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"Blockade Economic aspects."
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Naval blockades in peace and war : an economic history since 1750
A number of major blockades, including the Continental System in the Napoleonic Wars, the War of 1812, the American Civil War, and World Wars I and II, in addition to the increased use of peacetime blockades and sanctions with the hope of avoiding war, are examined in this text.
Book
The Economic Weapon
The first international history of the emergence of
economic sanctions during the interwar period and the legacy of
this development Economic sanctions dominate the landscape
of world politics today. First developed in the early twentieth
century as a way of exploiting the flows of globalization to defend
liberal internationalism, their appeal is that they function as an
alternative to war. This view, however, ignores the dark paradox at
their core: designed to prevent war, economic sanctions are modeled
on devastating techniques of warfare. Tracing the use of economic
sanctions from the blockades of World War I to the policing of
colonial empires and the interwar confrontation with fascism,
Nicholas Mulder uses extensive archival research in a political,
economic, legal, and military history that reveals how a coercive
wartime tool was adopted as an instrument of peacekeeping by the
League of Nations. This timely study casts an overdue light on why
sanctions are widely considered a form of war, and why their
unintended consequences are so tremendous.
eBook
Sugammadex or Neostigmine for prevention of post-operative pulmonary complications after major abdominal or thoracic surgery: study protocol for the SINFONIA (Sugammadex for preventioN oF pOst-operative pulmonary complIcAtions) randomised controlled superiority trial
Background
Post-operative pulmonary complications (PPCs) are an important source of morbidity and mortality after major abdominal and thoracic surgery. The use of neuromuscular blocking drugs in general anaesthesia is an important risk factor for PPCs. The incomplete reversal of this neuromuscular blockade at the end of surgery leads to residual weakness of respiratory muscles and predisposes to aspiration of pharyngeal contents, hypoventilation, and thus to PPCs such as atelectasis and pneumonia. Two reversal drugs for neuromuscular blocking agents are available: neostigmine and sugammadex. Compared with neostigmine, sugammadex use results in more rapid reversal of neuromuscular blockade, and small clinical efficacy studies have suggested an associated lower incidence of PPCs. The comparative clinical effectiveness of the two drugs in reducing length of hospital stay or mortality is uncertain. Moreover, a potential safety concern with sugammadex is the relatively high incidence of life-threatening allergic reactions in countries where this drug has been widely used over the last decade.
Methods
SINFONIA is a pragmatic, randomised, open-label, parallel group, superiority trial with an internal pilot which aims to compare the clinical and cost effectiveness of the two available drugs for reversal of neuromuscular blockade, sugammadex and neostigmine, in patients aged 50 years or older undergoing major abdominal or non-cardiac thoracic surgery. The trial will randomise 2500 patients from approximately 40 centres in the UK. The primary outcome will be days alive and out of hospital at 30 days (DAH-30), with key secondary outcomes of PPC incidence, quality of life, and mortality up to 180 days. An embedded observational study will investigate the rate of allergic sensitisation following exposure to sugammadex.
Discussion
The SINFONIA trial addresses an important question for anaesthetists and for patients undergoing major abdominal and thoracic surgery. The choice of reversal agent for neuromuscular blockade between sugammadex and neostigmine is currently largely a matter of anaesthetist preference. A growing body of evidence suggests that sugammadex may reduce the incidence of post-operative pulmonary complications relative to neostigmine. This pragmatic clinical effectiveness trial will provide robust evidence as to the effects of the two drugs on patient-centred outcomes such as DAH-30, as well as on cost effectiveness and the incidence of allergic sensitisation.
Trial registration
The trial was registered on the ISRCTN database (
https://www.isrctn.com
) prior to opening to recruitment (registration no 15109717).
Journal Article
A Rentier State under Blockade: Qatar’s Water-Energy-Food Predicament from Energy Abundance and Food Insecurity to a Silent Water Crisis
This article investigates Qatar’s sustainability crisis of the high levels of water, electricity and food use. The high levels of consumption have been enabled by Qatar’s significant hydrocarbons wealth, a generous rentier state’s redistributive water governance, and structural dependence on imported food and food production subsidies. The water crisis is silent because it does not generate supply disruptions nor any public discontentment. The geopolitical blockade Qatar is experiencing sparked discussions in policy circles on the best ways to ensure food security, but has only exacerbated its water insecurity. The blockade makes more urgent than ever the necessity to maximize and increase synergies among different sectors.
