day 75 ± 5 after the first and day 365 ± 14 after the last transplant. Secondary end points included insulin independence and standard measures of glycemic control.

RESULTS

The intention-to-treat analysis did not show a significant difference in C-peptide AUC at both day 75 (27 on reparixin vs. 18 on placebo, P = 0.99) and day 365 (24 on reparixin vs. 15 on placebo, P = 0.71). There was no statistically significant difference between treatment groups at any time point for any secondary variable. Analysis of patient subsets showed a trend for a higher percentage of subjects retaining insulin independence for 1 year after a single islet infusion in patients receiving reparixin as compared with patients receiving placebo (26.7% vs. 0%, P = 0.09) when antithymocyte globulin was used as induction immunosuppression.

CONCLUSIONS

In this first double-blind randomized trial, islet transplantation data obtained with reparixin do not support a role of CXCR1/2 inhibition in preventing islet inflammation-mediated damage.




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Plasma and Dietary Linoleic Acid and 3-Year Risk of Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort

OBJECTIVE

To study plasma and dietary linoleic acid (LA) in relation to type 2 diabetes risk in post–myocardial infarction (MI) patients.

RESEARCH DESIGN AND METHODS

We included 3,257 patients aged 60–80 years (80% male) with a median time since MI of 3.5 years from the Alpha Omega Cohort and who were initially free of type 2 diabetes. At baseline (2002–2006), plasma LA was measured in cholesteryl esters, and dietary LA was estimated with a 203-item food-frequency questionnaire. Incident type 2 diabetes was ascertained through self-reported physician diagnosis and medication use. Hazard ratios (with 95% CIs) were calculated by Cox regressions, in which dietary LA isocalorically replaced the sum of saturated (SFA) and trans fatty acids (TFA).

RESULTS

Mean ± SD circulating and dietary LA was 50.1 ± 4.9% and 5.9 ± 2.1% energy, respectively. Plasma and dietary LA were weakly correlated (Spearman r = 0.13, P < 0.001). During a median follow-up of 41 months, 171 patients developed type 2 diabetes. Plasma LA was inversely associated with type 2 diabetes risk (quintile [Q]5 vs. Q1: 0.44 [0.26, 0.75]; per 5%: 0.73 [0.62, 0.86]). Substitution of dietary LA for SFA+TFA showed no association with type 2 diabetes risk (Q5 vs. Q1: 0.78 [0.36, 1.72]; per 5% energy: 1.18 [0.59, 2.35]). Adjustment for markers of de novo lipogenesis attenuated plasma LA associations.

CONCLUSIONS

In our cohort of post-MI patients, plasma LA was inversely related to type 2 diabetes risk, whereas dietary LA was not related. Further research is needed to assess whether plasma LA indicates metabolic state rather than dietary LA in these patients.




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Health Care Expenditures Among Adults With Diabetes After Oregons Medicaid Expansion

OBJECTIVE

To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.

RESEARCH DESIGN AND METHODS

Using Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score–matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services.

RESULTS

Total PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures.

CONCLUSIONS

Newly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.




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