脑震荡后综合征及其客观评定技术的发展

脑震荡后综合征诊断具有很大的争议性。轻度创伤性脑损伤后脑震荡综合征的发病机制,涉及神经损伤和心理社会因素。迄今,已有大量的研究对现有的检查方法或工具(包括精神检查、常规CT和核磁共振、神经心理学测试和神经生化检查)的评定和诊断价值进行了分析。轻度创伤性脑损伤的受损部位主要分布在灰白质交界附近和大脑深部中线结构,由于大脑损伤的弥漫性,常规影像学检查无阳性发现。本文对脑震荡后综合征的流行病学研究、诊断现状及争议、常规诊断技术、新型核磁共振成像技术在脑震荡后综合征和轻度创伤性脑损伤诊断中的应用及展望进行了综述。现代大脑成像技术可无创定量评定大脑损伤,并可能成为脑震荡后综合征诊断及法医学鉴定更敏感和更有前途的评定工具。     

You Got What You Deserved

The Philosophy of Criminal Law collects 17 of Doug Husak’s articles on legal theory, 16 of which have been previously published, spanning a period of over two decades. In sum, these 17 articles make a huge and lasting contribution to criminal law theory. There is much wisdom contained in them; and I find surprisingly little to disagree with, making my job as a critical reviewer quite challenging. Most of the points on which Doug and I disagree can be found in my other published work in this field, so I will have little to say about them, except where they illuminate those few points of disagreement that arise in the particular essays I discuss. Most of what I will say will be in accord with Doug’s views and will principally explore their wider implications. The 17 essays in the book cover too many and too varied topics for one review essay. Therefore, I will focus on just three of them: “Rapes Without Rapists: Consent and Reasonable Mistake” (co-authored by George C. Thomas); “Mistakes of Law and Culpability”; and “Already Punished Enough.” Although I generally agree with the upshots of Doug’s arguments in these chapters, I think the issues they raise are worth further exploration.     

On Complicity and Compromise: A Reply to Peter French and Steven Ratner

Peter French’s and Steven Ratner’s thoughtful comments are helpful in advancing the analysis we offered in our book On Complicity and Compromise. Inevitably, there are areas of disagreement and bones to pick. However, our primary concern in this reply will be to press, with their assistance, the more positive agenda.     

Excellence in Psychological Injury and Law: Book Review of Motor Vehicle Collisions by Duckworth, Iezzi, and O’Donohue (2008)

In several ways, the book on motor vehicle collisions by Duckworth, Iezzi, and O’Donohue (2008) breaks new ground and should be considered a must-read for workers in the area of psychological injury and law. The editors have assembled a team of expert authors who have cogently analyzed the scientific evidence in the area of motor vehicle collisions and their aftermath, while calling for more research. The book is replete with information that will help practitioners understand and deal with cases involving conditions such as chronic pain, posttraumatic stress, and traumatic brain injury. Practitioners will learn about complications in such cases, including threats to validity and legal aspects. The inclusion of chapters from a medical perspective is a welcome innovation. The book is only lacking in that, although assessment is considered throughout, chapters specifically addressing this topic are not included. The book review concludes that the Motor vehicle collisions book by Duckworth et al. should be included as part of the growing list of excellent resources in the area of psychological injury and law.     

Minimal Semantics and Legal Interpretation

In this paper I will tackle three issues. First, I aim to briefly outline the backbone of semantic minimalism, while focusing on the idea of ‘liberal truth conditions’ developed by Emma Borg in her book ‘Minimal Semantics’. Secondly, I will provide an account of the three principal views in legal interpretation: intentionalism, textualism and purposivism. All of them are based on a common denominator labelled by lawyers ‘literal meaning’. In the paper I suggest a novel way of viewing this common denominator as almost identical to the Borgian ‘liberal truth conditions’, at least at a conceptual level. In the third section I will focus on the conceptual similarities between the two ideas. I intend to depict that, although legal theorists do not admit it explicitly, they treat literal legal meaning as minimal propositional content that can be ascribed liberal truth conditions. There are two main objections to liberal truth conditions: their under-determinacy and unintuitive character. Both objections can be applied to ‘literal meaning’. However, the idea of liberal truth conditions gives an adequate account of what lawyers call literal meaning and is helpful in explaining the mechanism of understanding of provisions and reasons leading to the necessity of statutory interpretation.     

