Neither peace nor democracy: the role of siege and population control in the Syrian regime's coercive counterinsurgency campaign

This article examines the role of siege warfare and population control in the coercive counterinsurgency strategy used by the Syrian regime of Bashar al-Assad to effectively crush the revolution that began in 2011. We extend the coercive counterinsurgency framework offered by Monica Duffy Toft and Yuri Zhukov to analyze the Syrian regime's use of the twin tactical pillars of siege warfare and population control. We focus on how these two types of denial - military and political - proved essential to the regime's military victory

The EU, Israel and the Arab Awakening

Depuis la fin de l’année 2010, le ‘Printemps arabe’ a entièrement redéfini le statu quo politique et social de la région Moyen Orient et Afrique du Nord (MENA). L’ensemble des principaux acteurs régionaux ont été touchés – de manière directe ou indirecte – par ces soulèvements sociaux et politiques de masse. Israël a suivi ce processus de transformation politique avec une attention toute particulière, faisant preuve à la fois de scepticisme et d’anxiété mais aussi d’espoir et d’empathie. Au niveau politique, avec quelques exceptions notables néanmoins, cette attitude ambivalente s’est traduite par une politique minimaliste et favorable au maintien de la stabilité.L’UE et ses États membres, quant à eux, se sont empressés, plus ou moins rapidement, d’exprimer leur soutien aux forces de démocratisation dans la région. La réaction de l’UE envers ces révolutions en cours est dotée de deux caractéristiques distinctes : en premier lieu, dans le cadre de son soft power, l’UE est intervenue rapidement afin de soutenir ces mouvements en introduisant notamment des instruments financiers visant à soutenir la démocratie, telle qu’un dispositif d’assistance à la société civile ainsi qu’un fond européen pour la démocratie. Néanmoins, quant à l’exercice d’un éventuel hard power européen, les Etats membres ont tergiversé et sont restés divisés sur la question de l’apport d’un soutien militaire direct aux rebelles, dans le cas libyen et ensuite sur le dossier syrien. Le premier objectif de cet article est de déconstruire et de comparer les discours européen et israélien concernant le Printemps arabe, en analysant plus spécifiquement l’équilibre trouvé entre défense de valeurs démocratiques et celle d’intérêts sécuritaires par chacun. La comparaison de ces discours est suivie d’une analyse des politiques israéliennes et européennes introduites afin de répondre aux défis mais aussi aux opportunités représentés par les évènements du Printemps arabe. Cet article montre finalement que malgré des perceptions fortement contrastées concernant leur compréhension de la démocratie et de la sécurité dans la région, l’UE et ses États membres – et plus particulièrement l’UE3, la France, l’Allemagne et le Royaume-Uni – et Israël ont réagi à ces mouvements avec la même volonté de défendre leurs intérêts et d’adapter leurs politiques à ce nouvel environnement régional. Ces deux acteurs se sont en effet évertués à tirer parti (ou au moins à ne pas trop perdre) de ces évènements venant bouleverser en profondeur la région MENA.Since late 2010, the so-called Arab Awakening has dramatically redefined the political and social status quo in the Middle East and North Africa (MENA) region. All the main regional players have been affected – either directly or indirectly – by the mass-scale social and political upheaval, with significant implications both at the regional and international level. Israel has been following the ongoing process of political transformation extremely carefully, showing at the same time skepticism and anxiety, but also hope and empathy. At the policy level, despite notable exceptions, this ambivalent attitude has been translated in a generally minimalist and pro-stability policy.The European Union and its Member States also followed the Arab Awakening closely, rushing to voice support for the forces of democratization active in the region. The EU reaction to the unfolding revolutions displayed two distinct features: at a ‘soft power’ level, the EU rapidly stepped in to support the Arab Spring movements, thus introducing new financial-democracy assistance instruments, like the Civil Society Facility and the European Endowment for Democracy. Yet at a ‘hard power’ level, Member States remained divided and oscillated continuously between direct military support to the rebels and a ‘wait and see’ approach, first in the Libyan case and now in Syria. The main aim of this article is to deconstruct and compare the dominant Israeli and European narratives on the Arab Awakening, focusing especially on how each party has framed the revolutions and balanced between pro-democratic values and stability and security concerns. In addition to comparing narratives, the study also analyzes the Israeli and European policies introduced to respond to the double challenge and opportunity represented by the Arab Awakening.The study shows that, despite clashing perceptions on their understanding of security and democracy in the region, the EU and its Member States – and more particularly the EU3, France, Germany and the United Kingdom – and Israel reacted to the upheavals with the same willingness to defend their interests and to adapt their policy to the new regional landscape. It seems indeed that both actors have been focusing on how to benefit (or at least not lose out) from this new MENA context

Omalizumab effectiveness in patients with a previously failed oral immunotherapy for severe milk allergy

Background: Some studies addressed the issue of omalizumab (OML) effectiveness in children starting their first oral immunotherapy (OIT) attempt but no study investigated the possible role of OML in the setting of patients with persisting milk allergy after a failed OIT attempt.Methods: Single-center, prospective, observational study in a selected group of patients with a persisting and severe cow milk (CM) allergy associated with moderate allergic asthma, in which a previous OIT attempt had already failed. We performed an open oral food challenge (OFC) to identify patients who tolerated less than 173 mg of cow's milk protein. At the end of the recruitment, we have found four patients with a mean age of 16.25 years (8-24) who had suspended a previous OIT attempt and still reacted to an amount of CM equal or below 173 mg. Enrolled patients, after an 8-week course of OML along with a CM avoiding diet, underwent again an open OFC with CM to re-evaluate their threshold. Eventually, a new OIT course was started using the same OIT protocol of the previous attempt, maintaining cotreatment with OML for the first 12 months. For each patient, we documented: the threshold of CM at OFC, level of specific immunoglobulin E (IgE) and IgG4 for milk, and quality of life (QoL).Results: During OIT the four patients experienced no reactions or extremely mild ones (oral itching, transient mild abdominal pain). All increased their threshold of CM in OML if compared with the baseline and maintained it long after that biologic therapy had discontinued. Specific milk proteins IgG4 levels significantly increased in all.Conclusion: In this series, OML was effective in patients with severe CM allergy who had previously failed OIT, allowing milk intake without adverse reactions and improving the QoL

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription