Negative Repercussion Research Articles

Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnetic resonance imaging: the MIDEX MRI trial

BackgroundChildren under 6 years who need magnetic resonance imaging usually require sedation to obtain best quality images, but the optimal sedation protocol remains to be determined. In 2018, we showed a 22% interruption in image acquisition during magnetic resonance imaging when performing a propofol-based sedation using a bolus approach. As non-pharmacological premedication is often insufficient to reduce the anxiety of children related to parental separation, pharmacological premedication may be useful to facilitate the induction of anesthesia. In our institution, effective premedication is obtained oral intake of midazolam, though its administration relies on patients’ compliance and could also lead to paradoxical reaction. Dexmedetomidine has a safe profile in the pediatric population and can therefore represent an interesting alternative. The primary objective of this trial is to demonstrate the superiority of intranasal dexmedetomidine compared to oral midazolam as premedication in reducing the occurrence of any event requiring temporary or definitive interruption of the examination to allow anesthesiologist intervention in children undergoing magnetic resonance imaging under propofol sedation.MethodsIn this single-center, prospective, randomized, double-blind, double-dummy, active comparator-controlled, superiority trial, we planned to include 250 patients, aged 6 months to 6 years, undergoing a scheduled magnetic resonance imaging requiring the presence of an anesthesiologist. After informed consent, the patients will be randomized to receive either oral midazolam or intranasal dexmedetomidine as premedication. The data will be analyzed in intention to treat, using Kolmogorov–Smirnov Z, chi-square, Wilcoxon, and Mann–Whitney U tests. A P-value < 0.05 will be considered statistically significant.DiscussionThe MIDEX MRI study will assess the efficacy of intranasal dexmedetomidine compared to oral midazolam to improve the quality of a propofol-based sedation prior to magnetic resonance imaging, without negative repercussion on the postoperative period.Trial registrationClinicalTrial.gov NCT05192629. Registered on 14 January 2022. Protocol version 2.1

Utilization of Bacillus cereus strain CGK5 associated with cow feces in the degradation of commercially available high-density polyethylene (HDPE).

The accumulation and mismanagement of high-density polyethylene (HDPE) waste in the environment is a complex problem in the present scenario. Biodegradation of this thermoplastic polymer is a promising environmentally sustainable method that offers a significant opportunity to address plastic waste management with minimal negative repercussion on the environment. In this framework, HDPE-degrading bacterium strain CGK5 was isolated from the fecal matter of cow. The biodegradation efficiency of strain was assessed, including percentage reduction in HDPE weight, cell surface hydrophobicity, extracellular biosurfactant production, viability of surface adhered cells, as well as biomass in terms of protein content. Through molecular techniques, strain CGK5 was identified as Bacillus cereus. Significant weight loss of 1.83% was observed in the HDPE film treated with strain CGK5 for 90days. The FE-SEM analysis revealed the profused bacterial growth which ultimately caused the distortions in HDPE films. Furthermore, EDX study indicated a significant decrease in percentage carbon content at atomic level, whereas FTIR analysis confirmed chemical groups' transformation as well as an increment in the carbonyl index supposedly caused by bacterial biofilm biodegradation. Our findings shed light on the ability of our strain B. cereus CGK5 to colonize and use HDPE as a sole carbon source, demonstrating its applicability for future eco-friendly biodegradation processes.