Major depression – a study on the validity of clinicians’ diagnoses in medicolegal assessment

Major depression ranges among the most frequently diagnosed psychiatric disorders. Accordingly, diagnoses of depression are often underlying insurance, compensation or disability claims. This report evaluates the validity of clinicians’ diagnoses of major depression in a sample of claimants. In 2015, n = 127 consecutive cases were examined for medicolegal assessment. For all of them, a diagnosis of major depression had been established by clinicians. All testees underwent a psychiatric interview, a physical examination, they answered questionnaires for depressive symptoms according to DSM-5, embitterment disorder, post concussion syndrome (PCS) and unspecific somatic complaints. Performance and symptom validity tests were administered. Only 31% fulfilled the diagnostic criteria for DSM-5 major depression according to self-report, while none did so according to psychiatric assessment. Negative response bias was found in 64% of cases, feigned neurologic symptoms in 22%. Symptom exaggeration was indiscriminate rather than depression-specific. By self-report, 64% of the participants qualified for embitterment disorder and 93% for PCS. In conclusion, clinicians’ diagnoses of depression seem often confounded by improper assessment of the diagnostic criteria, confusion of depression with bereavement or embitterment and also by response bias.     

Intervention with sexually abusive young people in Australia and New Zealand

Abstract

Research into the treatment of sexual offenders with an intellectual disability has increased over the past decade. This research can be used to investigate the efficacy of treatment; however, empirical limitations of the research make generalizations difficult. Marques has provided a framework for examining treatment efficacy that emphasizes the contribution of researchers and clinicians to report treatment outcomes rather than a strict reliance on rigorous empirical investigations, such as controlled outcome research. This review uses Marques’ framework to present an overview about group treatment for sexual offenders with an intellectual disability using nine identified studies. This paper attempts to consolidate our knowledge about specific treatment issues, while demonstrating the varied outcomes that are reported in the literature. In employing this framework, the literature suggests that our knowledge can be substantially improved by research addressing specific areas of treatment.     

Review of Findlay Stark,Culpable Carelessness: Recklessness and Negligence in the Criminal Law

This book review sketches the main arguments of Findlay Stark’s book, and then goes on to develop an objection to Stark’s account of one of the core notions in the book—namely, awareness of risk.     

A. P. Simester (ed): Appraising Strict Liability

The article is a review of A.P. Simester, ed., Appraising Strict Liability. We strongly recommend the book for the sophistication of the contributors’ analyses, and the contribution the book makes to clarifying the normative issues at stake in strict liability legal regimes. The review focuses on the more philosophical essays in the book. The specific issues from the book identified in the review are: the rights-based character of the prohibition on conviction without moral fault; the importance of the principle of proportionality; due diligence defences; the instrumental worth of strict liability in relation to quasi-criminal regulation; the faultiness of genuinely creating risks.     

Transparency of machine-learning in healthcare: The GDPR & European health law

Machine-learning (‘ML’) models are powerful tools which can support personalised clinical judgments, as well as patients’ choices about their healthcare. Concern has been raised, however, as to their ‘black box’ nature, in which calculations are so complex they are difficult to understand and independently verify. In considering the use of ML in healthcare, we divide the question of transparency into three different scenarios:

• 1)Solely automated decisions. We suggest these will be unusual in healthcare, as Article 22(4) of the General Data Protection Regulation presents a high bar. However, if solely automatic decisions are made (e.g. for inpatient triage), data subjects will have a right to ‘meaningful information’ about the logic involved.
• 2)Clinical decisions. These are decisions made ultimately by clinicians—such as diagnosis—and the standard of transparency under the GDPR is lower due to this human mediation.
• 3)Patient decisions. Decisions about treatment are ultimately taken by the patient or their representative, albeit in dialogue with clinicians. Here, the patient will require a personalised level of medical information, depending on the severity of the risk, and how much they wish to know.

