Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study.

BACKGROUND Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL. METHODS We used data from the HIV-CAUSAL Collaboration of cohort studies in Europe and the USA. We included 55 826 individuals aged 18 years or older who were diagnosed with HIV-1 infection between January, 2000, and September, 2013, had not started ART, did not have AIDS, and had CD4 count and HIV-RNA viral load measurements within 6 months of HIV diagnosis. We estimated relative risks of death and of death or AIDS-defining illness, mean survival time, the proportion of individuals in need of ART, and the proportion of individuals with HIV-RNA viral load less than 50 copies per mL, as would have been recorded under each ART initiation strategy after 7 years of HIV diagnosis. We used the parametric g-formula to adjust for baseline and time-varying confounders. FINDINGS Median CD4 count at diagnosis of HIV infection was 376 cells per μL (IQR 222-551). Compared with immediate initiation, the estimated relative risk of death was 1·02 (95% CI 1·01-1·02) when ART was started at a CD4 count less than 500 cells per μL, and 1·06 (1·04-1·08) with initiation at a CD4 count less than 350 cells per μL. Corresponding estimates for death or AIDS-defining illness were 1·06 (1·06-1·07) and 1·20 (1·17-1·23), respectively. Compared with immediate initiation, the mean survival time at 7 years with a strategy of initiation at a CD4 count less than 500 cells per μL was 2 days shorter (95% CI 1-2) and at a CD4 count less than 350 cells per μL was 5 days shorter (4-6). 7 years after diagnosis of HIV, 100%, 98·7% (95% CI 98·6-98·7), and 92·6% (92·2-92·9) of individuals would have been in need of ART with immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL, respectively. Corresponding proportions of individuals with HIV-RNA viral load less than 50 copies per mL at 7 years were 87·3% (87·3-88·6), 87·4% (87·4-88·6), and 83·8% (83·6-84·9). INTERPRETATION The benefits of immediate initiation of ART, such as prolonged survival and AIDS-free survival and increased virological suppression, were small in this high-income setting with relatively low CD4 count at HIV diagnosis. The estimated beneficial effect on AIDS is less than in recently reported randomised trials. Increasing rates of HIV testing might be as important as a policy of early initiation of ART. FUNDING National Institutes of Health.

Total Factor Productivity, Human Capital and Outward Orientation: Differences by Stage of Ddevelopment and Geographic Regions

Do openness and human capital accumulation promote economic growth? While intuition argues yes, the existing empirical evidence provides mixed support for such assertions. We examine Cobb-Douglas production function specifications for a 30-year panel of 83 countries representing all regions of the world and all income groups. We estimate and compare labor and capital elasticities of output per worker across each of several income and geographic groups, finding significant differences in production technology. Then we estimate the total factor productivity series for each classification. Using determinants of total factor productivity that include, among many others, human capital, openness, and distortion of domestic prices relative to world prices, we find significant differences in results between the overall sample and sub-samples of countries. In particular, a policy of outward orientation may or may not promote growth in specific country groups. even if geared to reducing price distortion and increasing openness. Human capital plays a smaller role in enhancing growth through total factor productivity.

Integration under 'One Country, Two Systems' - The Case of Mainland China and Hong Kong-

Ever since the handover of the territory in 1997, Hong Kong has had its own unique law and its own economic system and international legal personality, and has not been integrated with Mainland China. The Basic Law guarantees the uniqueness of the Hong Kong SAR until 2047. But close economic ties between Hong Kong and the Mainland will promote closer economic integration. The Basic Law limits only a customs union and the introduction of a single currency, but not the formation of a Free Trade Agreement (hereafter FTA) and monetary union. FTA has already been realized in the form of the Closer Economic Partnership Arrangement (hereafter CEPA). The Hong Kong SAR government, including the bureaucrat as well as the Chief Executive Tung Chee Hwa, was opposed to, and hesitant towards, the formation of a regional trade agreement with the Mainland, but the business community made them to adopt a positive attitude towards the CEPA. It is unclear how much integration can been deepened, but it can be argued that the current policy of the Hong Kong SAR is too supportive of business, and an excessive degree of economic integration may threaten the uniqueness of Hong Kong. But if Hong Kong achieves democracy and enjoys complete autonomy, it will be easy for economic integration to co-exist with the 'One Country, Two Systems' approach, in the interests of the business community and of the citizens of the SAR.