Antiandrogenic treatment of obsessive compulsive neurosis: A case review

IntroductionObsessive-compulsive disorder (OCD) is a mental disorder in which patients who suffer from it have repetitive and undesirable thoughts, feelings, ideas, sensations (obsessions) and behaviors that drive them to do something over and over again (compulsions).Often the person tries to get rid of the obsessive thoughts through compulsions, but this only provides short-term relief. Not carrying out the obsessive rituals can cause enormous anxiety and suffering.ObjectivesTo describe a 23-year-old male patient, who suffers from anxiety and mood symptoms, reacts to ego-dystonic obsessive ideas and sexual content, of months of evolution, and who manages to calm down through compulsive masturbation or watching sexual videos on the internet. All this clinic negatively interferes with their quality of life, asking the patient for medical help to calm these ideas.MethodsWe carried out a review in Pubmed with the terms Antiandrogens and TOC, in order to make a better description of the clinical case.ResultsAfter several treatment attempts (Sertraline, Paroxetine, Clomipramine, Clomipramine + SSRI), reaching maximum doses according to clinical guidelines, and with poor therapeutic response, it was decided to discuss the case with the endocrinology department of our hospital, deciding to start treatment with antiandrogens, in order to alleviate the persistent intrusive ideas of a sexual nature. The administration of antiandrogens in men can cause a decrease or increase in the development or involution of secondary sexual characteristics in men, reducing the activity or function of accessory sexual organs, and hyposexuality, with decreased sexual desire or libido.After several weeks, there was improvement in the obsessive symptoms with a decrease in compulsive rituals. However, after the 3rd mo, some symptoms reappeared, but not with the same severity and intensity as before treatment. In addition, we cannot ignore the adverse effects that have occurred, such as involution of secondary sexual characteristics. However, and taking into account the negative repercussion that this clinic had on the patient’s quality of life, the benefit obtained exceeded the risk, having noted clear improvement with this therapy, and maintaining evolutionary controls by both psychiatry and endocrinology.ConclusionsPatients suffering from obsessive-compulsive disorder can be effectively treated with anti-androgenic pharmacological agents with various modes of action. The most effective group of such agents is the long-acting analogues of the gonadotropin-releasing hormone. The objective of this review is to elucidate the possibility of using such powerful anti-androgenic agents in the treatment of obsessive-compulsive disorder.Disclosure of InterestNone Declared

Economic Protectionist State Policy: An Analysis of Its Enduring Practices in the Contemporary International Trade Relations

State protectionism in international trade relations has gained momentum and impacted global trade flows. The negative repercussion is inevitable as it contributes to the global economic downturn and slow global economic growth. The global economic rebound is expected to have occurred, still, it faces a magnificent impediment to being realized. Many major economies - including the US, China, Japan, and EU- which glorify the importance of free trade to raise global prosperity are even leading in exerting protectionist policy in their trade relations and thus influencing the increasing global trend of its practices. This article thus orients to investigate the root causes behind the increasing practices of state protectionism, which have negative consequences and endure slow global economic growth, by raising the issue of “why does protectionism still exist despite being criticized as suboptimal compared to free trade?”. In investigating this issue, this article employs the theoretical approach of state protectionism and instigate three main proposition based on it. This article argues that the enduring state protectionism is mainly caused by WTO's diminishing credibility in the world trade governance, the global financial crisis (GFC) 2008 occurrence, and the US rising anti-trade rhetoric that induced the domino effect of economic populism and protectionism. This article will proceed as follows. It will detail the background of contemporary state protectionism and briefly review the state protectionism theoretical approach. Eventually, it will analyze the fundamental causes behind the enduring state protectionist approach in contemporary international trade relations.

Cognitive behavioral therapy adapted for patients with acromegaly

In acromegaly, excess secretion of growth hormone and insulin-like growth factor 1 may result in coarse features and enlargement of the extremities. Its negative repercussion on self-esteem can impair quality of life. Ten patients with acromegaly participated in this study. The treatment covered nine weekly group sessions. Unhealthy behaviors, thoughts, and emotions were identified, and healthy behaviors and thoughts were constructed, along with positive reflections on their associated emotions. In Session 7, the “Think healthy and feel the difference” technique was adapted to help patients better deal with their physical appearance and improve their quality of life. Qualitative data was obtained from an analysis of the content of a collaborative exercise developed in Session 7. Factors, especially thoughts, emotions, and advantages and disadvantages associated with both healthy and unhealthy behaviors, were identified. The technique improved quality of life for patients with acromegaly in relation to their acceptance of their physical appearance. UTN U 1111–1220-9846 (September 24th, 2018).

