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Supply chain disintegration is considered, due to its importance as an enabler for the management of technology innovation. This research is urgent as it is relevant to a wide range of other occurrences outside of technology innovation management, including: major policy or regulatory changes, industrial actions, economic sanctions, trade wars, trade realignment – such as Brexit, natural disasters, civil disorder and conflict, and financial crises. Disintegration is the re-alignment of partners and coordination within a supply chain to enhance customer value. This process is driven by one of more of the following: introduction of new technology or input, elimination of existing technology or input, change in customer requirements, and/or change in other external factors. The interdisciplinary nature and intellectual foundations of disintegration are considered. Finally, areas of research need are offered.

ResumenObjetivosLa investigación epidemiológica de la violencia colectiva (con fines políticos, sociales o económicos) es muy incipiente a pesar de su creciente reconocimiento como un problema de salud pública. Este artículo describe el modelo conceptual y el diseño de una de las primeras investigaciones realizadas en España para medir el Impacto en la SAlud de la VIolencia Colectiva (estudio ISAVIC).MétodosA partir de una amplia revisión no sistemática de la literatura se describe el alcance global de dicho impacto y se propone un marco teórico que describe la relación. La revisión identifica las posibles consecuencias de la violencia colectiva en las dimensiones física, emocional y social de la salud. El modelo sirve de base para establecer el diseño del estudio y sus instrumentos de medida.ResultadosSe describe el conjunto de posibles secuelas producidas por la violencia colectiva y se propone un marco relacional y temporal. El modelo considera el efecto en víctimas primarias y secundarias, y su relación con el medio social. Se diseña un estudio empírico con una metodología mixta para estimar la magnitud y la naturaleza de la posible afectación de la salud por la violencia colectiva.ConclusionesEl estudio ISAVIC señala la coherencia del modelo diseñado, apoyando que la violencia colectiva puede afectar a las principales dimensiones de la salud en relación con el marco social donde opera. Es necesario validar estos resultados con nuevos estudios.AbstractObjectivesEpidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major public health issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims (study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva).Methods: Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments.ResultsThe possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims, as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described.ConclusionsThe ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies.

Terrorism is the war of the future for the human race. It takes many forms, but in essence the common denominator is the calculated use of violence or the threat of violence to attain political, religious, or ideologic goals. This is done through intimidation, coercion, or instilling fear. It achieves chaos and mass hysteria and the occasional overwhelming of medical care systems and other municipal public services. This battlefield is no longer remote, and the arrival of large numbers of casualties presents a unique challenge to medical facilities used to dealing with only one or two simultaneous trauma patients. In addition, in the past decade, the anxiety over the use of unconventional weapons of mass destruction by terrorist groups has increased. In most instances, the initial response and management of the terrorist event are provided by the local civilian law enforcement and medical agencies, but, depending on the scale of the event, military units are usually involved, not to mention that military personnel, installations, and barracks are sometimes the target of terrorist acts. 11,35 In theory, terrorism can be achieved by various means. The mere threat of using some vector of mass destruction can cause chaos and civilian unrest, even without actually performing the act (psychological terror). Longstanding threats can sometimes "bend" authorities and societies, thus reaching the goal of the party exercising the threat. The use of agents on property and human beings can be in the form of conventional munitions and explosives, chemical agents, toxic agents, biologic vectors, or nuclear threat. This latter problem has been the focus of several cover stories in the lay press in the past few years since the downsizing of the Soviet Union into many independent states, each capable of harboring these nuclear agents. With the exception of the chemical incidents in Matsumoto 36 and the Tokyo subway 27,28 in Japan, most terrorist attacks in the latter part of the twentieth century have used conventional weapons. Thousands of conventional traumatic injuries to the body and hundreds of fatalities have resulted. In the past, terrorists were assumed to seldom push their demands to the extent that they may lose their own lives. The experience in Beirut 7,10,35 and the numerous suicide explosions in Israel 22 involving fundamentalist groups have proved this notion to be obsolete. This article presents the various aspects of medical care in these events.

The objective of this paper is to provide an overview of the effects of war on children during the 20th century. It is argued that wars have both direct and indirect effects on the population. It also is noted that wars have changed from being "conventional" to being of "low intensity". Under these latter circumstances civilians, including children, as well as the infrastructure of the society become targets whereas in the past, the targets were usually only military ones. The effects of the strategy used in "low intensity" conflicts is the disruption of the medical, social, educational, and public services of a country and the terrorization of the population. Under these circumstances children suffer inordinately. Their homes are destroyed, their families disrupted, and their chances of becoming mature productive members of society are compromised.

