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Explores the varied relationship between political leaders and naval experts, from the sixteenth to twenty-first centuries. The shaping of national defence strategies is particularly difficult in the case of navies. Few political leaders have naval experience, in contrast to the case of armies where political leaders and army commanders have often shared similar social and professional backgrounds. Bringing together historical examples from Britain, the United States, Spain and France, the book provides insights into this key relationship. The authors highlight factors which have made for successful relationships between political leaders and naval experts, showing how changing circumstances have affected the dialogue and underlines the importance of good exchange of knowledge, expertise and understanding for successful policy making and strategic outcomes. Sea power continues to be crucial in the present world's increasingly unstable geopolitical situation, the mutual exchange of expertise between naval experts and political leaders is as important as ever, and the risk of political 'sea blindness' remains high. This book's historical examples provide good guidance on how to manage the relationship between political leaders and naval experts well.

The naval leader has taken centre stage in traditional naval histories. However, while the historical narrative has been fairly consistent the development of various navies has been accompanied by assumptions, challenges and competing visions of the social characteristics of naval leaders and of their function. Whilst leadership has been a constant theme in historical studies, it has not been scrutinised as a phenomenon in its own right. This book examines the critical period in Europe between 1700 -1850, when political, economic and cultural shifts were bringing about a new understanding of the individual and of society. Bringing together context with a focus on naval leadership as a phenomenon is at the heart of this book, a unique collaborative venture between British, French and Spanish scholars. As globalisation develops in the twenty-first century the significance of navies looks set to increase. This volume of essays aims to place naval leadership in its historical context.

Abstract Background Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. Methods A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. Results Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. Conclusion The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.

Abstract Background Cigarette smoking prevalence among gay men is twice that of population levels. A pilot community-level intervention was developed and evaluated aiming to meet UK Government cessation and cancer prevention targets. Methods Four 7-week withdrawal-oriented treatment groups combined nicotine replacement therapy with peer support. Self-report and carbon monoxide register data were collected at baseline and 7 weeks. N = 98 gay men were recruited through community newspapers and organisations in London UK. Results At 7 weeks, n = 44 (76%) were confirmed as quit using standard UK Government National Health Service monitoring forms. In multivariate analysis the single significant baseline variable associated with cessation was previous number of attempts at quitting (OR 1.48, p = 0.04). Conclusions This tailored community-level intervention successfully recruited a high-prevalence group, and the outcome data compares very favourably to national monitoring data (which reports an average of 53% success). Implications for national targeted services are considered.

Educators involved in the production or adaptation of educational materials for the hearing impaired must be concerned with the materials' potential for use in the schools. For example, the greatest filmstrip ever produced would be worthless without the technology intended for its utilization, i.e., the projector. With the current progress being made in the development of microcomputers and software, educators must be able to answer some very basic questions concerning the degree to which this technology is available in the schools prior to curricular development. With this question as a basis, the microcomputer-software survey was developed. A sample of 158 schools for the hearing impaired was chosen, and each was sent a survey designed to assess the extent of the availability of microcomputers and the variety of tasks for which microcomputers are currently being used. Other questions of interest which were addressed include: What models of microcomputers are available, what are the limiting factors for the use of microcomputers and the software, and what adaptations are necessary in currently available software? Responses were obtained from 120 schools representing 45 states. This paper presents the results and a sampling of responses from those schools.

Abstract
Prolonged stress leading to job-related burnout is of increasing interest in policing. Police officers involved in rape and serious sexual offences (RASSO) investigations experience heightened scrutiny alongside increased forensic demands whilst providing an accountable, victim-orientated service. The objective of the study was to examine correlates associated with burnout symptoms [emotional exhaustion (EE), depersonalization and lack of personal accomplishment (PA)]. RASSO investigators (n = 538) completed a cross-sectional online survey across five police force areas in England and Wales. Measures were screened using the Least Absolute Shrinkage and Selection Operator method, and three regression models were run against the three outcome measures. Excessive job demands encompassing workload, work–life balance and team pressures from colleagues and managers were strongly related to EE and DP. Male officers reported elevated levels of depersonalization. The learning climate was associated with all three burnout measures. The findings suggest that creating an effective learning environment for RASSO investigations and establishing effective organizational health policies to enhance team cohesion can reduce burnout. Further work is required to understand male officers' higher levels of depersonalization.

BACKGROUND: Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest. AIM: To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe. DESIGN: Qualitative study using thematic analysis of in-depth interviews and focus groups. SETTING/PARTICIPANTS: A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge). RESULTS: Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care. CONCLUSION: Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.

BACKGROUND:: Ensuring palliative care for all under a new global health policy must include key populations, that is, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, and sex workers. Accessibility and quality of care have not been investigated in lower and middle-income countries where civil rights are the weakest. AIM:: To examine the accessibility to, and experiences of, palliative care for key populations in Zimbabwe. DESIGN:: Qualitative study using thematic analysis of in-depth interviews and focus groups. SETTING/PARTICIPANTS:: A total of 60 key population adults and 12 healthcare providers and representatives of palliative care and key population support organisations were interviewed in four sites (Harare, Bulawayo, Mutare and Masvingo/Beitbridge). RESULTS:: Participants described unmet needs and barriers to accessing even basic elements of palliative care. Discrimination by healthcare providers was common, exacerbated by the politico-legal-economic environment. Two dominant themes emerged: (a) minimal understanding of, and negligible access to, palliative care significantly increased the risk of painful, undignified deaths and (b) discriminatory beliefs and practices from healthcare providers, family members and the community negatively affected those living with life-limiting illness, and their wishes at the end of life. Enacted stigma from healthcare providers was a potent obstacle to quality care. CONCLUSION:: Discrimination from healthcare providers and lack of referrals to palliative care services increase the risk of morbidity, mortality and transmission of infectious diseases. Untreated conditions, exclusion from services, and minimal family and social support create unnecessary suffering. Public health programmes addressing other sexually taboo subjects may provide guidance.