Export strategy and pricing policies in medium-sized manufacturing firms in the north of England with particular reference to the effect of sterling floatation

The objectives of this study are to contribute to the understanding of the export process in smaller firms and to provide a benchmark against which export strategy and pricing policies can be assessed, particularly in the context of the impact of floating currencies on exporters. The study consists, firstly, of a literature survey in the fields of pricing and export management, drawing on some 600 sources. Primary data were collected through a small number of depth interviews with export executives and a postal questionnaire survey of 250 medium-sized exporting manufacturers in the North of England, drawn from the Clothing. Furniture, Chemicals and Scientific Instrumentation industries. The theory of export strategy is reviewed, particularly in the context of key market concentration, as the foundation for export policies, including export pricing on which attention is focussed here. Challenges are offered to the arguments and empirical evidence on which the key market philosophy is founded and an alternative strategy proposed: market spreading. Empirical evidence is produced to show the existence of both concentration and spreading strategies in practical exporting, and to assess the underlying logic of market spreading as an alternative to market concentration, together with the situational cues associated with each. From general pricing theory and methods, attention is directed to the more specialised problems of export pricing. Consideration is given to the relationship between domestic market and export prices and pricing methods, and the existence and form of discriminatory pricing in exporting. The emphasis placed on price in the export marketing programme is analysed in the context of the debate on price versus non-price aspects of competition in international markets. Lastly, arising out of export pricing policy is the key issue of pricing currency, particularly as the mediator of the impact of floatation on the exporter. Attention is given to the export invoice currency decision, and the underlying reasons for currency choices as a challenge to the normative theory offered to exporters by the literature, together with the consequent implications of currency movements at the company level

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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