For a paediatrician in training a period of work in a developing country can be immensely rewarding. Living in a different culture, dealing with a new spectrum of clinical cases, and working with extremely limited resources, will provide problems, challenges and opportunities. The experience can be careerenhancing, and provide personal development as well as new skills as a clinician and a manager. But working overseas is not for everyone. In the daydreams of a tired SHO after a hard weekend, a developing country may seem a romantic, tropical paradise full of exotic tribal people in need of rescue by a heroic young British doctor. The reality is quite different. Poverty goes hand-in-hand with pollution, urban blight, bureaucracy, inertia and civil disorder. If you plan to go overseas, the process of finding a suitable placement is arduous, often frustrating and not always successful. If you make the journey with unrealistic expectations, you will quickly become disillusioned or depressed. A period of work overseas does not mean you can change the worldl You might, at besL make a small but useful contribution.

The uprising of the Palestinian population (Intifada) against the Israeli occupation of the Gaza Strip and the West Bank, which erupted in December 1987, has resulted in the deaths of hundreds of Israeli citizens and Palestinian residents. The data on dead victims, as reported by two civil rights organizations of opposite political orientation and by the official military authority, are analyzed and compared with the information obtained from post-mortem examinations of some 65% of the victims carried out over the period 1987 to 1992. The agencies' reports were found to differ, sometimes markedly, from the official autopsy data in respect of number of deaths, their cause and manner. The study indicates a generally downward trend in the number of Palestinians killed by the Israeli Defence Forces, which could be the result of the wider use of rubber and plastic bullets, and a steady continuous increase in Israeli victims killed by the Palestinians, possibly accounted for by a shift from the use of "cold weapons" in favour of firearms, and an escalation in violence. It is suggested that the post-mortem examination should be an essential tool for the detection and documentation of possible abuse and bodily harm.

Law enforcement agencies are recognizing the need to have emergency medical care available at the scene of any incident involving tactical operations. The potentially volatile and dangerous atmosphere surrounding tactical operations is conducive to severe injury to officers, hostages, suspects, and bystanders. This mandates the immediate availability of basic and advanced life support services. However, a purely traditional approach to emergency medical services in the tactical environment may not be feasible and may expose prehospital personnel to greater danger. It also may disrupt the law enforcement mission. These factors mandate a different set of field assessment and treatment priorities. To meet these needs, selected prehospital personnel and emergency physicians train to work with and support special weapons and tactics teams.

Protests began in early February after Venezuela’s hard-line opposition leader Leopoldo Lopez called on supporters to take to the streets against the government of President Nicolas Maduro. Some protests have been peaceful, demanding that the government resolve high crime, goods shortages, and a 56% annual infl ation rate in the oil rich nation of almost 30 million people. Meanwhile, a radical wing within the opposition has commenced a strategy of riots and burning street barricades to try to force the government’s outright resignation. With the government coalition winning 54% of the popular vote nationwide in local elections only 3 months ago, there seems little indication of a resignation occurring. At least 22 people have been killed and more than 300 have been wounded in the unrest. Those killed include opposition activists, government supporters, other civilians, and two National Guard officers. Although many parts of the country remain calm, in some cities street barricades have been constructed in the middle or upper-class zones, which form the opposition’s base of support. Venezuela’s health minister, Francisco Armada, said recently that the unrest had “signifi cantly” aff ected health services. Health authorities warn that the barricades and those manning them are creating an adverse physical, environmental, and psychological eff ect on public health. The Department of Health says that the burning tyres and rubbish on the barricades produce dangerous levels of toxic substances, and that the forced closure of road access to communities provokes a range of negative psychological emotions for residents trapped inside. Outside of the capital Caracas’ east side, the areas most aff ected by the barricades are the main cities of the Andean region in the west. In Merida, a student town with a population of 300 000, one of the city’s three hospitals has been entirely blocked off by the barricades. In a visit to the hospital, a nurse explained to The Lancet that patients had to be hauled over knee-length barbed wire to reach the entrance. Staff and patients seemed to be using the quiet morning period to leave and enter while barricaders slept.

Many police patrol officers in Newark, New Jersey, articulate a working image of violence in the city that is similar to Louis Wirth's classical model of the effects of urban social disorganization on deviant behavior. In Newark, however, the working theory posits the 1967 civil disorders as a cataclysmic disorganizing event that generated ominously unique patterns of violence in the post-disorder years, compared to earlier times. Using data on violent crimes reported to the Newark police between 1940 and 1980, this article attempts to test the adequacy of that working theory as an explanation of reality. Regression techniques similar to those used by Friesma (1979) to assess natural disaster impacts are applied to three transformations of these crime data. The analysis demonstrates that the police working version of the disorganization model is more accurate as an inference from the pattern of violence that characterizes their workload than it is one from the patterns of absolute incidence of violent crime or of the risk of violent victimization incurred by residents of Newark. The article closes with a discussion of the implications of these findings for the larger problem of police-citizen distance.