Journal Article
Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single center
The aim of the study is to evaluate the clinical and economic impact of introducing a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen for neuromuscular block (NMB) management.
We conducted a retrospective analysis of clinical outcomes and cost-effectiveness in five operating rooms at University Hospital of Padova. A clinical outcome evaluation after sugammadex administration as first-choice reversal drug in selected patients (rocuronium-sugammadex) and as rescue therapy after neostigmine reversal (rocuronium-neostigmine-sugammadex) compared to control was performed. A cost-analysis of NMB management accompanying the introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen was carried out. To such purpose, two periods were compared: 2011-2012, without sugammadex available; 2013-2014, with sugammadex available. A subsequent analysis was performed to evaluate if sugammadex replacing neostigmine as first choice reversal drug is cost-effective.
The introduction of a rocuronium-neostigmine-sugammadex strategy into a cisatracurium-neostigmine regimen reduced the average cost of NMB management by 36%, from €20.8/case to €13.3/case. Patients receiving sugammadex as a first-choice reversal drug (3%) exhibited significantly better train-of-four ratios at extubation (P<0.001) and were discharged to the surgical ward (P<0.001) more rapidly than controls. The cost-saving of sugammadex as first-choice reversal drug has been estimated to be €2.9/case. Patients receiving sugammadex as rescue therapy after neostigmine reversal (3.2%) showed no difference in time to discharge to the surgical ward (P=0.44) compared to controls. No unplanned intensive care unit (ICU) admissions with rocuronium-neostigmine-sugammadex strategy were observed. The potential economic benefit in avoiding postoperative residual curarization (PORC)-related ICU admission in the 2013-2014 period was estimated at an average value of €13,548 (€9,316-€23,845).
Sugammadex eliminated PORC and associated morbidities. In our center, sugammadex reduced the costs of NMB management and promoted rapid turnover of patients in operating rooms, with total cost-effectiveness that counteracts the disadvantages of its high cost.
Journal Article
Impairing Globalization: The Russo-Ukrainian War, Western Economic Sanctions and Asset Seizures
The potency of economic sanctions imposed on nations depends on demand and supply adjustment possibilities. Adverse GDP impacts will be maximal when import, export, production, distribution and finance are inflexible (universal non-substitution). This paper elaborates on these conditions and quantifies the maximum GDP loss that Western sanctions could have inflicted on Russia in 2022–2023. It reports the World Bank’s predictions, contrasts them with the results and draws inferences about the efficiency of Russia’s workably competitive markets. This paper shows that Russia’s economic system exhibits moderate universal substitutability and is less vulnerable to punitive discipline than Western policymakers suppose. The likelihood that economic sanctions will compel the Kremlin to restore Ukraine’s territorial integrity ceteris paribus is correspondingly low, even though war reduces Russia’s quality of existence. Western economic sanctions serve narrow geostrategic ends that are reconcilable with Pareto-efficient free trade and globalization, if precision-targeted, but as the Russo-Ukrainian war intensifies, an expanded array of novel and dubiously legal sanctions is degrading free trade, and spurring de-globalization and anti-Western coalitions. If this armed combat is prolonged, the goals of free trade and globalization could be set back for decades.
Journal Article
Developing the Desert: How Qatar Achieved Dairy Self-Sufficiency Through Baladna
This case study analyzes how Qatar rapidly achieved dairy self-sufficiency through public–private partnerships following the 2017–2021 blockade. Specifically, it examines the role of Baladna, Qatar’s leading dairy company, in scaling up its domestic production through alignment with government policies. A mixed-methods approach was employed, combining semi-structured interviews with key stakeholders from the Qatari government and Baladna and a review of Baladna’s internal documents and reports. Thematic content analysis was used to identify key themes, and data from Baladna’s reports were triangulated to validate the findings. Collaboration between Qatar’s government and Baladna ensured the self-sufficiency of domestic dairy demand, expanding operations with new products and exports, and strengthening supply chains. However, reliance on government support raises sustainability concerns, highlighting the need for efficiency and diversification. This partnership aligns with national policies, such as the Qatar National Food Security Strategy 2018–2023, and offers insights into how public–private collaborations can promote growth and supply security while balancing state support with market dynamics. This case study highlights how the blockade crisis catalyzed effective public–private collaboration, driving rapid growth in Qatar’s dairy sector to meet domestic demand. The lessons from Qatar’s developmental approach can provide insights for resource-rich countries struggling with food insecurity.
