Reflections on Studying Huang Di Nei Jing in the West.

Huang Di Nei Jing (《》The Yellow Emperor's Inner Classic) has been the source text of Chinese medicine knowledge and innovation for over two thousand years. Despite this key relevance, many of its ideas and practices have proven difficult to understand and implement fully into clinical practice. Cultural and language differences can be compounded with these challenges but may also present new opportunities for advancement and insight when studied by researchers outside of the originating culture. This article introduces the method of Classical-Text Archaeology and delves into the author's two-decade journey of researching this text, with a discussion on cultural differences and issues of medical scholarship.

Three-dimensional reconstruction of King Henri IV's paranasal sinuses and mastoid cells.

PURPOSE: The preserved head of King Henri IV of France (life 1553-1610, reign 1589-1610) has survived to the present day thanks to high-quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three-dimensional segmentation method. METHODS: The paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross-referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT-scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK-SNAP 4.0 software (open-source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA). RESULTS: Paranasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air-cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found. CONCLUSIONS: An innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.

Structural competency in global perspective.

This special issue aims to help fill two critical gaps in the growing literature as well as in practice. First, to bring together scholars and practitioners from around the world who develop, practice, review, and question structural competency with the aim of promoting a dialogue with related approaches, such as Latin American Social Medicine, Collective Health, and others, which have been key in diverse geographical and social settings. Second, to contribute to expanding structural competency beyond clinical medicine to include other health-related areas such as social work, global health, public health practice, epidemiological research, health policy, community organisation and beyond. This conceptual expansion is currently taking place in structural competency, and we hope that this volume will help to raise awareness and reinforce what is already happening. In sum, this collection of articles puts structural competency more rigorously and actively in conversation with different geographic, political, social, and professional contexts worldwide. We hope this conversation sparks further development in scholarly, political and community movements for social and health justice.

Determination of the radioanatomical factors related to the position of facial nerve in accessing jugular foramen and carotid artery in temporal bone.

Introduction: Preservation of the facial nerve is of great importance in temporal bone surgeries. We intend to investigate the measurements of the radioanatomical factors related to the position of the facial nerve in accessing jugular foramen and internal carotid artery (ICA) in temporal bone of patients who were candidates for temporal high resolution computed tomography (HRCT) scan. Methods: In this correlation cross-sectional study, samples were selected from patients referred to Amir Alam Hospital who were previously candidates for temporal HRCT. Radioanatomic factors were evaluated in three axial, coronal and sagittal views. Analyzes were performed using descriptive statistics, correlation analysis and factor analysis. Results: A total of 173 samples were investigated. The most reliable radioanatomical factor based on coefficient of variation (CV) was the distance of the 7th nerve to the temporomandibular joint (TMJ) in the inferior to the cochlea in the sagittal view (variable name S2) (CV = 8.1%) and then the distance from the 7th nerve to the TMJ in the inferior section of the cochlea in the axial view (variable name AI3) (CV = 8.4%). Based on correlation analysis and then confirmatory factor analysis, three common latent factors were identified (overall R2 = 0.999). Conclusion: The results of this study can be used for two purposes. First, the direct use of the estimated measures in surgical operations, and the second is more advanced modeling to choose the approach in the surgical operation and how to implement that approach. For the first aim, the two factors AI3 and S2 were the most reliable radioanatomical factors in different people. For the second aim, the three-dimensional understanding of the obtained measurements and the further identification of the anatomical nature of the latent factors can help in choosing the approach in surgery.

Medical clowning in hospitals: practices, training and perception.

Previous studies on medical clowning focused on patients, while research remains inadequate concerning clowning itself: training programmes and prerequisite requirements, clowning methods, deontology and accepted practices. Diverse approaches and paradigms in this field of complementary medicine are promoted by non-profit organisations worldwide. Based on an ethnographic study, we explore the current forms of medical clowning in 5 Israeli hospitals. The observed clowns are from the two Israeli organisations, Dream Doctors and Simchat Halev (in Hebrew: joy of the heart), consisting of paid professional medical clowns and volunteers, respectively. According to the findings, significant differences were observed to exist between the organisations. Dream Doctors is conceived and pursued as an expertise practised by performance art professionals, requiring extensive training. These clowns work unaccompanied, receive a salary, are considered members of the medical team, and, given their privileged status, have access to hospitals' open and closed areas. The Dream Doctors consider medical clowning as a paramedical practice, in which interventions are individually suited to the circumstances of each patient, and obtain therapeutic results. In contrast, Simchat Halev's medical clowns are volunteers with no prerequisite artistic background and undergo shorter periods of training. The access granted to these clowns, usually working in pairs, is restricted to open areas. Simchat Halev promotes medical clowning as a volunteer-based public practice, offering general entertainment to all patients indiscriminately, and their contribution is characterised as achieving basic entertainment value.