A note on ethnic return migration policy in Kazakhstan : changing priorities and a growing dilemma

This paper offers a brief analysis of the legal aspects of the ethnic return migration policy of Kazakhstan, a post-Soviet Central Asian state that has been active in seeking ties with its diaspora since independence. This paper examines the definition of oralman (repatriates) and the establishment of a quota on the number of Kazakh immigrants who are eligible for government funds to show how the rationale and preferences in repatriation policy have changed over the years. By focusing on changes in migration-related legislation in the late 2000s and early 2010s, the paper notes that two key goals of Kazakhstan’s migration policy are not necessarily consistent with each other: the promotion of an ethnically based nation-building project by encouraging the "return" of co-ethnics living abroad, and building a workforce that is best suited for the development of the state’s economy.

The International Human Rights Policies of New Democracies: Brazil and Chile in Comparative Perspective

Since the beginning of the 1990s, the majority of Latin American states have attempted to incorporate in some way or another human rights concern into their respective foreign policies, highlighting a history of human rights abuses and the return of democratic political rule as a trigger for galvanizing a commitment to assist in preventing such violations in other countries. Yet, while human rights have come to play a non-trivial role in the contemporary foreign policy of many Latin American states, there is great diversity in the ways and the extent to which they go about incorporating human rights concerns into their foreign policies. Explaining the diversity of human rights foreign policies of new Latin American democracies is at the heat of this project. The main research questions are the following: Why do new democracies incorporate human rights into their foreign policies? And what explains the different international human rights policies of new democracies? To answer these questions, this research compares the human rights foreign policies of Chile and Brazil for over two decades starting from their respective transitions to democracy. The study argues that states commitment to international human rights is the result of the intersection of domestic and international influences. At the international level, the search for international legitimacy and the desire for recognition and credibility affected the adoption of international human rights in both cases but with different degrees of impact. International values and pressures by themselves, while necessary, are an insufficient condition for human rights initiatives perceived to have not insubstantial political, economic or strategic costs. New democracies will be more or less likely to actively include human rights in their international policies depending on the following four domestic conditions: political leadership legitimizing the inclusion of human rights into a state's policies, civil society groups connected to international human rights advocacy networks with a capacity to influencing the foreign policy decisions of their government, and the Foreign Ministry's attitudes towards international human rights and the degree of influence it exercises over the outcome of the foreign policy process.

Chinese Intellectuals and China`s Policy toward Japan

This dissertation aims at integrating two scholarships: state-society relation studies and Chinese foreign policy analysis. I created Two-level Perception Gap Model to analyze different intellectual groups' relations with party-state by confirming Chinese intellectuals play a role in CFP making in general, China's Japan policy in particular. This model is an alternative approach, instead of conventional wisdom patron-client approach, to explain and analyze the pluralized intellectual-state relations in China. This model first analyzed the role of two intellectual groups, namely think tank scholars and popular nationalist, in China's Japan policy making, and then based on these analyses it explains the interactional patterns between these two intellectual groups and party-state. I used three case studies, which represented different types of issue, Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy, the controversy over the Yasukuni Shrine Visit, and the territorial dispute over the Diaoyu/Senkaku Islands, to examine this model. First, I examined think tank scholar groups and the extent they influenced "core interest issue and sensitive issue (Issue 1)," Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy, and their international patterns with party-state. Chapter 3 compares the responses of Chinese officials to the changes in the defense policy of Japan to the analyses from the think tank scholars. As the model assumes, results show that think tank scholars' analyses are consistent with China's policy position; nevertheless, it is difficult to confirm their analyses have influence on Chinese attitude toward the U.S.-Japan alliance and the Japanese defense policy. Based on the analysis of journal articles, most articles do not provide policy suggestions or simply provide suggestions that do not deviate from the policy. As Gu's theory of pluralist institutionalism and my hypothesis points out, most think tank scholars are establishment intellectuals so they tend to be self-disciplined. Second, this model provide a new concept "patriotic dilemma" for analyzing the challenge and constraints brought by popular nationalist discourses and public mobilization to Chinese foreign policy decision makers. Chapter 4 investigated the cases study of the controversy over the Yasukuni Shrine Visit, defined as "major/minor interest issue/ sensitive issue (Issue 3)," and the discourses from the popular nationalist, mainly focusing on anti-Japanese activists. The chapter also observes their influence on nationalist public opinions and analyzes how the nationalist public opinions constrain the policy choices among decision makers. Results strongly supported the hypothesis of patriotic dilemma that, although the popular nationalist group and public opinions constrained the policy choices of Chinese decision makers in the short term, they were unable to change the fundamental policy direction. Third, chapter 5 also focuses on anti-Japanese activists and examines the model with the case of the territorial dispute over the Diaoyu/Senkaku Islands. The result supported that hypothesis that China's policy change was not because of the influence from popular nationalist's discourses or public opinions but because of the change of priority of this issue, from major/minor interest issue to core interest issue. These two chapters also indicate that the patron-client model is unable to describe the popular nationalist. An alternative approach, such as the concept "patriotic dilemma" is needed to describe the relations between the popular nationalist and the government.

