Implementing Istanbul Protocol standards for forensic evidence of torture in Kyrgyzstan

The Kyrgyz government declared a policy of “zero tolerance” for torture and began reforms to stop such practice, a regular occurrence in the country's daily life. This study presents the results of 10 forensic evaluations of individuals alleging torture; they represent 35% of all criminal investigations into torture for the January 2011–July 2012 period. All individuals evaluated were male with an average age of 34 years. Police officers were implicated as perpetrators in all cases. All individuals reported being subjected to threats and blunt force trauma from punches, kicks, and blows with objects such as police batons. The most common conditions documented during the evaluations were traumatic brain injury and chronic seizures. Psychological sequelae included post-traumatic stress disorder and major depressive disorder, which was diagnosed in seven individuals. In all cases, the physical and psychological evidence was highly consistent with individual allegations of abuse. These forensic evaluations, which represent the first ever to be conducted in Kyrgyzstan in accordance with Istanbul Protocol standards, provide critical insight into torture practices in the country. The evaluations indicate a pattern of brutal torture practices and inadequate governmental and nongovernmental forensic evaluations.     

运用VBM方法检测创伤后应激障碍患者发病前脑灰质容积的改变

目的运用基于体素的形态学方法(voxel based morphometry,VBM)分析创伤后应激障碍(posttraumaticstress disorder,PTSD)患者是否于发病前即存在脑灰质容积的改变。方法 PTSD危险人群于创伤暴露后2天内行3 T MRI全脑扫描。搜集12例最终确诊的PTSD患者及12例年龄、性别及创伤暴露与之相匹配的对照组的脑结构图像,运用基于SPM5的VBM5进行数据分析,采用双样本t检验,以P<0.001(未校正)、核团体素>35视为差异有统计学意义。结果与对照组相比,PTSD组右侧杏仁核、海马旁回、前扣带回、额上回、颞中回、颞下回,楔前叶、左侧额下回、颞上回、岛叶、中央前回及中脑的灰质容积减少,未发现PTSD组较对照组灰质容积增加的区域。结论创伤暴露初期就能探测出PTSD患者存在与情绪控制、调节及记忆等功能相关的脑灰质结构改变,推测这些改变在创伤前可能已经存在,可能是PTSD的重要致病因素之一。     

In their own words: a synthesis of the qualitative research on the experiences of adults seeking asylum. A systematic review of qualitative findings in forced migration

Quantitative research indicates that some forced migrants have mental health needs. Asylum seekers are a group of forced migrants applying for asylum status in a host country, and are often subject to rights restrictions and threat of deportation, though little is known about subjective experiences of the asylum journey and process of claiming asylum. The current paper therefore describes a systematic review of the qualitative literature, examining asylum seekers experiences of asylum journey, from country of origin, to arrival and adaptation to host countries. A search of four databases yielded 122 studies. Inclusion/exclusion criteria were applied and 15 studies were retained and critically appraised. The country where research was conducted, study aims, sample characteristics and methodological approaches were all critically reviewed for included studies. Study aims fell into four themes; ‘an aspect of the asylum seeker journey’; ‘psychological distress and wellbeing’; ‘cultural identity and adaptation to new environment’ and ‘social welfare, employment and housing’. Studies were generally high quality and indicate issues around choice of asylum destination, distress created by uncertainty around asylum decision and hostile reactions of host communities. However, few studies have examined the experiences of asylum seekers specifically, which is important given the unique circumstances of this population.     

创伤后应激障碍的MRS研究进展

创伤后应激障碍（PTSD）是个体面临或经历了超负荷创伤性事件后产生的一种精神应激障碍疾病。常规MRI在诊断PTSD等精神疾病方面提供的信息量很少,而氢质子磁共振波谱（1H-MRS）能够在大脑结构改变之前检测到其细微的生物化学方面改变,近年来为PTSD的研究提供了有效手段。综述MRS在PTSD研究中的重要发现和研究进展,重点介绍MRS在海马、杏仁核、前扣带回和岛叶等脑区的研究发现,并展望今后可能的研究方向。     

Physician complicity in human rights violations: Involuntary sterilization among women from Mexico and Central America seeking asylum in the United States

