Explorations in anatomy: the remains from Royal London Hospital

This paper considers the faunal remains from recent excavations at the Royal London Hospital. The remains date to the beginning of the 19th century and offer an insight into the life of the hospital's patients and practices of the attached medical school. Many of the animal remains consist of partially dissected skeletons, including the unique finds of Hermann's tortoise (Testudo hermanni) and Cercopithecus monkey. The hospital diet and developments in comparative anatomy are discussed by integrating the results with documentary research. They show that zooarchaeological study of later post-medieval material can significantly enhance our understanding of the exploitation of animals in this perio

Foreign policy and political possibility

This article explores the relationship between foreign policy and political possibility in two parts. First, the relationship between foreign policy and political possibility is theorized around three analytical moments: political possibility is linked to the framing of conceivable, communicable and coercive foreign policy. Second, this framework is developed and demonstrated through a brief analysis of Coalition foreign policy in the War on Terror, considering American, British and Australian foreign policy between 2001 and 2003. This analysis dissects distinct and divergent Coalition foreign policies through a linked three-part conceptualization of political possibility. It enables an understanding of how the War on Terror was rendered possible through the construction of foreign policy in thinkable, resonant and ultimately dominant terms. The article concludes by looking to the wider analytical applicability of this particular theorization of the relationship between foreign policy and political possibility

Parallels, prescience and the past: analogical reasoning and contemporary international politics

Analogical reasoning has held a perpetual appeal to policymakers who have often drafted in historical metaphor as a mode of informing decision-making. However, this article contends that since the beginning of the ‘War on Terror’ we have arguably seen the rise of a more potent form of analogy, namely ones that are selected because they fulfil an ideological function. Analogical reasoning as a tool of rational decision-making has increasingly become replaced by analogical reasoning as a tool of trenchant ideologically-informed policy justification. This article addresses three key areas which map out the importance of analogical reasoning to an understanding of developments in contemporary international politics: the relationship between history and politics, in intellectual and policy terms; a critical assessment of the appeal that analogical reasoning holds for policymakers; and the development of a rationale for a more effective use of history in international public policymaking

Current anti-doping policy: a critical appraisal

BACKGROUND: Current anti-doping in competitive sports is advocated for reasons of fair-play and concern for the athlete's health. With the inception of the World Anti Doping Agency (WADA), anti-doping effort has been considerably intensified. Resources invested in anti-doping are rising steeply and increasingly involve public funding. Most of the effort concerns elite athletes with much less impact on amateur sports and the general public. DISCUSSION: We review this recent development of increasingly severe anti-doping control measures and find them based on questionable ethical grounds. The ethical foundation of the war on doping consists of largely unsubstantiated assumptions about fairness in sports and the concept of a "level playing field". Moreover, it relies on dubious claims about the protection of an athlete's health and the value of the essentialist view that sports achievements reflect natural capacities. In addition, costly antidoping efforts in elite competitive sports concern only a small fraction of the population. From a public health perspective this is problematic since the high prevalence of uncontrolled, medically unsupervised doping practiced in amateur sports and doping-like behaviour in the general population (substance use for performance enhancement outside sport) exposes greater numbers of people to potential harm. In addition, anti-doping has pushed doping and doping-like behaviour underground, thus fostering dangerous practices such as sharing needles for injection. Finally, we argue that the involvement of the medical profession in doping and anti-doping challenges the principles of non-maleficience and of privacy protection. As such, current anti-doping measures potentially introduce problems of greater impact than are solved, and place physicians working with athletes or in anti-doping settings in an ethically difficult position. In response, we argue on behalf of enhancement practices in sports within a framework of medical supervision. SUMMARY: Current anti-doping strategy is aimed at eradication of doping in elite sports by means of all-out repression, buttressed by a war-like ideology similar to the public discourse sustaining international efforts against illicit drugs. Rather than striving for eradication of doping in sports, which appears to be an unattainable goal, a more pragmatic approach aimed at controlled use and harm reduction may be a viable alternative to cope with doping and doping-like behaviour

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The state of war

This article frames the discussion of the 'state of war' in this issue of International Affairs. Beginning by noting the continued recurrence of 'traditional' modes of war along side so-called 'new wars' and calling to aid Rousseau's brutal satire of 1756, The state of war, the article offers a discussion of three 'responses' to the reality of war in international relations-the heroic response, the realpolitik response and the compassionate response and argues that a synthesis between them characterizes the general approach to war in any historical period. It then considers how the contemporary synthesis might be viewed and offers thoughts on the articles in this issue in the light of this suggestion

Gender and Security

Provides broad coverage of contemporary security studies, giving lecturers the flexibility to use the text in a way that supports their module. Assumes no background knowledge and makes effective use of learning features, making it accessible to students new to the subject. Brings together carefully edited contributions from international experts. Considers a range of traditional and non-traditional security issues, from terrorism and inter-state armed conflict to security issues centring on the environment, health, and transnational crime. Includes a new chapter on cyber-security, as well as more material on international organizations and institutions, private military companies, and nuclear proliferation and terrorism. New to this edition A rewritten economics chapter now utilises rational decision-making to show how economic instruments of the state can be used to pursue security goals, such as sanctions, trade agreements, or aid strategies. The rewritten development and security chapter presents globalization as an explanation for those structural conditions that expose people to a range of insecurities, which ultimately drive demands for change. The defence chapter now includes an historical overview of the trade in arms as well as the connections between the legal and illicit arms trade. Case studies include the procurement of weapon systems by terrorists, and efforts to limit the trade in particular weapon systems, such as landmines.The third edition of Contemporary Security Studies provides a comprehensive and accessible introduction to the rapidly developing field of security studies. Bringing together leading scholars in the field, it covers a broad range of approaches and issues, from terrorism and inter-state armed conflict to security issues centring on the environment, health, and transnational crime.The new edition includes a new chapter on cyber-security, as well as introducing more material on international organizations and institutions, private military companies, and nuclear proliferation and deterrence