In the final category of decisions made by patients, we suggest European healthcare law sets a more personalised standard of information requirement than the GDPR. Clinical information must be tailored to the individual patient according to their needs and priorities; there is no monolithic ‘explanation’ of risk under healthcare law. When giving advice based (even partly) on a ML model, clinicians must have a sufficient grasp of the medically-relevant factors involved in the model output to offer patients this personalised level of medical information. We use the UK, Ireland, Denmark, Norway and Sweden as examples of European health law jurisdictions which require this personalised transparency to support patients’ rights to make informed choices. This adds to the argument for post-hoc, rationale explanations of ML to support healthcare decisions in all three scenarios.     

From electronic health records to personal health records: emerging legal issues in the Italian regulation of e-health

In 2012, the Italian Legislator has provided an appropriate legal framework for the realisation of the national Electronic Health Records (EHR) system, in which the patient plays a pivotal role: with the implementation of the Fascicolo sanitario elettronico (FSE), patients will have access to their EHRs through the online platform, and decide which data to share and with whom. In this perspective, one of the most interesting innovations is the so-called ‘taccuino’, a digital space of patients’ FSE in which they can autonomously record data and information relating to their health. Patients’ ability to access their own health data and EHR at any time and to enter information by themselves in a personal area is a unique form of power at a European level, but their legal consequences are still vague. The aim of this contribution is to offer a first review of the Italian e-health reform, showing the most critical aspects.     

Book Review: How Mediation Works: Theory,Research, and Practice by Stephen B. Goldberg,Jeanne M. Brett,Beatrice Blohorn‐Brenneur,With Nancy H. Rogers

This is a book review of How Mediation Works: Theory, Research, and Practice by Stephen B. Goldberg, Jeanne M. Brett, Beatrice Blohorn‐Brenneur, with Nancy H. Rogers. How Mediation Works is intended for a wide range of audiences: practicing mediators; aspiring mediators; those who may refer cases to mediation; participants in mediation, including parties and attorneys; managers who facilitate disputes; and those interested in mediation without a specific plan to engage in the practice (who the authors call “mediation learners”). The book is a well‐written, thoughtful, easy‐to‐read, organized, and concise overview of mediation practice. The book is divided into six chapters: (1) conflicts, disputes, and their resolution; (2) dispute resolution processes; (3) the roles of the mediator and the disputing parties at each step of the mediation process; (4) dealing with difficulties; (5) mediation and the law; and (6) suggestions for aspiring mediators. Though not an authority for family law mediation, the book provides many insightful observations and suggestions that would be instructive and helpful to any mediator or individual with an interest in mediation.     

Do the interests of academic lawyers and practising lawyers ever overlap?

‘A book may be good for nothing; or there may be onlyone thing in it worth knowing; are we to read it all through?’(Samuel Johnson) This section is dedicated to the review of ideas, articles,books, films and other media. It will include replies (and rejoinders)to articles, the evaluation of new ideas or proposals, and reviewsof books and articles both directly and indirectly related tointellectual property law. The book-reading habits of practising lawyers can be very differentto those of academic lawyers. A well-known publisher of lawbooks for academics and practitioners provides its authors witha style guide, which includes the following, helpful advicefor writing     

On building a sovereign state from scratch: The law and economics of Theodor Herzl's programmatic work

Rarely has one book had the impact of Herzl's Der Judenstaat. To which other book can we points as having led to the creation of an entire state? In looking at the slim volume today, we are struck by its freshness of insight and its strict adherence to trying to find institutional solutions that would allow people to establish the new state and then conduct their lives according to what Herzl conceived as modern Jewish principles. This study is exemplary not only for its success. In a time of great economic and legal change, scholars particularly in the transitional economies are looking for analyses that help them create the functioning institutions that need to be built, often quite literally, from scratch. Herzl, who wrote his book not as a contribution to law and economics but as a contribution to furthering his cause, nevertheless left a remarkable exercise in applied law and economics.     

