Global action to prevent war: a programme for government and grassroots efforts to stop war, genocide and other forms of deadly conflict

At the end of history's bloodiest century and the outset of a new millennium, we have an opportunity to fulfil one of humanity's oldest dreams: making the world largely free of war. Global changes make this goal achievable. Nuclear weapons have shown the folly of war. For the first time, there is no war and no immediate prospect of war among the main military powers. For the first time, many proven measures to prevent armed conflict, distilled in the crucible of this century's wars, are available. If systematically applied, these measures can sharply decrease the frequency and violence of war, genocide, and other forms of deadly conflict. To seize the opportunity, nations should adopt a comprehensive programme to reduce conventional armaments and armed conflict. This programme will complement and strengthen efforts to eliminate nuclear arms. To assure its ongoing worldwide implementation, the conventional reduction programme should be placed in a treaty framework. We propose a four-phased process, with three treaties, each lasting five to ten years, to lay the groundwork for the fourth treaty, which will establish a permanent international security system. The main objectives of the treaties are to achieve: 1. A verified commitment to provide full transparency on conventional armed forces and military spending, not to increase forces during negotiations on arms reductions, and to increase the resources allocated to multilateral conflict prevention and peacekeeping. 2. Substantial worldwide cuts in national armed forces and military spending and further strengthening of United Nations and regional peacekeeping and peace-enforcement capabilities. 3. A trial of a watershed commitment by participating nations, including the major powers, not to deploy their armed forces beyond national borders except in a multilateral action under UN or regional auspices. 4. A permanent transfer to the UN and regional security organizations of the authority and capability for armed intervention to prevent or end war, accompanied by further substantial cuts in national armed forces and increases in UN and regional forces. This programme offers many valuable features: a global framework for conventional forces that parallels the nuclear Non-Proliferation Treaty; a verified no-increase commitment for national armed forces based on full data exchange; a commitment to undertake prescribed confidence-building measures, including limits on force activities and deployments; a commitment to a specified plan for increased funding of UN and regional peacekeeping capabilities; a commitment to strengthen international legal institutions; and after a trial period, a lasting commitment by each participant not to unilaterally deploy its armed forces beyond its borders, but instead to give the responsibility for peacekeeping and peace enforcement to international institutions. This programme of phased steps to reduce armed forces and strengthen peacekeeping institutions will make war rare. It will foster the spread of zones of peace like those in North America and Western Europe where, after centuries of violence, international and civil war have given way to the peaceful settlement of disputes.     

Right-sizing cardiac CT reimbursement through local and national efforts: A call to action for the imaging community

The proposed 2020 CMS Physician Fee Schedule (MFPS) and Hospital Outpatient Prospective Payment System (OPPS) rules issued a reduction in the technical component (TC) payment that would decrease reimbursement for cardiac CT codes by nearly 29% compared to the 2018 final rule. Cardiac CT codes are currently allocated to ambulatory payment classification (APC) 5571, which is used for level I imaging tests with contrast. However, cardiac CT exams utilize more resources and are very different in clinical scope. Current CMS methodology markedly underestimates the actual cost of performing cardiac CT exams. The low reimbursement is a key factor in slowing the adoption of cardiac CT into clinical practice. Grassroot efforts are needed at all institutions who perform cardiac CT, and at local and national levels, to “right-size” reimbursement for cardiac CT exams. This article will provide an overview of various factors affecting cardiac CT reimbursements and advocacy effort.     

A review on tramadol toxicity: mechanism of action,clinical presentation,and treatment

Forensic Toxicology - As an analgesic that acts upon the central nervous system (CNS), tramadol has gained popularity in treating moderate to severe pain. Recently, it has been increasingly...     

