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Pharmacies play a critical role in healthcare systems, especially during emergencies. Disruptions in the supply of medicines and consumables pose significant challenges in disaster response and recovery. Given the complexity and socio-political sensitivity of the resilient medicine supply chain, this study aimed to assess the resilience of the supply chain of medicines and consumables during disasters in Iran based on the World Economic Forum framework.
Methods
A cross-sectional, descriptive-analytical study was conducted using a validated questionnaire. Data were collected from 224 pharmacies in Shiraz city using the census method for hospital-based pharmacies and cluster and simple random sampling methods for city-level pharmacies. The collected data were analyzed and modeled using SPSS v.21 and Smart PLS v.3 software.
Results
The results confirmed the validity and reliability of the questionnaire developed for assessing the resilience of the supply chain of medicines and consumables during disasters based on the World Economic Forum framework. The results also demonstrated that participation (41.04), policy (30.22), information technology (26.72), and strategy (23.46) directly and positively contributed, respectively, to enhancing the resilience of the medicines and consumables supply chain during disasters.
Conclusions
According to the results, the medicines and consumables supply chain resilience in Iran can be improved by facilitating international partnerships, developing better relationships with suppliers, moving toward digital and information technology-based supply chains, having a strategic plan for the medicines and consumables supply chain in disasters, and developing coordinating policies and effective strategies.
Science and theatre were intertwined from the start of ‘modern drama’ in the works of Georg Buchner and Émile Zola, who ushered modern ideas about science into the theatre and made conscious engagement with science an intrinsic part of a break with the theatrical past. This chapter traces the explicit, conscious interaction between science and the modern stage, from August Strindberg and Henrik Ibsen’s works through to those of Bernard Shaw, Leonid Andreyev, Maxim Gorky, Elizabeth Robins, Eugène Brieux, Harley Granville Barker, Karel Čapek, Tawfiq al-Hakim, James Ene Henshaw, Mary Burrill, Susan Glaspell, and Sophie Treadwell; the probing of race science on stage by Harlem Renaissance playwrights; the Federal Theatre Project’s science-inflected productions; and Bertolt Brecht’s changing depiction of science and scientists. In addition, there is another meaning of ‘science in the theatre’ that the chapter draws out: the hidden, often unacknowledged roles played by science and technology in staging.
This article analyzes the interplay between medicine and politics in East Germany. It analyzes the meetings of the Politburo medical commissions (1958–60) to frame and define the habitus of a generation, the “Tenners” (born 1910–20), which included most of the experts in the Politburo meetings. This generation consisted of politically committed doctors who were also influential medical scholars, many with international reputations. The Politburo meetings revealed major quarrels between these experts and the Party. The communiqué (1960) issued by the Politburo showed a partial victory for the experts, because the Party acknowledged many of their claims, proving that “totalitarian” interpretations do not hold. However, this was not a victory of medicine over politics. The experts formulated their claims by combining medical and political arguments and defended the jurisdiction of their medical expertise over the Party, precisely because they believed it could more decisively contribute to achieving the goals of socialism.
This revision guide is an invaluable resource for psychiatric trainees preparing for exams. With 55 case vignettes and over 200 topical multiple-choice questions (MCQs), the content covers a broad spectrum of relevant psychiatric disorders, including schizophrenia, anorexia nervosa, addiction, and gender dysphoria. Case vignettes provide a focused discussion of each disorder, while strategically placed topical MCQs consolidate learning and highlight concepts across disorders. Recurring features are included at the end of each chapter, including 'Exam Essentials,' which highlight the most crucial information students should remember, 'Clinical Pearls', which provide tips for practical application, and the 'Diving Deep' section allows interested students to explore specific concepts further. An engaging and comprehensive revision resource, this will be a go-to resource for MRCPsych candidates and those taking specialist examinations.
Between the fifth and first century BC, calendars that compiled astronomical and meteorological information, known as parapēgmata, came to be used throughout the Greek-speaking world. In the course of the Hellenistic period, numerous such almanacs attributed to scientific authorities who operated in different regions were circulating, some of which emphasized distinct atmospheric phenomena. By ca. 100 BC at the latest, individuals and communities began combining astrometeorological parapēgmata to produce their own, including inscribed public versions. I argue that politically active citizens and doctors would have benefited from the use of these calendars within the context of the Hellenistic polis because weather was believed to have a direct impact on the collective food supply and health of communities and such documents were perceived as an invaluable tool for anticipating important atmospheric changes, determining when meteorological thresholds were crossed and building consensus for communal action taken in response.