Negative neuromuscular and functional repercussion of forced swimming after axonotmesis

Peripheral nerve injuries are cause of sensory disturbances and in functional abilities, and are associated personal and social costs. Strategies that maximize nerve regeneration and functional recovery are necessary, the exercise is an option. This study evaluated the effects of forced swimming exercise on neuromuscular histomorphometry and on functional recovery in a median nerve crush model. Sixteen Wistar rats underwent median nerve crush and were divided into control group (CG) and swimming group (SG). The forced swimming protocol started one week after the injury and was performed for 1 hr a day, 5 days per week, for 2 weeks. The rats swam with an overload of 5% and 10% of body weight in the first and second week, respectively. The functional recovery was assessed in three moments using the grasping test. On day 21, fragments of the median nerve and of the forearm flexors muscles were removed for histomorphometric analysis. The SG had functional recovery impaired (P<0.001) and presented lower myelinated fibers number, fiber and axon minimal diameter, myelin thickness and g-ratio in the proximal e distal segments of the median nerve (P<0.005) and area muscle fiber (P<0.005) than CG. Also, the SG presented a number of capillaries in the proximal segments of the median nerve greater than CG (P<0.005). The exercise protocol used in this study impaired the regeneration of the median nerve and negatively influenced the functional recovery.

The Induction of Hypothyroidism during Gestation Decreases Outer Hair Cell Motility in Rat Offspring.

Introduction Perinatal hypothyroidism has a negative repercussion on the development and maturation of auditory system function. However, its long-term effect on auditory function remains unsettled. Objective To evaluate the effect of prenatal hypothyroidism on the auditory function of adult offspring in rats. Methods Pregnant Wistar rats were given the antithyroid drug methimazole (0.02% -1-methylimidazole-2-thiol- MMI) in drinking water, ad libitum, from gestational day (GD) 9 to postnatal day 15 (PND15). Anesthetized offspring from MMI-treated dams (OMTD) and control rats were evaluated by tympanometry, distortion product otoacoustic emission (DPOAE), and auditory brainstem response (ABR) at PNDs 30, 60, 90, and 120. Results Our data demonstrated no middle ear dysfunction, with the OMTD compliance lower than that of the control group. The DPOAE revealed the absence of outer hair cells function, and the ABR showed normal integrity of neural auditory pathways up to brainstem level in the central nervous system. Furthermore, in the OMTD group, hearing loss was characterized by a higher electrophysiological threshold. Conclusion Our data suggest that perinatal hypothyroidism leads to irreversible damage to cochlear function in offspring.

Sustainability of Micro, Small and Medium Enterprises in India during Covid-19

The novel Corona Pandemic has put the world trade and economy in a great crisis. No country is free from the jaws of the deadly virus. It not only causing huge forfeiture of human life but also inducing economic disaster, with a halt in production, a crumble in consumption and a magnified unreliability in stock exchanges. The Covid-19 has severely disrupted the global supply chain system. All the sectors like aviation, tourism, retail, capital markets, oil and particularly Micro, Small and Medium Enterprises (MSMEs) are the most affected with negative repercussion. In the global view, the small businesses are the most sufferers than the big ones as they are vulnerable with lesser resources to redesign to the new social change. The main purpose of this article is to study the present status of Micro, Small and Medium Enterprises (MSMEs) of India and its sustainability amid this pandemic. It will notably discuss the impacts of Covid-19 on this sector and the initiatives taken to regenerate this sector. The study will be based on reviewing the available literatures considering research papers, reports and policy documents. This article comes forward with applicable recommendations for MSMEs facing this epidemic in India.