Counter-Stories in the way of caste: towards an anti-casteist public health praxis in contemporary India.

How can ethnographic methods track implicit & explicit forms of structural casteism in Indian public health policy and praxis? How can a critical attention to ordinary stories and subjectivities of casted lives reveal the underlying Brahmanical moralities, assumptions and imaginations of public health but equally also unravel anti-caste counter-framings/counter-theorizations of symptoms, afflictions, injuries and chronic wounds wrought by caste? How, in other words, can the horizons of anti-colonial theory-making be expanded to capaciously conceptualize casteism as a core determinant of community health outcomes and life-chances in India? By mobilizing 'counter-storytelling' as a concept and method for critical medical anthropology from the Global South, and case studies from longitudinal ethnography in northern India, this paper provides a dual critique of: 1. Public health praxis in relation to questions of caste, addiction, respiratory debilitation, air pollution and TB. And, 2. Epistemologies of health policy making pertaining to wellness for 'the poor' and the gendered and casted labour of community care workers like ASHAs and non-institutionalized health actors.

Body integrity dysphoria and moral responsibility: an interpretation of the scepticism regarding on-demand amputations.

A patient who requests an amputation deemed medically unnecessary by professionals is disqualified per se from being regarded as having medical decision-making capacity. This decision is based on the assumption that there is an option to pursue something other than amputation; such an assumption in many cases overflows into therapeutic obstinacy. This is the case for individuals who have ill or damaged body parts and who wish to avoid recurrent and painful medical treatment designed to save the limb, as well as for individuals affected by body integrity dysphoria (BID). BID is a condition that is recognised by the WHO and is included in the International Classification of Diseases, 11th edition. Individuals who are affected develop an intense feeling of overcompleteness of their body configuration, which leads to the development of a strong sense of dysphoria and consequently the desire to amputate in order to remove the source of such discomfort. In the few cases in which amputation has been carried out, the results have proved successful; the individual's quality of life has improved and they have had no new amputation desires. No medical therapy, including medical amputation, is available currently for individuals affected by the condition. This situation leads many with BID to mutilate themselves. Such events create a challenging ethical dilemma for the medical world.The present paper is focused on the capacity of the individual with BID to do other than request amputation and the implications that this carries regarding moral responsibility. It is proposed that the autonomy of the patient cannot be disqualified by default based on the amputation request, despite its oddity, and that any scepticism demonstrated by the physicians is based on a false preconception of ill will or ignorance, which results in a blaming attitude towards the requesting person.

Contention and collaboration: the tenuous encounter of modern Ayurveda and Western medicine in the twentieth and twenty-first centuries.

Complementary medicine systems are ascending to rapid popularity as the twenty-first century progresses. Often adapted from ancient systems of healing such as Ayurveda, these modern alternative medical movements reappraise millennia-old health traditions that found their inception at the confluence of religious philosophy and herbal healing. Naturally, contemporary global economic forces and a desire to market traditional medicine products in an enticing fashion have characterised how historic traditional medicine systems are presented in the modern context. By establishing a vision of complementary medicine born from ancient traditions, it becomes clear how traditional methods of healing can contend with Western biomedicine-the prevailing standard of care around the globe. The claims made by both sides parry along a line of scientific validity, efficacy and regulatory purview. India, the birthplace of Ayurveda and an epicentre of contemporary medical education, is a prime arena to study the friction between biomedicine and traditional medicine. In this piece, I focus on the modernisation of Ayurveda and how it has found conflict with allopathic medicine. I posit that Ayurveda has re-emerged since the early twentieth century as a key tenet of Indian modernity: and in doing so has found contention with Western medicine. I furthermore argue that despite existing discord, the two medical traditions are not inherently antithetical. They can be synergistic, so long as healthcare delivery and education recognise the limits of each and focus on coaction rather than contradiction.