Suicide behaviours in incarcerated males: Links to psychopathic traits,forms of aggression to others,personal characteristics,and current penitentiary variables

Self-injurious behaviours and suicide attempts among incarcerated people are higher when compared with the general population. The current research is designed to examine the prevalence of self-injurious behaviours and suicide attempts among incarcerated males in Spain, and the factors associated with these behaviours. 201 men imprisoned in Spain completed anonymous self-report measures of demographic variables (e.g., age, marital status), the Triarchic Psychopathy Model (boldness, meanness, and disinhibition) and impulsive/premeditated aggression and aggressive behaviour (including physical, verbal, hostility, and anger). Official records were also consulted for information related to criminality (i.e., prior imprisonment and type of offence). Overall, 37.5% of residents reported having injured themselves at a time of anger or despair and 24.9% reported attempting suicide at any point in their lives. Lower scores in meanness, higher scores on impulsive aggression, serious illnesses and previous imprisonment were associated with an increased risk of self-injurious and/or suicide attempting behaviours. Being married acted as a protective factor of attempting suicide. Trait variables related to psychopathy (lower meanness) and aggression (higher impulsive aggression) were associated with increased frequency of suicide attempts in prisoners even after controlling for personal and criminal variables. The prevention of high rates of suicide in prisons needs the treatment of those cognitive variables in addition to more contextual personal and criminal variables.     

Delivery of medical services to different national groups during the war: an example from Bosnia and Herzegovina, 1991-2000

OBJECTIVE: To investigate the delivery of health services to different ethnic groups in the war and postwar periods in the area of Livno, Bosnia and Herzegovina. METHODS: The total population, percentages by nationality, and numbers of persons medically or surgically treated at the War and General Hospital of Livno between January 1991 and October 2000 were retrospectively analyzed. Demographic data from church, military, and local government archives of the Livno region were used. RESULTS: In the prewar period (1991-1995), there had been living approximately 40,000 inhabitants (Croats, 75%; Moslems, 17%; Serbs, 8%) and 685,361 patients were treated (Croats, 46%; Moslems, 33%; Serbs, 21%). In the war period, 1590 patients were treated surgically (Croats, 78.5%; Moslems, 16.8%; Serbs, 4.7%). In the postwar period (1996-2000), surgery was performed for 3217 patients (Croats, 76.8%; Moslems, 19.3%; Serbs, 3.9%). CONCLUSION: The constant numbers of patients of different nationalities treated during and after the war reveal that the medical staff worked in an ethical and highly professional manner.     

Sports-related injuries in children. A study of their characteristics, frequency, and severity, with comparison to other types of accidental injuries

In 1981 to 1982, within a 1 year period, details were recorded of children aged 0 to 15 years and 3 months, who were treated for accidental injury in a French health care district; 789 sports-related accidents were registered, representing 11% of all accidents. Sports areas were the leading sites of accident among children over age 12. Out-of-school sports accidents were more frequent among boys, but boys and girls had similar injury rates in school physical education. Compared to home, school, and road accidents, sports accidents had the highest rate of upper limb injury. The fracture rate was 22% and the hospitalization rate 11%. In most cases children were injured without any participation of other players or sports equipment. Sports-related injuries were usually benign, but several hospital admissions for the same accident were required in 20% of the admitted children (significantly higher than in home, school, and road accidents), and the time elapsed between the accident and the end of the last stay in hospital was significantly greater than in other kinds of accidents. This might be explained by a higher rate of epiphyseal fractures (10%) and internal fixation (17%). Musculoskeletal sequelae were observed in 12% of inpatient children.     

Hearing thresholds for U.S. Marines: comparison of aviation, combat arms, and other personnel

INTRODUCTION: Aviation personnel in the U.S. Marine Corps are exposed to auditory trauma that may produce hearing loss in excess of personnel with other work exposures. METHODS: U.S. Marine Corps personnel in the Navy and Marine Corps Hearing Conservation Database (1995-1999; n = 20,645) were analyzed. The outcome variable was a hearing threshold at 4000 Hz in the left ear greater than 25 dB for annual and periodic audiograms. Personnel were characterized by gender, officer status, 5-yr age groups, and by military occupational skills (MOS) groups of "aviation," "combat arms," and "other." RESULTS: After adjustment by logistic regression for age group, gender, and officer status, the "aviation" group was not different from the "other" category, while the "combat arms" group was more likely to have elevated hearing thresholds. Officers and women demonstrated significantly lower rates for elevated thresholds. DISCUSSION: These findings provide information for personnel planning and assessing military hearing conservation programs.     

