Optimal Versus Required Defence Spending

The recent rescheduling of the Turkish long-term defence procurement programmes following the economic crisis in the country and the reaction of the Greek authorities to reduce their own by about 25% has become the subject of extensive discussions. The issues involved in such discussions concern the possibility of a causal relationship between the developments in the two countries and the extent to which the two sides entangled, for ages now, in an expensive arms race, can afford a reduction of their defence expenditure. This leads to the next question, which involves the calculation of an “optimal” defence burden providing for maximum security in the face of an outside threat bounded by the constraints imposed by the economy

Optimal Versus Required Defence Spending

The recent rescheduling of the Turkish long-term defence procurement programmes following the economic crisis in the country and the reaction of the Greek authorities to reduce their own by about 25% has become the subject of extensive discussions. The issues involved in such discussions concern the possibility of a causal relationship between the developments in the two countries and the extent to which the two sides entangled, for ages now, in an expensive arms race, can afford a reduction of their defence expenditure. This leads to the next question, which involves the calculation of an “optimal” defence burden providing for maximum security in the face of an outside threat bounded by the constraints imposed by the economy

Optimal Versus Required Defence Expenditure Revisited

The scope of this paper is to supplement our earlier work on the issue concerning the Greek-Cypriot Integrated Defence Doctrine. The term describes a purely defensive dogma the scope of which is to face any form of offensive action against one or both of the allies. It aims, in addition, at defending the strategic and political interests of the two allies in the Aegean Sea and the broader East Mediterranean area in an environment of an arms race against Turkey (Hellenic Ministry of Defence 2000). Given the complexity and multi-disciplinary aspect of this issue we restrict ourselves to focusing on a very interesting aspect of the topic that has not been considered in the literature thus far. What we examine, more specifically, is the relative security contribution of Greece and Cyprus to their alliance and the benefits that each side derives in that respect

Optimal Versus Required Defence Expenditure Revisited

The scope of this paper is to supplement our earlier work on the issue concerning the Greek-Cypriot Integrated Defence Doctrine. The term describes a purely defensive dogma the scope of which is to face any form of offensive action against one or both of the allies. It aims, in addition, at defending the strategic and political interests of the two allies in the Aegean Sea and the broader East Mediterranean area in an environment of an arms race against Turkey (Hellenic Ministry of Defence 2000). Given the complexity and multi-disciplinary aspect of this issue we restrict ourselves to focusing on a very interesting aspect of the topic that has not been considered in the literature thus far. What we examine, more specifically, is the relative security contribution of Greece and Cyprus to their alliance and the benefits that each side derives in that respect

Circulating Erythrocyte Microparticles and the Biochemical Extent of Myocardial Injury in ST Elevation Myocardial Infarction

Objectives: Red blood cell microparticles (RBCm) have potential adverse vascular effects and they have been shown to be elevated in ST elevation myocardial infarction (STEMI). The purpose of this study is to investigate their relationship with biochemical infarct size. Methods: RBCm were quantified with flow cytometry in blood drawn from 60 STEMI patients after a primary angioplasty. The creatine kinase-myocardial brain fraction (CK-MB) was measured at predefined time points and the area under the curve (AUC) was calculated. Results: RBCm count was correlated with CK-MB AUC (Spearman's rho = 0.83, p < 0.001). The CK-MB AUC values per RBCm quartile (lower to upper) were: 3,351 (2,452-3,608), 5,005 (4,450-5,424), 5,903 (4,862-10,594), and 8,406 (6,848-12,782) ng x h/ml, respectively. From lower to upper quartiles, the maximal troponin I values were: 42.2 (23.3-49.3), 49.6 (28.8-54.1), 59.2 (41.4-77.3), and 69.1 (48.0-77.5) ng/ml (p = 0.005). In multivariable analysis, RBCm remained a significant predictor of CK-MB AUC (standardized beta = 0.63, adjusted p = 0.001). Conclusions: Erythrocyte microparticles appear to be related to the total myocardial damage biomarker output. The exact pathophysiologic routes, if any, for this interaction remain to be identified. However, these results suggest that erythrocytes may be a - thus far virtually ignored -player in the pathogenesis of ischemic injury. (C) 2016 S. Karger AG, Base

Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing

BACKGROUND Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not dear, especially in the elderly. OBJECTIVE The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and “positive” invasive electrophysiologic testing (EPT). METHODS This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms. RESULTS Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P =.001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P <.001) and that of any-cause death was 41% vs 56% (P =.023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders. CONCLUSION In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause). (C) 2017 Heart Rhythm Society. All rights reserved

A stand-alone structured educational programme after myocardial infarction: a randomised study

Background Acute myocardial infarction (MI) is a major clinical manifestation of coronary artery disease. Post-MI morbidity and mortality can be reduced by lifestyle changes and aggressive risk factor modification. These changes can be applied more effectively if the patient is actively involved in the process. The hypothesis of this study was that an educational programme in post-MI patients could lead to reduced incidence of cardiovascular events. Methods Post-MI patients were prospectively randomised into two groups. Patients in the intervention arm were scheduled to attend an 8-week-long educational programme on top of usual treatment, while controls received optimal treatment. The primary endpoint was the composite of all-cause death, MI, cerebrovascular event and unscheduled hospitalisation for cardiovascular causes. Endpoint adjudication was blinded. Results 329 patients (238 men) were included, with a mean follow-up time of 17 +/- 4 months. In the primary analysis, mean primary end point-free survival time was 597 days (95% CI 571 to 624) in controls, compared with 663 days (95% CI 638 to 687) in the intervention group (p<0.001). The HR in the univariate Cox regression analysis was 0.48 (95% CI 0.32 to 0.73; p=0.001). The raw rates of the primary endpoint were 20.8% (6 deaths, 13 MIs, 2 strokes and 14 hospitalisations) vs 36.6% (8 deaths, 22 MIs, 7 strokes and 22 hospitalisations), respectively (OR 0.46, 95% CI 0.28 to 0.74; p=0.002). Conclusion These results suggest that a relatively short adult education programme offered to post-MI patients has beneficial effects, resulting in reduced risk of cardiovascular events