Involuntary sterilization is a violation of human rights and grounds for asylum in the United States. Forensic medical evaluations can be useful in documenting this form of persecution and supporting asylees’ claims for immigration relief. We conducted a retrospective case analysis of the personal and medical affidavits of 14 asylum-seeking women from four Latin America countries who all reported they had been involuntarily sterilized. Sixty-four percent said that “consent” was coerced; the remainder were unaware of having been sterilized at the time of the procedure. In all cases, findings on hysterosalpingogram were consistent with sterilization, revealing that all 14 had undergone a tubal ligation. Eighty-six percent of the women had been sterilized at the time of childbirth. The healthcare providers involved in the 14 cases failed to obtain informed consent, misled patients about sterilization, engaged in discriminatory behavior, and/or breached patient confidentiality regarding their HIV-status. All 14 asylum cases were defensive; of the 7 cases (50%) that have been decided to date, 100% have been granted asylum.     

创伤后应激障碍脑功能神经影像学研究和进展

创伤后应激障碍是个体经历严重的创伤性事件(如战争、受虐)后产生的严重的精神障碍。近年来,脑神经影像研究尤其是功能神经影像学研究在创伤后应激障碍中的应用日益增多,功能神经影像技术有利于观察创伤后应激障碍功能脑区以及神经环路的异常。本文综述功能神经影像技术(功能磁共振成像,正电子发射断层扫描,和单光子发射计算机体层扫描)在创伤后应激障碍研究中的重要发现,并提出今后可能的研究方向。     

5.12地震北川县城废墟内救援回顾与思考

目的探讨地震灾害中废墟内救治经验。方法回顾性分析我院医疗队在2008年5月15日晨至16日晨在北川废墟内救援成功的11例伤员。结果重伤3例,轻伤8例;其中废墟内截肢2例,后送医院内截肢1例;安置假肢3例,痊愈8例。结论地震灾害救援中废墟内现场救援至关重要,只要采取果断科学的决策,可以提高救治成功率。     

Court room exposure to medical students: A practical approach to legal procedures in Indian Scenario

BackgroundEducation of law and bioethics has been recognized as an integral part of medical education. Medical professionals are required to contribute to the jurisprudence in various roles including the role of an ‘Expert Medical Witness’. Practical knowledge of legal procedures enables the medical professional to facilitate the judiciary in delivering justice in its right spirit. Unfortunately medical students lack this practical empowerment and thus may not be able to contribute to the justice system to the fullest potential during their professional life. We offered exposure to real life courtroom procedures to medical students to enhance their knowledge and confidence.Materials and methodsNinety seven medical students were exposed to real courtroom visits in batches of 20. They attended the legal proceeding of a medical witness examination in real case scenario and also interacted with the judge, public prosecutor and defense lawyer. All the relevant issues were discussed thoroughly before and after the court visits. A consensually validated questionnaire was used to determine the enhancement in their knowledge whereas their experience was assessed through a semi structured questionnaire.ResultsThe average knowledge level improved significantly from 34.4 (SD = 5.59) to 40.74 (SD = 5.35) [p < 0.001, 95% CI of the difference: (?7.455, ?5.225)]. Only 7 students reported that they require more such visits to attain desired confidence level. The average rating for the whole process was 8.08(SD = 1.35) out of 10, with only 5 students rating the process below 5 points.ConclusionThe process served as an ice breaker for the doubts and fear about the court and legal procedures. This module may be refined and replicated to develop a medical professional who is confident and empowered about the legal system which will benefit the judiciary and in turn the common man of the society.     

Medical imaging in pharmaceutical clinical trials: what radiologists should know

The role of medical imaging in pharmaceutical clinical trials includes identification of likely responders; detection and diagnosis of lesions and evaluation of their severity; and therapy monitoring and follow-up. Nuclear imaging techniques such as PET can be used to monitor drug pharmacokinetics and distribution and study specific molecular endpoints. In assessing drug efficacy, imaging biomarkers and imaging surrogate endpoints can not only be more objective and faster to measure than clinical outcomes, but also allow small group sizes, quick results and good statistical power. In this article some basic principles of drug clinical development are explained. Study design, image reading and quantitative image processing in clinical trials with imaging components are discussed.     