A new formulation of Tc-99m minimicroaggregated albumin for marrow imaging: comparison with other colloids, In-111 and Fe-59

The biodistributions of five Tc-99m colloids were compared with the 24-hr distributions of Fe-59 and In-111 in dogs by direct radioassay 1 hr after intravenous injection. One formulation of Tc-99m minmicroaggregated albumin (particle size 30-100 mn), produced the highest marrow concentration, approximately six times that of Tc-99m sulfur colloid, with similar blood, and liver concentrations and a lower splenic uptake. Nevertheless, the best colloid marrow uptake was lower than the 24-hr value for In-11 and much lower than that for Fe-59. The marrow concentration of minimicroaggregated albumin was also higher than that of sulfur colloid in rats at 30 min after injection. The principal disadvantage of Tc-99m antimony sulfide colloid was its slow blood clearance. Clinical evaluation of Tc-99m minimicroaggregated albumin for marrow imaging appears warranted, although its hepatic activity will obscure overlying and immediately adjacent marrow.     

Advanced MRI imaging of nerve roots in lumbar radiculopathy due to discoradicular conflict: DWI,DTI, and T2 mapping with clinical and neurophysiological correlations

Purpose

To evaluate the lumbar nerve root alterations in patients with lumbar disc herniation sciatica using advanced multimodality MRI sequences and the correlations with clinical and neurophysiological findings.

Material and methods

We prospectively evaluated 45 patients suffering from unilateral lumbar radiculopathy due to disco radicular conflict. All patients underwent MRI examinations using a standard MRI protocol and additional advanced MRI sequences (DWI, DTI, and T2 mapping sequences). Relative metrics of ADC, FA, and T2 relaxation times were recorded by placing ROIs at the pre-, foraminal, and post-foraminal level, either at the affected side or the contralateral side, used as control. All patients were also submitted to electromyography testing, recording the spontaneous activity, voluntary activity, F wave amplitude, latency, and motor evoked potentials (MEP) amplitude and latency, both at the level of the tibialis anterior and the gastrocnemius. Clinical features (diseases duration, pain, sensitivity, strength, osteotendinous reflexes) were also recorded.

Results

Among clinical features, we found a positive correlation of pain intensity with ADC values of the lumbar nerve roots. The presence of spontaneous activity was correlated with lower ADC values of the affected lumbar nerve root. F wave and MEP latency were correlated with decreased FA values at the foraminal level and increased values at the post-foraminal level. The same neurophysiological measures correlated positively with pre-foraminal T2 mapping values and negatively with post-foraminal T2 mapping values. Increased T2 mapping values at the foraminal level were correlated with disease duration.

Conclusions

Evaluation of lumbar nerve roots using advanced MRI sequences may provide useful clinical information in patients with lumbar radiculopathy, potentially indicating active inflammation/myelinic damage (DTI, T2 mapping) and axonal damage/chronicity (DWI).

     

The development of bacteriology, sanitation science and allied research in the British Army 1850-1918: equipping the RAMC for war

The recent 90 year anniversary of the end of the First World War is an opportune time to reconsider the important role of the Royal Army Medical Corps in this conflict. One area which has been neglected is the role of the Royal Army Medical Corps in responding to infectious diseases and to understand this properly it is important to consider the development of bacteriology, sanitation science and allied research in the British Army up to the Great War. The context of the home front is also central, with the British population from 1880-1914 increasingly benefiting from improved public sanitation and the new science of bacteriology. Historians acknowledge that the British campaign in the Crimea in the 1850s was pursued with inadequate medical provision and as a result, the Army suffered severely from infectious diseases. Limited changes were introduced after the Crimean War, such as the establishment of the Army Medical School, with its high quality instruction in military hygiene and later bacteriology. Army medics also led the way in various branches of scientific research, through research in the colonies. As compared with the continental powers, however, the application of bacteriology and sanitation to field craft in the British Army was delayed. It took the experiences of the South African and Russo-Japanese Wars for the importance of these sciences to be recognised by the Army as a whole. These subjects began to form part of the education of army Medical Officers, but training was basic and few trainees had specialised in bacteriology by 1914. In spite of these limitations, the Royal Army Medical Corps responded well to the demands placed upon it by World War One, recruiting civilian bacteriologists to its ranks, developing technological innovations such as mobile bacteriological laboratories for them to work in, forming a sanitation service and fostering medical research.     