Impact of Shifting Cultivation on Green Infrastructure: A Remote Sensing Perspective

The study deals with the spatio-temporal dynamics with special reference to shifting cultivation in Nagaland, Northeast India using multi-temporal satellite observation during the last three decades (1987-2017). The study exhibited a significant change in green infrastructure over the temporal scales and highlights the influence of shifting cultivation in the region as evident in the initial decade of observation (1987, 1991, 1996) compared to recent decades barring 2013. The principal component analysis of major vegetation indices highlights a decrease in very high green infrastructure while an increase in very low, moderate, and moderately high green infrastructure (by 69.25%) during 2005-2020 in Nagaland. Although green infrastructure is the most dominant land surface feature (74.25%) in Tuensang district, the large parts were significantly affected due to shifting cultivation (9-17%) and footprint of shifting cultivation as fallow land (29.79% to 30.15%) during 1987-2017. The topographical control was observed on hills with gentle slopes (&gt;15%) with southeastern, south, and southwest aspects for shifting cultivation while an increase was observed in the higher relief. The reduction in the cycle of shifting cultivation and its transformation to permanent intensive agriculture will have a far more negative repercussion on the ecosystem. The study necessitates the incorporation of sustainably managed methods in conjugation with the traditional customs and practices to maintain environmental boundary conditions by means of promotion of agroforestry and tree-based land uses to reshape the adversities of shifting cultivation.

Repercussions of the pandemic of COVID-19: care of the pediatric population in Primary Health Care

Objective: to describe the repercussions of the COVID-19 pandemic on the care of the pediatric population in Primary Health Care. Methods: qualitative study conducted with 28 primary care coordinators linked to a regional health region. Data were imported into the NVivo Release Program for content analysis. Results: there was a reduction of access to primary care for actions of prevention and promotion of child health, intensifying assistance based on the biomedical model to the detriment of surveillance of child development as well as the need for (re)organization of assistance through new strategies. Conclusion: the pandemic had a negative repercussion on child health care represented by the reduction in demand and pediatric demand in Primary Health Care, however, it was identified that services were reorganized through new appointments and tele-attendance to maintain the principles of primary care and the Brazilian Unified Health System. Contributions to practice: the study enabled the identification of new forms of health organization regarding the care of children in primary care in the context of the COVID-19 pandemic. Because, the use of telehealth can contribute to the monitoring of children in other realities.

Vaping among youth: reasons, realization and intention to quit

PurposeVaping has become a prominent public health problem that has impacted young adults. The purpose of this study is to empirically examine the effects of different intrinsic and extrinsic motivations on young adults’ realization of excessive vaping and their intention to quit vaping.Design/methodology/approachA survey was used to collect data from 232 young vapers (primarily Generation Z and Millennials) to test the hypothesized relationships using a covariance-based structural equation model.FindingsThe findings of this study suggest that “realization of excessive vaping” is negatively associated with “sensation seeking” and positively associated with “deal proneness,” “environmental cues” and “negative repercussion.” The “intention to quit vaping” is negatively associated with “marketing cues” and positively associated with “alternative to smoking” and “environmental cues.” Finally, the “realization of excessive vaping” is positively associated with “intention to quit vaping.”Originality/valueThis study takes a two-dimensional approach to understand the complex motivations behind a relatively new addictive behavior – vaping. It contributes to the literature of addictive behavior, social cognitive theory and theory of planned behavior. Further, it has important implications for public policy and the marketing of addictive products to youths.

Social Media Addiction and its Impact on Social Relationships

Social media is a platform that allows users to engage in activities and collaborate. Social media can make communicating with fellow humans easier via a smartphone connected to an internet connection. But on the other hand, the presence of social media can have a negative impact. Excessive use of social media can be addicting and can have a negative repercussion on one's social relationships. Therefore, this paper will analyze the relationship between social media addiction on social relationships and how it impacts one's social relationships. To analyze that, a research instrument in the form of a questionnaire was used. After that, the validity and reliability tests were carried out regarding the questionnaire. If the questionnaire passed the test, the questionnaire was distributed. The results from the questionnaire were analyzed by an assumption and hypothesis test respectively,, to describe the objectives of this study.