Naval warfare changed out of all recognition from the late sixteenth century onwards through the rapid development of large square-rigged warships carrying heavy broadside gun batteries. A whole series of developments followed, with a long (if far from smooth) evolution in ships, equipment, strategy, and tactics continuing down to the last sailing navies of the early nineteenth century. It was clearly no accident that this naval revolution coincided with a great age of global European empires, which would have been impossible to create or maintain without effective naval power. Galleys and other oared craft became largely obsolete, except for some amphibious operations in the Mediterranean and for use in shallow waters around the innumerable Baltic islands. The crushing Dutch victory over a Spanish fleet at the battle of the Downs (1639) marked the first occasion when the full power of broadside gunnery became evident. Then the three Anglo-Dutch wars between the 1650s and 1670s saw a series of savage and bloody engagements between the fleets of two nations that were coming to be known as the Maritime Powers. The combination of imperial and trading ambitions, new financial arrangements, and relatively open societies enabled first the Dutch, and then the British, to develop naval power to new heights, in turn allowing them to punch well above their weight on the international stage. Under Louis XIV, France did mount a serious challenge to the Dutch and English, and for a time possessed the largest navy in the Western world. However, by the 1690s the French, and more gradually the Dutch, were finding the costs of maintaining this level of power at sea, as well as on land, to be too great.
Galen of Pergamum, known as 'the prince of medicine', is an important figure not only for the history of medicine but also for ancient philosophy, history of ideas and cultural history. In this book, Aistė Čelkytė explores Galenic physiology and examines how this highly influential figure theorised the unity of the multi-part, ever-moving and ever-changing human body. She approaches this question by first studying how Galen 'takes the body apart', that is, the different divisions of the body into parts that he proposes, and then how he 'puts it back together', that is, his use of philosophical tools to posit the vital unity among these parts. She then looks at Galen's theorisation of human nature, his understanding of parthood, the hierarchies between the parts that underpin vital functions, the 'mechanisms' that make the body one, and Galen's understanding of the body as a multifaceted but unified whole.
Despite its expanding presence in codes of practice and ethical guidance for healthcare professionals, there is limited research into the precise components of compassion in clinical settings. This chapter continues the exploration of compassion in healthcare by noting occasional confusion surrounding the term ‘compassion’, and the distress that an absence of compassion can cause for patients, families, and staff. The chapter examines research that seeks to define compassionate healthcare and delineate its constituent elements. Patients experience compassionate care when healthcare providers are emotionally present, communicate effectively, enter into their experience, and display understanding and kindness. Listening and paying close attention are the most dominant features of compassionate care, along with following‐up and running tests, continuity, holistic care, and respecting preferences. Other factors include honesty and kindness, as well as specific behaviours such as smiling. These are simple ways to demonstrate the compassion that healthcare workers routinely feel but sometimes do not convey clearly, owing to challenging circumstances. The chapter concludes with considerations of cultural and ethnic factors, as well as the importance of engagement, mindful awareness, and emotional intelligence in generating and deepening compassionate practice.
To care for the 14,000 black infantrymen, a new hospital opened when the men arrived. Equipped with state-of-the-art material, it employed the best black doctors in the country, recruited by the Surgeon General’s office. It offered all the features of Deluxe Jim Crow, black excellence in a segregated setting. During the war, it offered the best care possible to men whose health was often shaky, and provided a safe haven for those seeking to escape a racially biased discipline.
The conclusion explores Herman Melville’s Benito Cereno (1855), focusing on the way its characters and, we, as readers, make sense of embodied actions on board the San Dominick. Being able to read the emplotment of bodies becomes the key to solving the mystery on the ship, and to making sense of the story itself. By doing so, Melville complicates the mind-centered ontological paradigm’s structuring of our reading practices, our “mind-centered reading practices,” that reduce all bodies to just so many textual objects recording lived experience. By privileging the expressive agency of the material body, Melville also presents a competing reading practice, a “body-centered reading practice,” that understands the body as an active agent making meaning out of lived experience. The conclusion contrasts Amasa Delano’s faulty “mind-centered reading practice” with Babo’s rebellious “body-centered reading practice.” Melville thus “minds the body” to demonstrate the way the material expressions of the lived experiences of racial embodiment can short-circuit the objectification of Black bodies in the nineteenth-century chattel slave economy. And by doing so, Melville also models for us, as twenty-first-century readers, new ways to interpret critically the resistant meaning-making possibilities of embodied experience in all of its expressive dynamism.
