Beyond NATO

In this new Brookings Marshall Paper, Michael O’Hanlon argues that now is the time for Western nations to negotiate a new security architecture for neutral countries in eastern Europe to stabilize the region and reduce the risks of war with Russia. He believes NATO expansion has gone far enough. The core concept of this new security architecture would be one of permanent neutrality. The countries in question collectively make a broken-up arc, from Europe’s far north to its south: Finland and Sweden; Ukraine, Moldova, and Belarus; Georgia, Armenia, and Azerbaijan; and finally Cyprus plus Serbia, as well as possibly several other Balkan states. Discussion on the new framework should begin within NATO, followed by deliberation with the neutral countries themselves, and then formal negotiations with Russia

Medya Irak’ta Adil Davranıyor Mu ?

DergiPark: 326492trakyasobed[Abstract Not Available

Hypertrophic cardiomyopathy and ultra-endurance running - two incompatible entities?

Regular and prolonged exercise is associated with increased left ventricular wall thickness that can overlap with hypertrophic cardiomyopathy (HCM). Differentiating physiological from pathological hypertrophy has important implications, since HCM is the commonest cause of exercise-related sudden cardiac death in young individuals. Most deaths have been reported in intermittent 'start-stop' sports such as football (soccer) and basketball. The theory is that individuals with HCM are unable to augment stroke volume sufficiently to meet the demands of endurance sports and are accordingly 'selected-out' of participation in such events. We report the case of an ultra-endurance athlete with 25 years of > 50 km competitive running experience, with genetically confirmed HCM; thereby demonstrating that these can be two compatible entities

Quantifying the impacts of predation by great black-backed gulls Larus marinus on an Atlantic puffin Fratercula arctica population: implications for conservation management and impact assessments

The management of predator-prey conflicts can be a key aspect of species conservation. For management approaches to be effective, a robust understanding of the predator-prey relationship is needed, particularly when both predator and prey are species of conservation concern. On the Isle of May, Firth of Forth, Scotland, numbers of breeding Great Black-backed Gulls Larus marinus, a generalist predator, have been increasing since the 1980s, which has led to increasing numbers of sympatrically breeding Atlantic Puffins Fratercula arctica being predated during the breeding season. This may have consequences for species management on the Isle of May and impact assessments of offshore windfarms in the wider Firth of Forth area. We used population viability analysis to quantify under what predation pressure the Atlantic Puffin population may decline and become locally extinct over a three-generation period. The predation level empirically estimated in 2017 (1120 Puffins per year) was not sufficient to drive a decline in the Puffin population. Rather, an increase to approximately 3000 Puffins per year would be required to cause a population decline, and >4000 to drive the population to quasi-extinction within 66 years. We discuss the likelihood of such a scenario being reached on the Isle of May, and we recommend that where predator-prey conflicts occur, predation-driven mortality should be regularly quantified to inform conservation management and population viability analyses associated with impact assessments

Prognostic Significance of Myocardial Fibrosis in Hypertrophic Cardiomyopathy

ObjectivesWe investigated the significance of fibrosis detected by late gadolinium enhancement cardiovascular magnetic resonance for the prediction of major clinical events in hypertrophic cardiomyopathy (HCM).BackgroundThe role of myocardial fibrosis in the prediction of sudden death and heart failure in HCM is unclear with a lack of prospective data.MethodsWe assessed the presence and amount of myocardial fibrosis in HCM patients and prospectively followed them for the development of morbidity and mortality in patients over 3.1 ± 1.7 years.ResultsOf 217 consecutive HCM patients, 136 (63%) showed fibrosis. Thirty-four of the 136 patients (25%) in the fibrosis group but only 6 of 81 (7.4%) patients without fibrosis reached the combined primary end point of cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge (hazard ratio [HR]: 3.4, p = 0.006). In the fibrosis group, overall risk increased with the extent of fibrosis (HR: 1.18/5% increase, p = 0.008). The risk of unplanned heart failure admissions, deterioration to New York Heart Association functional class III or IV, or heart failure-related death was greater in the fibrosis group (HR: 2.5, p = 0.021), and this risk increased as the extent of fibrosis increased (HR: 1.16/5% increase, p = 0.017). All relationships remained significant after multivariate analysis. The extent of fibrosis and nonsustained ventricular tachycardia were univariate predictors for arrhythmic end points (sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverter-defibrillator discharge, sudden cardiac death) (HR: 1.30, p = 0.014). Nonsustained ventricular tachycardia remained an independent predictor of arrhythmic end points after multivariate analysis, but the extent of fibrosis did not.ConclusionsIn patients with HCM, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance is an independent predictor of adverse outcome. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; NCT00930735

Tumor markers in breast cancer - European Group on Tumor Markers recommendations

Recommendations are presented for the routine clinical use of serum and tissue-based markers in the diagnosis and management of patients with breast cancer. Their low sensitivity and specificity preclude the use of serum markers such as the MUC-1 mucin glycoproteins ( CA 15.3, BR 27.29) and carcinoembryonic antigen in the diagnosis of early breast cancer. However, serial measurement of these markers can result in the early detection of recurrent disease as well as indicate the efficacy of therapy. Of the tissue-based markers, measurement of estrogen and progesterone receptors is mandatory in the selection of patients for treatment with hormone therapy, while HER-2 is essential in selecting patients with advanced breast cancer for treatment with Herceptin ( trastuzumab). Urokinase plasminogen activator and plasminogen activator inhibitor 1 are recently validated prognostic markers for lymph node-negative breast cancer patients and thus may be of value in selecting node-negative patients that do not require adjuvant chemotherapy. Copyright (C) 2005 S. Karger AG, Basel