Eminence-based medicine versus evidence-based medicine: level v evidence in sports medicine

Through extensive survey analysis, we investigated expert opinion in sports medicine. The study had 3 purposes: to provide clinical guidance for cases in which the correct action is not necessarily apparent, to examine expert opinion itself, and to delineate areas of future study. A total of 500 members of the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine evaluated a set of 25 statements on unresolved issues in sports medicine. The following 10 statements were deemed false: "It's okay for 12-year-old pitchers to throw curve balls; it's the pitch count that matters"; "Resistance training ('weight lifting') should be avoided until physeal closure"; "Jogging during pregnancy is to be avoided"; "At an athletic event, if sideline coverage is offered by an emergency medical technician and athletic trainer, there is little additional benefit from having a physician present"; "Contact sport athletes who sustain a second concussion should be excluded from contact sports permanently"; "The utility of pre-season medical screening is derived from the history; as such, student-athletes should complete a questionnaire, with physical examination reserved for only those with a positive relevant history"; "Femoroacetabular impingement is a myth-the designation of anatomic variation as disease"; "An AC (acromioclavicular) separation in a contact athlete should not be treated surgically if the athlete won't give up the sport; it will fail"; "Ankle taping induces weakness and atrophy of the dynamic stabilizers of the ankle"; "Only autografts should be used in ACL (anterior cruciate ligament) surgery, as allografts have an unnecessary high failure rate in clinical practice." One statement was accepted as true: "Surgery to treat anterior (patello-femoral) knee pain in a patient with normal patellar mechanics and stability is contraindicated." In short, expert opinion may be a helpful adjunct to clinical practice. Expert opinion cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.     

Radiology in Medical Education: A Pediatric Radiology Elective as a Template for Other Radiology Courses

PurposeTraditionally, the pediatric radiology elective for medical students and pediatric residents constituted a morning teaching session focused mainly on radiography and fluoroscopy. A more structured elective was desired to broaden the exposure to more imaging modalities, create a more uniform educational experience, and include assessment tools.MethodsIn 2012, an introductory e-mail and formal syllabus, including required reading assignments, were sent to participants before the start date. A rotating weekly schedule was expanded to include cross-sectional imaging (ultrasound, CT, MR) and nuclear medicine. The schedule could accommodate specific goals of the pediatric resident or medical student, as requested. Starting in 2013, an online pre-test and post-test were developed, as well as an online end-of-rotation survey specific to the pediatric radiology elective. Taking the Image Gently pledge was required. A scavenger hunt tool, cue cards, and electronic modules were added.ResultsPre-test and post-test scores, averaged over 2 years, showed improvement in radiology knowledge, with scores increasing by 27% for medical students and 21% for pediatric residents. Surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments.ConclusionsWe have successfully created an elective experience in radiology that dedicates time to education while preserving the workflow of radiologists. We have developed tools to provide a customized experience with many self-directed learning opportunities. Our tools and techniques are easily translatable to a general or adult radiology elective.     

医学科研设计中的随机化问题

目的:引起科研工作者在医学科研设计中对贯彻随机化原则的重视,进一步提高科研的质量. 方法:由医学科研设计中一些实际案例的分析入手,提出了随机化的内涵、要求及常见问题.结果:医学科研中由于随机化设置存在很多问题,影响了研究结论的科学性、可靠性. 结论:随机化原则是医学科研设计中非常重要的原则,在科研过程中必须认真贯彻.     

远洋船员心身疾病与心理应激的关系(论著)

目的：调查远洋船员心身疾病的发病状况并探讨其与心理应激的关系。方法：调查了344名远洋货轮船员的心身疾病发生率和焦虑自评量表总分，并调查了其中34名船员61天远航不同阶段和公休期的焦虑自评量表总分，24小时尿17-羟皮质类固醇、17-酮类固醇、儿茶酚胺、肾上腺素和去甲肾上腺素排出量。结果与结论：远洋船员心身疾病发生率较高；远航中船员存在心理应激问题,且随航期的延长有加剧的趋势，而离船公休能得到缓解；患心身疾病组船员心理应激状况较重。提示，远洋船员的心身疾病与心理应激有关。