Looking for stability: Experiences of rehabilitation for Congolese survivors of torture in Athens and the role of the Congolese community in their support

Introduction: On-going conflict and political instability in the Democratic Republic of Congo (DRC) has led to increasing numbers of people fleeing their country for Europe. Many need rehabilitation services upon arrival in Greece after experiencing torture in DRC.  The scarcity of state resources and the limited capacity of non-governmental organisations to assist survivors of torture means many needs remain unmet. This study explored the experiences of rehabilitation for male Congolese survivors of torture living in Athens, as well as the potential role of the wider Congolese community in Athens in supporting rehabilitation.  Methods: This qualitative study included in-depth interviews with survivors of torture attending a rehabilitation clinic and key informant interviews with representatives of the wider Congolese community in Athens. Data was thematically analysed to construct and develop codes and themes. Results: 19 survivors and 10 key informants were interviewed. For many survivors, rehabilitation was an unclear concept. Despite the appreciation for services received at the clinic and the amelioration of physical and psychological symptoms, survivors felt rehabilitation was incomplete as it did not meet their accommodation needs nor provide stability through granting refugee status. Survivors were wary of trusting other Congolese people after experiencing torture and did not always associate themselves with the local Congolese community. The role of local Congolese leaders and organisations was not seen as replacing the clinical element of rehabilitation but aiding in practical issues such as information sharing and integration, especially in partnership with other organisations. Discussion: Systemic shortcomings in Greece, including poor access to accommodation and insecure asylum status, impeded processes of rehabilitation. Many participants found themselves navigating an unstable and unpredictable landscape in their journey towards “feeling whole again.” The role of the wider Congolese community in Athens in supporting rehabilitation remains complex and a lack of trust threatens social cohesion. Nonetheless, the willingness of the community to be more proactive should not be ignored by organisations and policy-makers. &nbsp

It never happened to me, so I don’t know if there are procedures”: identification and case management of torture survivors in the reception and public health system of Rome, Italy

Background: Access and linkage to care for migrant torture survivors is contingent on their identification and appropriate referral. However, appropriate tools for identification of survivors are not readily available, and the (staff of) reception systems of host countries may not always be equipped for this task. This study explores practices in the identification and case management of torture survivors in the reception structures and in the public health sector in Rome, Italy. Method: Data were analysed manually and codes and themes generated. Results: A non-homogeneous level of awareness and experience with torture survivors was observed, together with a general lack of knowledge on national and internal procedures for correct identification of torture survivors. Identification and case management of torture survivors was mainly carried out by non-trained staff. Participants expressed the need for training to gain experience in the identification and management of torture survivors’ cases, as well support and increased resources at both the reception and public health system levels. Conclusions: The crucial process of identification and prise en charge of survivors of torture among migrant and refugee populations is relegated to nontrained and inexperienced professionals at different levels of the reception system and public health care sector, which may carry a risk of non-identification andpossible harm to survivors. Additional resources and structured interventions are urgently needed, in the form of developing procedures, training, and adapted multidisciplinary services

Gefitinib in Non Small Cell Lung Cancer

Gefitinib is an oral, reversible, tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR) that plays a key role in the biology of non small cell lung cancer (NSCLC). Phase I studies indicated that the recommended dose of gefitinib was 250 mg/day. Rash, diarrhea, and nausea were the most common adverse events. The positive results obtained in early phase 2 clinical trials with gefitinib were not confirmed in large phase 3 trials in unselected patients with advanced NSCLC. The subsequent discovery that the presence of somatic mutations in the kinase domain of EGFR strongly correlates with increased responsiveness to EGFR tyrosine kinase inhibitors prompted phase 2 and 3 trials with gefitinib in the first line-treatment of EGFR-mutated NSCLC. The results of these trials have demonstrated the efficacy of gefitinib that can be now considered as the standard first-line treatment of patients with advanced NSCLC harbouring activating EGFR mutations

Innovative radiation-based direct heat exchanger (DHX) for liquid metal cooled reactors

Considering the importance of safety features in the development of Generation IV nuclear reactors, an innovative and passive decay heat removal system (DHRS) has been proposed for liquid metal cooled reactors. The attention is here focused on the direct heat exchanger (DHX) of the system constituted by a bayonet tube that allows to remove the decay heat from the primary coolant; both primary and secondary fluids flow in natural circulation. Since each bayonet tube is equipped with a vacuum gap, the most important heat transfer mechanism characterizing the DHX is radiation. Furthermore, the presence of the vacuum gap guarantees a physical separation and a complete decoupling between primary and secondary fluids, enhancing the safety features of the whole system. Several CFD analyses have been carried out in order to obtain a characterization of the DHX both for sodium and lead cooled fast reactors, in order to optimize the DHX geometry on the basis of the specific application, and the results are discussed in the paper. (c) 2013 Elsevier B.V. All rights reserved

In situ and satellite long-term monitoring of slow clayey landslides and of the structures built on them

This paper reports the results of a long-term monitoring of the slow movements of two deep earthflows in tectonized clay shales of southern Apennines. The cumulated movements have caused over the years severe damage to buildings and infrastructure, with important social and economic costs. Deep and superficial displacements, along with pore water pressures, are being monitored since 2005; in some areas of the slope, displacement monitoring by inclinometers started about 30 years ago. The kinematics of the landslides have been clarified sufficiently on the basis of ground-based measurements. On the other hand, the mostly N-S orientation of displacements, and the rather limited urbanization, make it rather challenging to monitor the area by satellite interferometry methodology. To minimize such problem, satellite data relative to areas where the displacements and their directions are clearly determined by inclinometers and GPS were analysed at the most detailed scale of analysis. The data validation allowed to confidently exploit remote sensing results in a wider area. Thus, images acquired by the COSMO-SkyMed satellite system, supplemented by ERS and Envisat data (available since 1993), allowed the reconstruction of the kinematic history of the urbanized area even where inclinometer displacement series were available only over short periods. Indications about the effectiveness of the remedial measures constructed in the area under study could also be obtained

Screening of asymptomatic rheumatic heart disease among refugee/migrant children and youths in Italy

Abstract Background Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population. Methods From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. ‘Definite’ and ‘borderline’ cases were defined according to the World Hearth Federation criteria. Results Six hundred fifty-three individuals (13–26 years old) were screened; 95.6% were below 18 years old (624/653). Six ‘definite RHD’ were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1–20.3‰), while 285 (436.4‰) were defined as ‘borderline’ (95% CI 398.8–474.9‰). Out of 172 “non-negative borderline” cases available for being retested (113 “non-negative borderline” lost in follow-up), additional 11 were categorized as ‘definite RHD’, for a total of 17 ‘definite RHD’, yielding a final prevalence of 26.0‰ (95% CI 16.2–41.5‰) (17/653), and 122 (122/653) were confirmed as ‘borderline’ (final prevalence of 186.8‰, 95% CI 158.7–218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both ‘borderline’ (OR 4.3 [2.8–6.5]) and ‘definite RHD’ (OR 5.2 [1.7–15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD. Conclusions Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of ‘definite RHD’ was similar to that identified in resource-poor settings, while the prevalence of ‘borderline’ cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children