This chapter explores the medically-trained writer, Robert Montgomery Bird, and his fraught experience of the way the competing ontological paradigms that inflected Edgar Huntly also conditioned early nineteenth-century medical discourse. Bird uses his picaresque novel, Sheppard Lee (1836), to interrogate what was called “regular” medical discourse and its mind-centered ontology, and to imagine instead the ontological possibilities that result from the body-centered ontology of metempsychosis. For Bird, metempsychosis involves our consciousness migrating from one body to another, and being defined by its different embodiment. In representing the lived experience of both white and Black embodiment, Bird uses metempsychosis to interrogate “regular” medicine’s mind-centered ontological paradigm, even as he puts pressure on “irregular” medicine as well. As I argue, Bird understands conscious existence as ontological drift, as I call it, a far less clear, but far more capacious ontology than either regular or irregular medical discourses entertain. By “minding the body” in this way, Bird uses his novel’s interrogation of the mind-body relationship to imagine a less repressive, but not unproblematic, form of racialized conscious existence in the antebellum period.
While exploring how specialist medical publishers and regular practitioners worked together to publish and advertise medical works on sexual matters, Chapter 3, Publishing for Professional Advantage, shows that the boundaries between communicating knowledge, promoting expertise, and trading on medical eroticism were not just blurry in contexts of the pornography trade and irregular medical practice. They were also blurry in regular medicine. Works on reproduction and sexual health issued by medical publishers were often textually similar to those issued by pornographers and irregulars, worked up using similar techniques, advertised, and distributed to non-medical readers in similar ways, and, regular practitioners often argued, for similar purposes. The chapter explores how and why these overlaps aroused particular concern among groups that advocated radical reforms to the medical profession. Rather than seeking to discipline regular medical publishing, however, reformers initially took a different route: they launched campaigns aimed at stamping out irregular practitioners’ trade in sexual health manuals.
Chapter 1, Holywell Street Medicine, traces the pornography trade’s birth out of the collapse of revolutionary politics in the 1820s, and shows how early agents in the trade scavenged for content to fill lists of sexual material. This fostered a vibrant mid-century traffic in cheap reprints and reworkings of works on contraception, venereal disease, fertility, and midwifery alongside pornographic novels and prints, bawdy songbooks, and other sexual material, operating out of London’s Holywell Street and other thoroughfares near the Strand. While showing how these agents harnessed the expanding infrastructures of the press and the post to sell their wares works across the nation, this chapter demonstrates that they framed medical works through two different, but compatible, lenses. Following a long line of disreputable publishers, Holywell Street publishers framed medical works as titillating reading material. However, they also adapted earlier radical arguments for sex education and female sexual pleasure, marketing medical works as containers of practical information about the body that readers could apply to support safe, active, and pleasurable sex lives.
This introduction outlines how studying the book trade can help us better understand the circulation of medical knowledge about sex and reproduction during the Victorian period, and the development of busineses, institutions, and narratives that claimed authority over it. Weaving a historiographic overview with an overview of the book’s approach and argument, it turns readers’ attention to medical works’ status as more than texts, highlighting the fact that they are material objects that must be made, promoted, and distributed, and that these actions accrue meanings of their own. It then articulates the book’s focus on the activities of four differently identified groups of players – pornographers, radicals, regular practitioners, and irregular practitioners – who brought sexual knowledge into non-expert readers’ hands and, in various ways, became embroiled in debates about medical obscenity. The introduction then outlines how the book tracks these agents’ intersecting activities to open up an argument about how and why allegations of obscenity became a means of selling books, contesting authority, and consolidating emergent collective identities.
Chapter 5, Dull Instead of Light, examines regular practitioners’ increasing efforts to disambiguate “medicine” and “quackery” in the wake of the 1868 formulation of the Hicklin test of obscenity. The first section explores how medical groups experimented with using obscenity laws as alternatives to the Medical Act (1858) to regulate medical practice. These actions’ impact on the book trade is debatable, but regular practitioners’ tireless efforts to collapse quackery and obscenity influenced new legislation governing medical advertising. The rest of the chapter examines parallel efforts to professionalize medical publishing. In advocating for limitations on medical book advertising, the use of dry, technical language in medical writing, and other changes to medical print culture, regular practitioners further sought to disambiguate “medicine” from “quackery.” The lines between popular and professional medical works had previously been blurry. The changes examined in this chapter helped cleave a growing chasm between the kinds of sexual knowledge accessible to medical and non-medical audiences.