Globalizing transit worker stress.

Health scientists have claimed that urban transit workers suffer from higher rates of stress-related disease than workers in most other occupations. This paper examines how a network of scientists and labor organizers constructed the problem of transit worker stress as a global phenomenon. According to study participants, transit workers worldwide are subject to a similar set of stress-related risks, which can serve as a basis for worker solidarity. This paper analyzes how the concept of stress has been used to identify pathogenic environments and considers anthropological claims that the concept often abstracts and depoliticizes harmful arrangements. The findings show that scientists and labor organizers use the stress concept to construct a figure of a universally at-risk transit worker that serves the ends of transnational labor organizing. At the same time, by focusing on the case of San Francisco's transit workers, this analysis shows that a persistent association between stress and 'hard work'-in both lay and scientific discourses-may block recognition of stress-related harms for transit workers who are accused of being lazy and overpaid.

"Somewhere Between an Actual Disease and a Disease": A Grounded Theory Study on Diagnosing Functional Neurological Disorders From a Multi-Informant Perspective.

Functional Neurological Disorders are characterized by sensory-motor or cognitive symptoms. Recent research has revealed their complex nature involving biological, psychological, and social factors. Care requires a multidisciplinary approach, which, to date, has yet to be considered. A Constructivist Grounded Theory study was conducted to understand the reasons behind this, exploring Functional Neurological Disorders diagnosis, communication, and understanding from multiple perspectives (patients and healthcare professionals). The core category was "negotiating Functional Neurological Disorders meanings and care amid a dissatisfying dichotomy," with sub-categories: i) seeking to "word" the disease, ii) exposing reductionism, and iii) a pluralist vision emerging. Diagnosing and communicating Functional Neurological Disorders is a process of negotiating meanings and care that hinges on participants' diverse ontological perspectives regarding the condition. Results highlight the difficulty in finding common ground and achieving mutual understanding among the various viewpoints, creating a challenge in establishing a unified approach to Functional Neurological Disorders care. In this context, only a few healthcare professionals emphasized the potential benefits of increased integration. A shift is required from a reductionist to an integrated biopsychosocial perspective to develop a more cohesive approach. Defining a medical paradigm through dialogue with teams and patients is essential in addressing Functional Neurological Disorders effectively. Furthermore, the required interdisciplinary approach holds the potential to mitigate the dissatisfaction arising from fragmented and compartmentalized care (the "dissatisfying dichotomy") experienced by our participants. It signifies a comprehensive strategy that could address the concerns of all involved parties and enhance the overall quality of care provided.

[On specialized oversights: biomedicine as an intrinsic part of life for indigenous peoples]. / De omisiones especializadas: la biomedicina como parte intrínseca de la vida de los pueblos originarios.

The vast majority of studies on traditional medicine disregard the existence of biomedicine and alternative and complementary medicines in the lives of the indigenous peoples of Mexico and Latin America in general, despite the fact that these populations increasingly make use of biomedical knowledge more and more intensively. In this text I have attempted to elucidate this expansion of biomedicine and the decline of traditional medicine, through ethnographic information related to different indigenous groups. This expansion of biomedicine takes place despite the various negative consequences it generates due to different factors such as its comparative effectiveness, which is evidenced in the use of and demand for pharmaceuticals, biomedical services, and in particular the construction of hospitals in their communities. The indigenous population combines the uses of traditional medicine and biomedicine with a tendency to increasingly utilize biomedicine, even on the part of traditional healers.

La gran mayoría de los estudios de la medicina tradicional excluyen la existencia de la biomedicina y de las medicinas alternativas y complementarias en la vida de los pueblos indígenas de México y de Latinoamérica en general, pese a que estos pueblos utilizan la biomedicina en forma creciente e intensa. En este texto, he tratado de poner de manifiesto este proceso de expansión biomédica y de declive de la medicina tradicional, a través de información etnográfica referida a distintos pueblos originarios. Esta expansión biomédica se desarrolla a pesar de las varias consecuencias negativas que genera, debido a diversos factores, entre ellos, su eficacia comparativa, que se expresa a través de los usos y la demanda de fármacos, de los servicios biomédicos y, en particular, de la instalación de hospitales en sus comunidades. La población indígena articula los usos de la medicina tradicional y de la biomedicina con la tendencia a utilizar cada vez más la biomedicina, incluso por parte de los curadores tradicionales.