Investigations into the Combined Effect of Mahua Biodiesel Blends and Biogas in a Dual Fuel Engine

Rapid depletion of conventional fuel sources has led to the use of alternative fuels and implementation of variant engine technologies to reduce deleterious emissions being released and deliver thermal energy for numerous applications. This research aims to study the usage of mahua methyl ester in a single-cylinder 4-stroke CI engine, optimized to operate in the dual fuel mode. Performance, combustion and emission characteristics are recorded and compared with diesel with the sole aim of finding the blend that provides adequate performance and diminishing emissions. To this effect, the percentage of mahua biodiesel blend, load, biogas flow rate and methane fraction are varied. The experimentation is conducted using three mahua biodiesel blend variants namely B10, B20 and B30. Gaseous fuel comprising biogas (CH4 and CO2 in ratio of 3:2) and methane (CH4) are incorporated in the dual fuel condition at 8 litre per minute (lpm) and 12 lpm. B20 blend demonstrated better performance and emission characteristics. The addition of biodiesel (B20) showed more than 5% improvement in brake thermal efficiency. Additionally, comparing with normal diesel mode, B20 showed lower CO (0.061%) and NOx (615 ppm) emissions. In the dual fuel condition, methane and biogas are effective in reducing the NOx emissions, but with a negative repercussion of extortionately elevated HC and CO emissions. The best combination is deduced to be B20 mahua biodiesel at 8 lpm of biogas flow rate in the dual fuel mode due to better performance and emission characteristics.

Exercise-Induced Hyponatremia: An Assessment of the International Hydration Recommendations Followed During the Gran Trail De Peñalara and Vitoria-Gasteiz Ironman Competitions.

IntroductionHyponatremia often occurs during the practice of endurance sports. We evaluated the impact on hyponatremia of the hydration recommendations of the Third International Exercise-Associated Hyponatremia Consensus Development Conference 2015 (3IE-AHCD) during the 2017 Gran Trail de Peñalara marathon (GTP) and the Vitoria Gasteiz Ironman triathlon (VGI).MethodsProspective study of GTP and VGI athletes participating in four information sessions in the months prior to the events, to explain that hydration should only be according to their level of thirst, per the recommendations of the 3IE-AHCD. Consenting event finishers were included in final analysis. Pre- and post-race anthropometric and biochemical parameters were compared.ResultsThirty-six GTP (33 male) and 94 VGI (88 male) finishers were evaluated. GTP race median fluid intake was 800 ml/h, with 900 ml/h in the VGI race. 83.3% GTPfin and 77.6% VGIfin remained eunatremic (blood sodium 135–145 mmol/L). Only 1/36 GTP and 1/94 VGI participant finished in hyponatremia, both with a sodium level of 134 mmol/L. Fourteen percent of GTP, and 21.2% of VGI participants finished in hypernatremia, with no increase in race completion times. No participating athlete required medical attention, except for musculoskeletal complaints. Pro-BNP and Copeptin levels rose significantly. Changes in copeptin levels did not correlate with changes in plasma osmolality, nor total body water content in impedance analysis.ConclusionsRecommending that athletes' fluid intake in endurance events be a function of their thirst almost entirely prevented development of hyponatremia, without induction of clinically significant hypernatremia, or a negative repercussion on race completion times.

Barriers and facilitators to discussing parent mental health within child health care: Perspectives of parents raising a child with congenital heart disease.

This study aimed to identify barriers and facilitators to discussing parent mental health within child health care for parents of children with congenital heart disease (CHD). Seventy-nine parents of young children with CHD who received care across 40 hospitals in the United States responded to questions about barriers and facilitators to discussing their mental health with their child's health care providers. Responses were analyzed using qualitative research methods. Parents described multiple barriers: (1) belief that parent mental health support was outside the care team's scope of practice, (2) perceived expectation to "stay strong," (3) fear of negative judgment or repercussion, (4) individual preferences for communication/support, (5) desire to maintain care resources on their child, (6) perceived need to compartmentalize emotions, and (7) negative reactions to past emotional disclosure. Parents also described several facilitators: (1) confidence in the care team's ability to provide support, (2) intentional efforts by the care team to provide support, (3) naturally extroverted tendencies, and (4) developing personal connections with health care providers. It is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.