This section introduces the reader to Beckett’s personal encounters with illness, infirmity, and medicine; to his reading of medical books and books on psychology; and to his own psychological crisis and psychotherapy at the Institute of Medical Psychology in London. It provides an overview of previous work in the field and introduces the book’s seven chapters.
Bringing together perspectives from the histories of medicine, sexuality, and the book, Sarah Bull presents the first study of how medical publications on sexual matters were made, promoted, and sold in Victorian Britain. Drawing on pamphlets, manuals, textbooks, periodicals, and more, this innovative book illustrates the free and unruly circulation of sexual information through a rapidly expanding publishing industry. Bull demonstrates how the ease with which print could be copied and claimed, recast and repurposed, presented persistent challenges to those seeking to position themselves as authorities over sexual knowledge at this pivotal moment. Medical publishers, practitioners, and activists embraced allegations of obscenity and censorship to promote ideas, contest authority, and consolidate emergent collective identities. Layer by layer, their actions helped create and sustain one of the most potent myths ever made about the Victorians: their sexual ignorance.This title is also available as open access on Cambridge Core.
For both developed and developing countries in the world, the twenty-first century will be marked by great challenges for healthcare systems. The overwhelming reason will be aging societies that will face an increase in multimorbid, chronic diseases which will include neurological diseases. The probability of surviving acute illness and the medical opportunities to prolong life in chronic-progressive disease will improve in future. As a result the numbers of neurological patients with respiratory impairment caused by prolonged, chronic or chronic-progressive life-threatening disease will increase. Minimizing dependency on life-supporting technologies and care, stabilizing vital functions, optimizing quality of life and participation and alleviating suffering are paramount goals for these patients. The therapeutic approach therefore must integrate intensive care, neurorespiratory care, rehabilitation and palliative care. Furthermore, patient-centered and family-oriented care, which covers the whole lifespan and bridges the gap between inpatient and outpatient care, is needed.
The core idea in this chapter is that there was a substantial, transnational, effort to rethink medical ethics – how it was framed by, taught to, and practiced by health professionals such as physicians – after the Holocaust. Because of the intense involvement of medical professionals in the Holocaust, both in the extermination process and through medical experimentation, there was a widespread sense after 1945 that the medical profession needed to rethink its ethical foundations. The chapter in particular highlights postwar currents in east-central European ethical thought, which engaged its own indigenous tradition of medical ethics (“deontology” as it was called) in ways that sometimes went beyond the parallel but more familiar debates in western Europe and the USA. The Holocaust informed – but did not determine – the evolution of biomedical ethics throughout the postwar period. Such thinking was also, necessarily, shaped by other currents – economic, political, and scientific – such that it is hard to say that medicine has “learned the lessons of the Holocaust,” at least not completely.
Mass Gathering Medicine focuses on mitigating issues at Mass Gathering Events. Medical skills can vary substantially among staff, and the literature provides no specific guidance on staff training. This study highlights expert opinions on minimum training for medical staff to formalize preparation for a mass gathering.
Methods
This is a 3-round Delphi study. Experts were enlisted at Mass Gathering conferences, and researchers emailed participation requests through Stat59 software. Consent was obtained verbally and on Stat59 software. All responses were anonymous. Experts generated opinions. The second and third rounds used a 7-point linear ranking scale. Statements reached a consensus if the responses had a standard deviation (SD) of less than or equal to 1.0.
Results
Round 1 generated 137 open-ended statements. Seventy-three statements proceeded to round 2. 28.7% (21/73) found consensus. In round 3, 40.3% of the remaining statements reached consensus (21/52). Priority themes included venue-specific information, staff orientation to operations and capabilities, and community coordination. Mass casualty preparation and triage were also highlighted as a critical focus.
Conclusions
This expert consensus framework emphasizes core training areas, including venue-specific operations, mass casualty response, triage, and life-saving skills. The heterogeneity of Mass Gatherings makes instituting universal standards challenging. The conclusions highlight recurrent themes of priority among multiple experts.