Cultural Pragmatism: In search of alternative thinking about cultural competence in mental health.

Researchers have tended to approach cultural competence through two primary models: acquisition of culturally tailored skills and orientation to cultural process. While each model plays an important, complementary role in cultural competence, both can be limited in conceptualizing and responding to cultural understandings of distress. This article draws on research in multicultural psychology, medical anthropology, and pragmatic philosophy, to introduce cultural pragmatism, a novel orientation to cultural competence that reconceptualizes what it means to hold something to be true in the mental health fields. This article first draws on research in multicultural psychology and anthropology to identify an important limitation regarding how truth is understood in contemporary cultural competence models and how this limitation can impact culturally competent care. Following this, the article considers philosophical pragmatism as an alternative, and introduces a model for practicing cultural pragmatism in clinical settings. As a whole, this article makes two interrelated arguments: first, that a better articulated theory of truth is needed to achieve the goals of cultural competence and, second, that cultural pragmatism can help resolve the limitation that cultural competence approaches currently exhibit.

Social construction of risk and prevention practices related to Aedes mosquito-borne disease in an endemic municipality in Colombia.

INTRODUCTION: This article analyzes risk discourses around dengue, zika and chikungunya constructed by lay people, community leaders and disease control experts from the fields of medical anthropology, medical sociology, and public health. METHODS: A qualitative ethnographic study was conducted in a municipality in Colombia (December 2016 and January 2018) with semistructured and open-ended interviews, informal dialogues, and fieldwork journal observations. RESULTS: This study found a mismatch in risk discourse about vector-borne diseases among health officials, lay people, and community leaders. These discourses are linked to the sociocultural contexts in which people live, and offer particular ways of giving meaning and acting in the face of disease prevention. CONCLUSION: The findings show a multisituated risk that refers to the inside and outside of homes; and the prevention practices mentioned by different actors, in which a continuity of tensions between lay people, leaders and government officials can be observed.

An Individual's Lived Experiences of Taking Cannabis-Based Medicinal Products (CBMPs) to Treat Anxiety.

This report documents the case of a patient (the author) participating in a clinical trial of medical cannabis (Cannabis sativa L.)-the Sapphire Access Scheme, run by the Sapphire Medical Clinic as part of the UK Medical Cannabis Registry-to explore the impacts of cannabis-based medicinal products (CBMPs) on anxiety. For most of my life, I have experienced often very serious bouts of poor mental health arising, in part, from childhood abuse, and have been diagnosed with several mental health conditions which constitute disabilities. I have received various conventional treatments and multiple alternative therapies. However, none of these have enabled me to consistently manage my conditions long-term, and I often suffer relapses. As part of the Sapphire Access Scheme, I complete regular quantitative questionnaires regarding the impacts of the CBMPs on my anxiety and have also obtained the clinic's permission to qualitatively document and write up the impacts of CBMPs on my mental health. Here, I present a preliminary autoethnographic exploration of my lived experiences of CBMP use over the first four months of the trial, which show that even within such a short space of time, CBMPs have had a positive impact on treating what had previously been treatment-refractive chronic anxiety.

Social health: rethinking the concept through social practice theory and feminist care ethics.

The social sciences have long shown that health is not born of pure biology, empirically (re)centred the social and material causes of disease, and affirmed the subjective experiences of disease. Disputed both in popular and academic discourses, social health has variously attempted to stress the social aspects of health. Existing conceptions remain analytically limited as they are predominantly used as descriptors for populational health. This article theorises social health as an analytical lens for making sense of the relations, affects and events where health unfolds and comes into expression. Drawing on social practice theory, feminist care ethics and posthumanism this conceptual paper re-imagines how social health might be conceived as lived social practices anchored in care. Care within our framework acknowledges the unavoidable interdependency foundational to the existence of beings and stresses the 'know how' and embodied practices of care in the mundane in order to emphasise that care itself is absolutely integral to the maintenance of social health. The article argues that health needs to be understood as a verb intrinsically (re)made in and through social contexts and structures and comprised of meaningful, human-human and human-non-human interactions. Ultimately, in theorising social health through mundane care practices, we hope to open up research to making sense of how the doing of health unfolds inside often banal, patterned forms of social activity. Such taken-for-granted social practices exemplify the often overlooked lived realities that comprise our health. To understand health in its own right, we argue, these everyday practices need to be interrogated.

