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Hierarchical relationships--rules that structure both international and domestic politics--are pervasive. Yet we know little about how these relationships are constructed, maintained, and dismantled. This book fills this lacuna through a two-pronged research approach: first, it discusses how great power negotiations over international political settlements both respond to domestic politics within weak states and structure the specific forms that hierarchy takes. Second, it deduces three sets of hypotheses about hierarchy maintenance, construction, and collapse during the post-war era. By offering a coherent theoretical model of hierarchical politics within weaker states, the author is able to answer a number of important questions, including: Why does the United States often ally with autocratic states even though its most enduring relationships are with democracies? Why do autocratic hierarchical relationships require interstate coercion? Why do some hierarchies end violently and others peacefully? Why does hierarchical competition sometimes lead to interstate conflict and sometimes to civil conflict? Daniel McCormack was Post-Doctoral Fellow at the University of Pennsylvania, USA. His current research focuses on political violence in America.--

In this article, we demonstrate that through their use as tools of military containment, sanctions play an unappreciated role in international politics. We show that sanctions can be used to smooth shifts in relative power that would otherwise lead to preventive war. After presenting a model of shifting relative power and sanctions, we discuss two cases in which sanctions were imposed to destroy an adversary's military capability. We also explore the implications of this argument for the evaluation of sanctions' effectiveness. Because sanctions may be deployed as a mechanism to lock in the status quo rather than revise it, the outcome of a sanctions episode must be compared to its counterfactual rather than the status quo ante. Our argument suggests that sanctions may be effectively deployed in response to expected adverse shifts in relative power; therefore observed outcomes disadvantageous to the sanctioning state are insufficient proof that sanctions have failed.

In this article, we demonstrate that through their use as tools of military containment, sanctions play an unappreciated role in international politics. We show that sanctions can be used to smooth shifts in relative power that would otherwise lead to preventive war. After presenting a model of shifting relative power and sanctions, we discuss two cases in which sanctions were imposed to destroy an adversary's military capability. We also explore the implications of this argument for the evaluation of sanctions' effectiveness. Because sanctions may be deployed as a mechanism to lock in the status quo rather than revise it, the outcome of a sanctions episode must be compared to its counterfactual rather than the status quo ante. Our argument suggests that sanctions may be effectively deployed in response to expected adverse shifts in relative power; therefore observed outcomes disadvantageous to the sanctioning state are insufficient proof that sanctions have failed.

This paper presents a qualitative study of the integration of supply chain management and business process management activities. It reviews published literature in both fields and a number of supporting areas, revealing a minimal overlap in the research. A number of case studies of progressive organisations are examined, including an in‐depth study of Nortel Networks Corporation's recent market repositioning and current supply chain integration activities. The study concludes that, while there is little evidence of research exploring the integration of processes extending throughout supply chains, some businesses are gaining competitive advantage by maximising the efficiency of their "global" supply chains or "virtual" organisations. A conceptual model of an integrated business process, derived from the case study, is presented, which highlights the importance of communication between processes and between partners in the supply chain.

Abstract

Aims
Naltrexone is recommended first-line to manage alcohol use disorder (AUD). With previous studies indicating poor retention on naltrexone, we determined duration of naltrexone use and assessed the association between prescription setting and time to discontinuation in Ontario.


Methods
We conducted a retrospective population-based cohort study among Ontario public drug beneficiaries diagnosed with AUD who initiated publicly funded naltrexone from June 2018 to September 2019. The primary outcome was time to naltrexone discontinuation, with a secondary analysis assessing receipt of at least one prescription refill. We used Cox proportional hazards models and logistic regression to test the association between prescription setting and each medication persistence outcome.


Results
Among 2531 new naltrexone patients with AUD, the median duration of naltrexone use was 31 days and 394 (15.6%) continued naltrexone for 6 months or longer. There was no association between setting of initiation and duration of naltrexone use; however, those initiating naltrexone following an acute inpatient hospital stay were more likely to fill a second prescription (aOR 1.43, 95% CI 0.96–2.14), while those initiating after an ED visit were less likely to be dispensed a second prescription (aOR = 0.69, 95% CI 0.52–0.90) compared to those starting in a physician's office.


Conclusion
Persistence on naltrexone to treat an AUD is low, regardless of the setting of initiation. Further research is needed to elucidate the barriers encountered by patients with AUD that lead to poor treatment persistence in order to develop interventions that facilitate patient-centered access to evidence-based treatment for AUD in the province.