Restricted Selection Index to Relieve the Negative Repercussion in Reproductive Performance of Holstein Cows

The aim of this investigation was to develop restricted selection index aiming to improve 305-day yields of milk (MY), fat (FY) and protein (PY), while keeping the deterioration in days open (DO), calving interval (CI) and number of services per conception (NSPC) at minimum levels in Holstein cows. The data represent 3682 records of 1122 cows, daughters of 95 sires and 712 dams. The data were analyzed by multi-trait animal model with repeated measures. Eight selection indexes (five unrestricted and three restricted) were derived using MY, FY, PY, CI, DO and NSPC in various combinations as sources of information in the indexes. However, the true breeding value included MY, FY and PY. The highest accuracy of selection (0.60) resulted from selection based on the full index. Milk yield and SPC appeared to be the most valuable traits in the full index. Combining the two traits into one index (the best reduced index) gave 0.57 accuracy of selection. The index based on MY alone (the most accurate single trait index) gave 0.53 accuracy. It seems possible to reduce the expected genetic deterioration in the reproductive traits by restricting the full index to result in zero genetic change in NSPC (rTI=0.48). This restriction will allow the breeder to mitigate the deterioration in DO and CI by 12 and 16 days respectively, by sacrificing with part of the expected genetic improvement in productive traits (29, 40 and 48% in MY, FY and PY, respectively).

Functional reserve and sex differences during exercise to exhaustion revealed by post-exercise ischaemia and repeated supramaximal exercise.

Females have lower fatigability than males during single limb isometric and dynamic contractions, but whether sex-differences exist during high-intensity whole-body exercise remains unknown. This study shows that males and females respond similarly to repeated supramaximal whole-body exercise, and that at task failure a large functional reserve remains in both sexes. Using post-exercise ischaemia with repeated exercise, we have shown that this functional reserve depends on the glycolytic component of substrate-level phosphorylation and is almost identical in both sexes. Metaboreflex activation during post-exercise ischaemia and the O2 debt per kg of active lean mass are also similar in males and females after supramaximal exercise. Females have a greater capacity to extract oxygen during repeated supramaximal exercise and reach lower , experiencing a larger drop in brain oxygenation than males, without apparent negative repercussion on performance. Females had no faster recovery of performance after accounting for sex differences in lean mass. The purpose of this study was to ascertain what mechanisms explain sex differences at task failure and to determine whether males and females have a functional reserve at exhaustion. Exercise performance, cardiorespiratory variables, oxygen deficit, and brain and muscle oxygenation were determined in 18males and 18 females (21-36years old) in two sessions consisting of three bouts of constant-power exercise at 120% of until exhaustion interspaced by 20s recovery periods. In one of the two sessions, the circulation of both legs was occluded instantaneously (300mmHg) during the recovery periods. Females had a higher muscle O2 extraction during fatiguing supramaximal exercise than males. Metaboreflex activation, and lean mass-adjusted O2 deficit and debt were similar in males and females. Compared to males, females reached lower and brain oxygenation during supramaximal exercise, without apparent negative consequences on performance. After the occlusions, males and females were able to restart exercising at 120% of , revealing a similar functional reserve, which depends on glycolytic component of substrate-level phosphorylation and its rate of utilization. After ischaemia, muscle O2 extraction was increased, and muscle was similarly reduced in males and females. The physiological response to repeated supramaximal exercise to exhaustion is remarkably similar in males and females when differences in lean mass are considered. Both sexes fatigue with a large functional reserve, which depends on the glycolytic energy supply, yet females have higher oxygen extraction capacity, but reduced and brain oxygenation.

Investor confidence and life insurance demand: can economic condition limit life insurance business?