Rehabilitating, repairing and restoring against demolishing, tearing down and destroying: the recovery of the military fort for the Santa Pola town museum

This communication develops the process of interventions of the Renaissance fortress of a new plant built in 1554–57 in Santa Pola. It is one of the earliest examples built with reference to military architecture theoretical treaties (XV–XVI) and best preserved. The study runs its own story from its initial military use, through the use of civil equipment until the final cultural and Museum Center. First, the project of Italian origin is examined and its use as barracks for troops for a duration of three centuries (1557–1850), pointing out the architectural constants of war machinery in a defense position and its origin as a rainwater collector and cistern: a perfect square with two bastions in which a plan of the uprising is preserved (1778). Secondly, we study the changes in the mentioned architecture throughout a century and a half (1850–1990) after its change of ownership (from the state to the municipality), and as a result of the new use as a city hall and public endowment: a market and health and leisure centre, which meant the demolition of defensive elements and the opening up to the outside of the inner parade ground. And thirdly, the new transfer of the municipal offices brings in the beginning of a project of transformations (1990–2015) that retrieves the demolished elements at the same time as it assigns the entire fort for a cultural centre: exhibition, research and history museum, promoting the identity between the citizens and the building which stands in the foundations of their city. The conclusions take us through an interesting route that goes from the approach of defensive tactics, its use as administrative headquarters to the current cultural policy of preservation. In addition, all the known plans of the fort are recovered (of military, civil and cultural use), some unpublished, as well as the project of the North wing that has guided the last operation and which has been set as a pattern of reference.

All Roads Lead to Rome: Background, Context and Legacy of the Treaty on the European Community. Jean Monnet/Robert Schuman Paper Series Special Issue 3, August 2012

From the Introduction. The rejection by the French National Assembly of the ill-fated European Defense Community (EDC) Treaty in August 30, 1954, together with the automatic shelving of the equally faulty European Political Community (EPC) proposal, put an end, at least for the time being, to any form of political and military union of the existing Western Europe on a supranational level. The times were difficult in Europe and the international atmosphere was cloudy. The end of the Korean War coincided with the insistence of the Soviets to stick to a policy of détente, leading to the suppression of the Hungarian rebellion. France was facing opposition to her colonial presence in Indochina, as well as in North Africa. But the crisis of Suez prompted the French government to distance itself from the British and the United States. The defeat of the EDC and EPC was not going to be the end of the story and the dream inaugurated by Monnet and Schuman in 1950. It was not long before plans in favor of a European re-launch were taking shape. 1

To Be or Not to Be a Normative Power: The EU’s Promotion of Human Rights and Democracy in Russia. Bruges Regional Integration & Global Governance Papers 2/2013

The ‘Normative Power Europe’ debate has been a leitmotif in the academic discourse for over a decade. Far from being obsolete, the topic is as relevant as when the term was first coined by Ian Manners in 2002.1 ‘To be or not to be a normative power’ is certainly one of the existential dilemmas in the foreign policy of the European Union. This paper, however, intends to move beyond the black-and-white debate on whether the European Union is a normative power and to make it more nuanced by examining the factors that make it such. Contrary to the conventional perception that the European Union is a necessarily ‘benign’ force in the world, it assumes that it has aspirations to be a viable international actor. Consequently, it pursues different types of foreign policy behaviour with a varying degree of normativity in them. The paper addresses the question of under what conditions the European Union is a ‘normative power’. The findings of the study demonstrate that the ‘normative power’ of the European Union is conditioned upon internal and external elements, engaged in a complex interaction with a decisive role played by the often neglected external elements.

The Great Game around Turkmenistan. OSW Point of View, August 2008

The rise of a new leader of the state of Turkmenistan – President Gurbanguly Berdymukhammedov, who became ruler of the central Asian state after the 21-year rule of Saparmurad Niyazov, the self-proclaimed Turkmenbashi, who died on December 21, 2006 – has initiated changes in Turkmenistan’s political life. The new president has broken with the previous policy of self-isolation, and has directed the country towards openness to the outside world. Opportunities have thereby arisen for competitors in the ‘Great Game’, to gain political influence in Turkmenistan and access to hitherto unexploited Turkmen deposits of gas and oil. A new stage in the Great Game, which has been played for influence in Central Asia and control of access to its energy resources for many years, can thus be said to have been launched, and Turkmenistan has become the main setting for it. The major actors involved are Russia, the United States, China and the European Union.

