Overview of key technologies for peace operations; remote sensing, mine clearance and less-than-lethal weapons

Following the end of the Cold War in the late 198Os, a series of international peace operations, led by the United Nations, took place in diverse parts of the world, including Somalia, El Salvador, Cambodia, Bosnia, Angola, and Mozambique. Earlier, superpower tensions had frequently acted to prevent international interventions (Angola and El Salvador are clear examples). Conflicts were often “sponsored” by a major power that preferred to wage a surrogate battle for influence rather than to resolve the matter through international consensus and a compromise peace. Through the mechanism of the Security Council veto (or, more generally, the threat of a veto), the United Nations was effectively prevented from taking decisive action in nearly all cases, except for those in which there already was an agreement between the United States and the USSR that an internationally brokered effort was desirable or, at least, not objectionable. Examples of UN missions undertaken in this period from the 1950s through most of the 1980s are those in Cyprus, Lebanon, Western Sahara, and a small observer group in Kashmir. The UN missions from the earlier era were nearly all true peacekeeping ones. That is, they acted with the consent of all parties to the conflict, and their goal was to maintain a cease-fire or truce (usually just by observation and reporting to the parties) that had already been agreed to. The UN operations in the new era, in contrast, have sometimes taken place in areas or countries in which conflicts were not resolved. While an initial agreement of the parties was generally obtained, at times the situation rapidly evolved into one in which at least one party was not in agreement with the UN presence or activities (e.g., Bosnia, Somalia, Cambodia). Further, in these sorts of operations, the role of the UN extended well beyond observing a truce. The international force also engaged in humanitarian relief operations, in postconflict rebuilding of a nation’s infrastructure (including holding elections, frequently a nontrivial effort-eg., Cambodia), and, most significantly, in attempting to enforce rather than to observe compliance with a truce among warring parties

Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis

Objectives Mycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in ILD.Design Population included any ILD diagnosis, intervention included MMF or AZA treatment, outcome was delta change from baseline in per cent predicted forced vital capacity (%FVC) and gas transfer (diffusion lung capacity of carbon monoxide, %DLco). The primary endpoint compared outcomes relative to placebo comparator, the secondary endpoint assessed outcomes in treated groups only.Eligibility criteria Randomised controlled trials (RCTs) and prospective observational studies were included. No language restrictions were applied. Retrospective studies and studies with high-dose concomitant steroids were excluded.Data synthesis The systematic search was performed on 9 May. Meta-analyses according to drug and outcome were specified with random effects, I2 evaluated heterogeneity and Grading of Recommendations, Assessment, Development and Evaluation evaluated certainty of evidence. Primary endpoint analysis was restricted to RCT design, secondary endpoint included subgroup analysis according to prospective observational or RCT design.Results A total of 2831 publications were screened, 12 were suitable for quantitative synthesis. Three MMF RCTs were included with no significant effect on the primary endpoints (%FVC 2.94, 95% CI −4.00 to 9.88, I2=79.3%; %DLco −2.03, 95% CI −4.38 to 0.32, I2=0.0%). An overall 2.03% change from baseline in %FVC (95% CI 0.65 to 3.42, I2=0.0%) was observed in MMF, and RCT subgroup summary estimated a 4.42% change from baseline in %DLCO (95% CI 2.05 to 6.79, I2=0.0%). AZA studies were limited. All estimates were considered very low certainty evidence.Conclusions There were limited RCTs of MMF or AZA and their benefit in ILD was of very low certainty. MMF may support preservation of pulmonary function, yet confidence in the effect was weak. To support high certainty evidence, RCTs should be designed to directly assess MMF efficacy in ILD.PROSPERO registration number CRD42023423223