An anthropologist's voice in a veterinarian's noise: gearing up for new cultural realities.

Over the past three decades, the veterinary profession has faced a cultural shift towards postspeciesism that requires a reassessment of the foundations of the existing distinctions between human and non-human animals proclaimed by the speciesism paradigm, which represents institutionalized discrimination against species and recognizes only the subjectivity of humans. Based on ethnographic observations in anthropological fieldwork and using speciesism/postspeciesism distinction, we aimed to explain the main causes of small animal practitioners' work-related stress and apply humanistic knowledge to recommend ways to alleviate the negative effects of the work environment. The explanatory model of disease, illness, and sickness, the example of the concept of family, and the circumstances of the feminization of the veterinary profession are discussed to illustrate the divergence between speciesist naturalistic veterinary knowledge and the postspeciesist cultural framework and its consequences. By failing to accommodate the changing values towards animals and by failing to challenge the anthropocentric hierarchy of values, the speciesist rationale of the veterinary profession contributes to many of the problems faced by practicing veterinarians. The incorporation of a modern moral-philosophical mindset towards animals may not even be possible because veterinary science is subject to a paradigm that is irreversibly tied to institutional discrimination against species and defies reflection on veterinary science itself. However, the veterinary profession has a privileged position in establishing an alternative ontological thinking and an alternative conception of "animal life." Anthropological knowledge was applied to anticipate further intervention of social and cultural sciences in the problems of small animal practitioners. Rather than further diversifying and increasing expectations towards veterinarians by expecting them to acquire additional skills, we propose another practitioner who can support, mediate, and enhance veterinary performance - the cultural anthropologist. With their deep knowledge of cultural differences and social dynamics, they can collaborate with veterinarians to act as a liaison between cultures, paradigms, and species.

The pandemic body: the lived body during the COVID-19 pandemic.

In this study, we conduct a detailed analysis of qualitative survey data focusing on adult populations in the UK, Japan and Mexico to address the following question: How has the COVID-19 pandemic changed people's lived experience of their bodies, other people's bodies and the world? We identify five themes: (i) fear and danger, (ii) bodily doubt and hypervigilance, (iii) risk and trust, (iv) adapting and enduring and (v) changes in perspective. We use two theoretical frameworks: first, Mary Douglas' anthropological work on purity, risk, danger and symbolism is applied to understand how social and cultural meanings attached to the body have changed during the pandemic. Second, we use the concept of bodily doubt developed by Havi Carel to interpret how people experience their bodies and other people's bodies differently during the pandemic. While we recognise the significant variation in people's embodied experience of the pandemic, our findings suggest there are commonalities that span different countries and cultures. Specifically, we look at responses to COVID-19 protective countermeasures such as national lockdowns and physical distancing which we suggest have reduced people's ability to put faith in their own bodies, trust other people and trust the political leadership. We conclude by proposing that the changes to our lived experience during the COVID-19 pandemic have prompted changes in perspective and a renewed focus on what people consider important in life from a social, moral, cultural and political point of view.

Clinician-associated traumatization from difficult medical encounters: Results from a qualitative interview study on the Ehlers-Danlos Syndromes.

Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse - but preventable - health outcomes.

"It is difficult for us to treat their pain". Health professionals' perceptions of Somali pastoralists in the context of pain management: a conceptual model.

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals' perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals' perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. 'Patient-professional relationship' was the core category we identified within the conceptual model. This category was closely linked with issues of '(mis)trust' and 'communication (barriers)'. 'Patient-related conditions' (eg, (under)-reporting of pain, care preferences and beliefs) and 'health professional-related' conditions' (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.

Does medical humanities matter? The challenge of COVID-19.

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.