Presidents Notes

These are times of change in our world as profound as those foreseen by Rear Admiral Stephen B. Luce when he founded the Naval War College in 1884. The Admiral founded the College to help the U.S. Navy meet the demands of change. He saw his navy entering a world which required new and better thought than had sufficed, developed by more intellectually prepared naval officers than could easily be found. We should recall his foresight now, for I think we are on a similar threshold

President’s Notes

The world and the international security environment in which we operate is changing at a pace unthinkable just a few years ago

Presidents Notes

A standard catechism has developed on change in the Soviet Union. Early in the development of this catechism a procrustean bed was fashioned to which observations and arguments about change in the Soviet Union have been fitted selectively. Now this catechism, one that is remarkably optimistic, has gained permanence through repetition. However, it is too soon, and dangerous, to decide how the rest of the story will run. The supporters of the catechism of optimism seem to include the majority of our countrymen and Western friends

President’s Notes

We often express our consensus as an American polity with quotations, slogans or aphorisms. For example, all of our coins are engraved with the aphorisms Liberty, E Pluribus Unum, and In God We Trust. Forbes magazine devotes its final page to aphorisms and quotations, and John Bartlett is famous for a book of them

President Notes

The confluence of events at the Naval War College has raised anew questions about our purposes and programs. As this is written, we are developing our logic for the impending Congressional field nearing at the College by a committee chaired by Congressman Ike Ske1ton of Missouri. This Committee will ask us to explain our plans to meet the requirements of the Goldwater-Nichols legislation for increased jointness

President\u27s Notes

It is my cherished belief that education deals with the accumulation of information, the encouragement of thoughtfulness and the growth of intellect to cope with the challenges of complexity and change

Special Note

In 1968, as the Naval War College Review was completing its 20th year of publication, Commander Robert M. Laske, U.S. Navy, assumed the position of Managing Editor, thus beginning a long and useful association with this journal. One and one-half years later he was appointed Editor, a position he held until his retirement from the Navy in 1975

President\u27s Notes

During the past two years, as the Defense Attache at the U.S. Embassy in Moscow, I have witnessed both fascinating political reform and acute controversy. Tales of those years will have to await future columns, however, because now, in Newport, I have been plunged into a controversy over educational reform. The issues raised by this current controversy are what I would like to share with you now in this, my first Naval War College Note

Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies

Pfinder M, Kunst AE, Feldmann R, van Eijsden M, Vrijkotte TGM. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies. BMC Pregnancy and Childbirth. 2013;13(1): 49.BACKGROUND: Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and SGA differs according to maternal education, maternal mental distress or maternal smoking. METHODS: The Amsterdam Born Children and their Development (ABCD) Study (N=5,238) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (N=16,301) are both large studies. Women provide information on alcohol intake in early pregnancy, 3 months postpartum and up to 17 years retrospectively. Multivariate logistic regression analyses and stratified regression analyses were performed to examine the association between prenatal alcohol exposure and PTB and SGA, respectively. RESULTS: No association was found between any level of prenatal alcohol exposure (non-daily, daily, non-abstaining) and SGA. The offspring of daily drinkers and non-abstainers had a lower risk of PTB [ABCD: odds ratio (OR) 0.31, 95% confidence interval (CI) 0.13, 0.77; KiGGS: OR 0.75, 95% CI 0.57, 0.99]. Interactions with maternal education, maternal distress or maternal smoking were not significant. CONCLUSIONS: Although these results should be interpreted with caution, both studies showed no adverse effects of low-moderate prenatal alcohol exposure on PTB and SGA, not even in the offspring of women who were disadvantaged in terms of low education, high levels of distress, or smoking during pregnancy

Increased risk of severe clinical course of COVID-19 in carriers of HLA-C*04:01

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been increasing urgency to identify pathophysiological characteristics leading to severe clinical course in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Human leukocyte antigen alleles (HLA) have been suggested as potential genetic host factors that affect individual immune response to SARS-CoV-2. We sought to evaluate this hypothesis by conducting a multicenter study using HLA sequencing. Methods: We analyzed the association between COVID-19 severity and HLAs in 435 individuals from Germany (n = 135), Spain (n = 133), Switzerland (n = 20) and the United States (n = 147), who had been enrolled from March 2020 to August 2020. This study included patients older than 18 years, diagnosed with COVID19 and representing the full spectrum of the disease. Finally, we tested our results by meta-analysing data from prior genome-wide association studies (GWAS). Findings: We describe a potential association of HLA-C*04:01 with severe clinical course of COVID-19. Carriers of HLA-C*04:01 had twice the risk of intubation when infected with SARS-CoV-2 (risk ratio 1.5 [95% CI 1.1-2.1], odds ratio 3.5 [95% CI 1.9-6.6], adjusted p-value = 0.0074). These findings are based on data from four countries and corroborated by independent results from GWAS. Our findings are biologically plausible, as HLA-C*04:01 has fewer predicted bindings sites for relevant SARS-CoV-2 peptides compared to other HLA alleles. Interpretation: HLA-C*04:01 carrier state is associated with severe clinical course in SARS-CoV-2. Our findings suggest that HLA class I alleles have a relevant role in immune defense against SARS-CoV-2. Funding: Funded by Roche Sequencing Solutions, Inc