PurposeLife insurance is bought with a prior belief that promise stipulated in policy will be honored when due. Discernibly, this belief is backed by the confidence that financial markets and economy will demonstrate satisfactory performance. However, individuals' confidence levels may get shaken through naïve reinforcement learning if they witness negative market or economic condition. Considering this the authors investigate the relationship between investor confidence and life insurance demand.Design/methodology/approachThe authors used bias corrected bootstrapped sample of OECD economies to examine the link between investor confidence and life insurance demand when two possible economic conditions were witnessed: 1) normal/economic expansion and 2) economic/debt impairment. The findings are robust to alternate estimation techniques and endogeneity.FindingsThe authors found that lower investor confidence, sovereign debt impairment and negative market condition will have negative repercussion on life insurance demand. On the other hand, investor confidence-life insurance demand nexus is merely influenced by market and economic condition.Originality/valueThis is a premier research explaining the nexus between investor confidence and life insurance demand in the context of life-cycle hypothesis, sovereign ratings channel and experience-confidence-belief framework. The finding will help economic policy-makers in developing pre-emptive measures to protect life insurance businesses from negative repercussions of lower confidence and negative market conditions.

Brexit and the Implementation of the Withdrawal Agreement

The Agreement on the UK’s withdrawal from the EU of January 2020 should focus on dissolution, while the future relationship is governed by the yet to ratify Trade and Cooperation Agreement of December 2020. Yet, continuing bonds impact on the future, most prevalent in the situation of EU citizens who moved to the UK and UK citizens who moved to the EU, relying on the continuity of the UK’s EU membership, and the necessity of managing the hybrid position of Northern Ireland and its people, which is protected by the Belfast Good Friday Agreement. Part Two of the Withdrawal Agreement and the Protocol on Ireland / Northern Ireland retain some EU citizenship rights and Northern Ireland’s access to the EU Internal Market for goods. Implementing those remnants of EU membership constitutes a permanent struggle. This chapter elaborates the ensuing difficulties and concludes with practical proposals how to alleviate negative repercussion.

China

In recent years, China has been steadily expanding its non-military footprint in the Pacific region in an unprecedented manner. The multi-dimensional expansion of Chinese presence in the Pacific has arguably, made the region a microcosm of power politics amongst regional and established powers. Part of the explanation for the Chinese fastpace growth in the Blue Pacific is the presence of the Taiwanese who have been one of the biggest providers of aid for diplomatic recognition. The aid-dependent Pacific Island Countries (PICs) by being active creators of the Sino-Taiwan chequebook diplomacy have time and again switched their diplomatic allegiance in order to secure more foreign aid for their social development and economic growth. Despite such an “unreliable” behaviour, Beijing has widened and deepened its presence in the region by providing concessional loans with “no strings attached.” The latter element has been conveniently alluring to all the PICs so much so that they have borrowed more than 50 percent of their GDP from China. This has alarmed the traditional donors such as US, Japan and Australia which are revisiting their policies and re-engaging in the Pacific politics actively, all aimed at preventing the Island nations sinking in Chinese debt and consequently losing their strategic leverage to the People’s Republic of China (PRC). As for Taipei, it had managed to ally itself with six PICs in return for provision of foreign aid and foreign direct investments. However, in September 2019, two of its diplomatic allies ditched it in favour of Beijing. There has also been a paradigm shift in Beijing’s earlier policy vis-à-vis the PICs. In the past, PRC would not allocate aid to Taiwan’s (ROC) allies, however, after a shift in policy, ROC’s diplomatic allies currently get more aid from Beijing than from Taipei. The other worrying factor for the local population is a steady growth of the Chinese diaspora. Despite anti-Chinese riots in many countries, the new wave of Chinese immigrants do not seem deterred by the negative repercussion of their presence in the region. These Chinese new arrivals invest heavily in real estate in a bid to legitimise their presence in the island nations. This development has caused massive trepidation among regional powers, as they believe, would pave the way for Chinese military presence in the region under a legitimate claim to protect its overseas nationals.