Journal Article
Modelling the impact of VAT fiscality on branch-level performance in the construction industry: Evidence from Romania
Fiscal policy stands as a crucial pillar of economic development through its economic financing function. The regulatory effects of fiscality have been shown to reduce the ripple effects of uncertainties on economic growth within the EU. Unlike the average European economy, the Romanian economy has exhibited particularities concerning economic growth (ranking highly in economic growth among European nations in absolute terms), partly due to a more assertive fiscal policy applied to a consumption-based economy affected by hyperinflation (especially in the last five calendar years). The research issue stems from the premise of the lack of predictability in Romanian fiscal policy and its implications for the business environment. Our aim is to develop an econometric model of the fiscal effects of VAT on the business performance of the construction sector in Romania for the period 2010-2021. The methods employed involve empirical analysis and the development of consolidated industry-level databases followed by econometric modeling using the multiple linear regression method. The results of the research demonstrate that financial independence and solvency promote excessive taxation in emerging markets and developing countries, such as Romania, being correlated with the macroeconomic evolution of the respective state. Additionally, the results indicate that tax pressure can constitute a barrier to the sustainable development of firms, with direct repercussions for consumers. Attractiveness to investors is also affected, remaining a priority for companies. The study's findings will enable the identification of the main impediments and opportunities brought about by VAT taxation on branch-level performance, proving useful for construction sector managers and fiscal policy makers in fostering sustainable industry development and establishing a sustainable fiscal regime to safeguard investors.
Journal Article
Obstacles to Insurrection: Militarised Border Crossings Hindering the Rojava Liberation Struggle
The aim of this paper is to broaden our understanding of multidimensional socio-spatial relations as they apply to anti-systemic insurrectionary movements. As an illustrative case I discuss the Rojava insurrectionary movement, particularly the difficulties it faces in maintaining its solvency as a free territory due to multiple mechanisms of state power and capital accumulation in the world-system. I discuss where anarchist theory in the social sciences has been adequate and where it has come up short in understanding the potentialities of anarchist insurrectionary movements. I do this by paying particular attention to the sociohistorical and sociospatial realities in Rojava as it applies to territory, place, scale, and networks. In conclusion I call for a synthesis of anarchist theorisation with the world-systems perspective.
Journal Article
Unrestricted Access to Sugammadex: Impact on Neuromuscular Blocking Agent Choice, Reversal Practice and Associated Healthcare Costs
Sugammadex is known to rapidly and completely reverse the effects of amino-steroidal neuromuscular blocking agents. However, the high costs of sugammadex have so far prevented its introduction as the standard reversal agent in most healthcare systems. At the Royal Perth Hospital, sugammadex was recently introduced as an unrestricted alternative to neostigmine for the reversal of amino-steroidal neuromuscular blocking agents. The aim of this retrospective observational audit was to investigate the impact of this change on clinical practice and associated healthcare costs. Data from all patients intubated during a one-month period in April to May 2010 and for a similar period in 2011 were retrospectively collected and the use of neuromuscular blocking agents and reversal agents were identified and the associated costs were calculated. More steroidal neuromuscular blocking agents and sugammadex (+743%), but less glycopyrrolate and neostigmine (-48%) were used in 2011. Using the manufacturer's list price, muscle relaxation and reversal costs increased from about A $42 per case to about A$ 127 per case. Between the investigated time periods no differences were found for anaesthesia time, operating time or time spent in the post anaesthesia care unit. However, there was a statistically significant decrease in the time between surgery and discharge (median 2.0 vs 2.2 days). While the design of the audit was such that no inferences can be made about the cause of this change, this is an interesting observation worthy of further investigation.
Journal Article