Speaking-up for patient safety: A scoping narrative review of international literature and lessons for radiography in Ghana and other resource-constrained settings

ObjectivesEmployees ‘speaking-up’, or raising concerns about unsafe practices, has gained traction across healthcare, however, the topic has not been widely discussed within radiography generally or within resource-constrained healthcare settings. A systematic scoping narrative review identified the experiences of radiographers in speaking-up about safety concerns, which was extended to healthcare professionals more broadly. The scope of the review was further extended to cover speaking-up in non-healthcare resource-constrained settings in Africa.Key findingsSixty-three studies were included in the review. The majority originated from westernised and/or higher resource health systems, with a dearth of literature from Africa and other resource-constrained settings. Several studies identified barriers and enablers confronting healthcare workers wishing to speak-up. While ‘speaking-up’ as a concept has gained international interest, most studies are, however, focussed on nursing and medical practice contexts, overlooking other healthcare professions, including radiography. The findings are synthesised into a series of key lessons for healthcare and radiography practitioners in Ghana and other resource-constrained settings.ConclusionThe topic has been largely overlooked by policy makers, both within healthcare generally and specifically within radiography in Ghana. This is particularly concerning given the many complexities and risks inherent to radiography. A radiography and a healthcare workforce lacking in voice is poorly positioned to improve workers' safety and patient safety. More generally, promoting speaking up could enhance Ghana's ambitions to deliver a high-quality health care system and Universal Health Coverage (UHC) in the future.Implications for practiceNational and regional policy makers need to implement speaking-up processes and procedures reflecting the lessons of the literature review, such as ensuring no detriment as result of speaking-up and making staff feel that their concerns are not futile. Speaking-up processes should be implemented by individual organisations, alongside staff training and monitoring.     

Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel,inhuman or degrading treatment or punishment

In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.     

FDSTools: A software package for analysis of massively parallel sequencing data with the ability to recognise and correct STR stutter and other PCR or sequencing noise

Massively parallel sequencing (MPS) is on the advent of a broad scale application in forensic research and casework. The improved capabilities to analyse evidentiary traces representing unbalanced mixtures is often mentioned as one of the major advantages of this technique. However, most of the available software packages that analyse forensic short tandem repeat (STR) sequencing data are not well suited for high throughput analysis of such mixed traces. The largest challenge is the presence of stutter artefacts in STR amplifications, which are not readily discerned from minor contributions. FDSTools is an open-source software solution developed for this purpose. The level of stutter formation is influenced by various aspects of the sequence, such as the length of the longest uninterrupted stretch occurring in an STR. When MPS is used, STRs are evaluated as sequence variants that each have particular stutter characteristics which can be precisely determined. FDSTools uses a database of reference samples to determine stutter and other systemic PCR or sequencing artefacts for each individual allele. In addition, stutter models are created for each repeating element in order to predict stutter artefacts for alleles that are not included in the reference set. This information is subsequently used to recognise and compensate for the noise in a sequence profile. The result is a better representation of the true composition of a sample. Using Promega Powerseq™ Auto System data from 450 reference samples and 31 two-person mixtures, we show that the FDSTools correction module decreases stutter ratios above 20% to below 3%. Consequently, much lower levels of contributions in the mixed traces are detected. FDSTools contains modules to visualise the data in an interactive format allowing users to filter data with their own preferred thresholds.     

Ultrasonographically defined parenchymal patterns of the breast: relationship to mammographic patterns and other risk factors for breast cancer

We have used ultrasound of the breast to define four parenchymal patterns in which increasing proportions of the breast are replaced by densely echogenic tissue. A series of 452 symptomatic women examined by both ultrasound and conventional X-ray mammography was reviewed to determine whether these ultrasonographic images could predict the breast parenchymal pattern defined mammographically. A very strong correlation was demonstrated between the breast pattern on ultrasound and the volume of the breast replaced by either dysplasia (Kendall's tau-b = 0.731 +/- 0.026, p less than 0.0001) or ductal prominence (Kendall's tau-b = 0.641 +/- 0.049, p less than 0.0001). This was seen both on initial reporting and on a blind re-reading of a random sample of 100 cases. The strength of correlation was similar for subgroups defined by family history of breast cancer, age, menopausal status, and history of benign breast disease, and the breast parenchymal pattern assessed by mammography or ultrasound showed similar associations with these variables. Ultrasonographic parenchymal patterns of the breast can predict the tissue patterns defined mammographically and may therefore be useful as a marker of breast cancer risk.