Russia's policy in the Southern Caucasus and Central Asia. OSW Study 23/2006

The Southern Caucasus and Central Asia are priority areas for the foreign policy of the Russian Federation. Russia mainly sees its influence in both regions as an important factor determining its international stature, and as a precondition for reinforcing its position as a world power. The Caucasus and Central Asia are also important for Russia from the points of view of economy, especially because of those area's natural resource wealth, and security, as both regions generate serious potential threats to the Russian Federation, including Islamic fundamentalism, terrorism, the drugs trade and illegal migration.

EU Sanctions: A Relevant Foreign Policy Tool? EU Diplomacy Paper No. 3, May 2014

This paper examines an instrument which establishes an explicit link between economic power and foreign policy of the European Union (EU): restrictive measures or sanctions. As the EU is increasingly confronted with situations requiring a firm response, sanctions – arguably the EU’s ‘hardest’ tool – have become somewhat of a standard reaction. To what extent are sanctions a relevant tool for EU external action? By looking at several case studies from a set of 47 autonomous EU sanction cases, this paper acknowledges the many internal and external difficulties the EU faces when using the sanctions tool. However, it also shows that despite those challenges, the ‘hard’ and coercive nature of the sanction instrument nevertheless make it a relevant foreign policy tool which allows the EU to react to external crises.

Potemkin conservatism. An ideological tool of the Kremlin. OSW Point of View 48, February 2015

Since the beginning of his third presidential term, Vladimir Putin has consistently invoked conservative ideology. Thus he legitimises the Kremlin’s new political strategy, the aim of which is to stabilise the regime and prevent any political mobilisation in Russia around a liberal agenda. This strategy is also intended to strengthen the legitimacy of the current model of government, by portraying it as ‘traditional’ for Russia; and to justify the government’s repressive and anti-Western policies. It also includes the policy of reintegrating the post-Soviet space under the auspices of Moscow, as evidenced by the annexation of Crimea and the Novorossiya project. This strategy was devised as a response to the galvanisation of adherents of liberalisation in Russia, namely the new middle class and a part of the business and administrative elites who publicly demonstrated their dissatisfaction with the regime in 2011 and 2012. However, the dissonance between the conservative slogans mouthed by the ruling elite and its actual conduct suggest that the Kremlin’s ‘conservative project’ is purely instrumental in nature, which in the longer term will undercut its effectiveness by undermining its credibility in the eyes of Russian society.

Innovations of the European Central Bank in the Context of Financial and Monetary Integration: A Chinese Assessment. ZEI Discussion Paper C229, 2015

In the 15 years since the introduction of the Euro, the integration process within the European Economic and Monetary Union has seen rapid development in terms of both breadth and depth. Exclusively responsible for the monetary policy of the Eurozone, the European Central Bank has continued to adjust to meet the challenges brought about by these changes. The paper explores financial and monetary integration in the Eurozone and reviews the reasons, specific performance and impact of changes in the European Central Bank’s decision-making mechanisms. The purpose of which is to deepen and expand understanding in academic circles of the European economy and the European Economic and Monetary Union, as well as their development trends.

The Israeli lobby for Research and Innovation in the European Union. An example of efficient cooperation in the European Neighbourhood? Bruges Political Research Papers 49/2015.

Israel figures among the world-leaders in R&D expenditure and has a high-performing scientific community. Since the 1990s it has been associated with the Scientific Policy of the European Union via the European Research Framework Programmes (FP). The cooperation between Israel and the EU in this domain has gradually increased and benefits the scientific communities on both sides. In 2014 the association of Israel to the latest and biggest European FP ever adopted (Horizon 2020) was renewed for the fourth time. Based on all the scientific evidence provided, the elaboration of a European Research Policy can be identified as a highly regulated domain, offering relevant ‘channels of influence’. These channels offer Israel the opportunity to act within the Research Policy system. Being a member of several formal EU bodies in charge of implementing EU Research Policy, Israel is able to introduce its positions effectively. This is accompanied by an outstanding level of activity by Israel in linking concrete EU Research Policy measures to the Israeli Scientific Community at the national level. To carry out this task, Israel relies on an effective organization, which remodels the provided EU structures: European ‘National Contact Points’ (NCPs) are concentrated within the ‘Europe Israel R&D Directorate’ (ISERD). ISERD connects efficiently all the relevant actors, forums and phases of EU-Israeli Research Policy. ISERD can be recognized as being at the heart of Israel's research cooperation with the EU, and its structure may be a source of in