Shoemaker on Sentiments and Quality of Will

In this comment, I raise a number of concerns about David Shoemaker’s adoption of the quality of will approach in his recent book, Responsibility from the Margins. I am not sure that the quality of will approach is given an adequate grounding that defends it against alternative models of moral responsibility; and it is unclear what the argument is for Shoemaker’s tripartite version of the quality of will approach. One possibility that might fit with Shoemaker’s text is that the tripartite model is meant to be grounded in empirical claims about the structure of encapsulated emotions; but I argue that those empirical claims are not made out, and that regardless it is doubtful whether this is the most helpful model of the emotions to deploy in this context. In contrast, I propose that the quality of will approach is better defended in ethical terms, by reference to the vision of the value of living together as equals (in some sense) that is embodied in P.F. Strawson’s picture of the engaged attitude, and the emotions involved in it.     

Trade mark cartoons 'FOR LIFE(R)'

‘A book may be good for nothing; or there may be onlyone thing in it worth knowing; are we to read it all through?’(Samuel Johnson) This section is dedicated to the review of ideas, articles,books, films and other media. It will include replies (and rejoinders)to articles, the evaluation of new ideas or proposals, and reviewsof books and articles both directly and indirectly related tointellectual property law. Writing a book review has never been more entertaining. The‘book’ under review is a 12 page trilingual (English,French, and Spanish) comic book compiled and co-published byWIPO and the National Institute for     

Mitigating Murder

In Loss of Control and Diminished Responsibility, Alan Reed and Michael Bohlander collect a wide range of essays on the eponymous partial defences to murder. These essays provide detailed analysis of recent English reforms in this area and place these reforms in comparative perspective. This review considers the contribution made by this book to the explanation and evaluation of partial defences. It concentrates in particular on the exculpatory force of loss of control; the distinctness of loss of control from diminished responsibility; and the defences’ unique mitigatory effect.     

The Perils of ‘As If’ European Constitutionalism

This review article offers thoughts on Kaarlo Tuori's recent book, European Constitutionalism, and more particularly on what he calls the ‘disciplinary contest over the legal characterisation of the EU and its law’. As the book's title suggests, Tuori privileges the constitutional perspective in that contest, so much so—he freely admits—that his analysis ‘predetermine[s] how the EU and its law will be portrayed’. And therein also lies the book's main weakness. Tuori's predetermined ‘constitutional’ interpretation, like so much of the dominant legal discourse in the EU today, ultimately obscures the core contradiction in EU public law. National institutions are increasingly constrained in the exercise of their own constitutional authority but supranational institutions are unable to fill the void because Europeans refuse to endow them with the sine qua non of genuine constitutionalism: the autonomous capacity to mobilise fiscal and human resources in a compulsory fashion. The EU's lack of constitutional power in this robust sense derives from the absence of the necessary socio‐political underpinnings for genuine constitutional legitimacy—what we can call the power‐legitimacy nexus in EU public law. To borrow Tuori's own evocative phrase, the EU possesses at best a ‘parasitic legitimacy’ derived from the more robust constitutionalism of the Member States as well as from the positive connotations that using ‘constitutional’ terminology evokes regardless of its ultimate aptness. The result is an ‘as if’ constitutionalism, the core feature of which is an increasingly untenable principal‐agent inversion between the EU and the Member States, one with profound consequences for the democratic life of Europeans. The sustainability of integration over the long term depends on confronting these adverse features of ‘European constitutionalism’ directly, something that legal elites—whether EU judges, lawyers, or legal scholars—ignore at their peril.     

Validity and Determinants of Clinicians’ Return to Work Judgments for Individuals Following Whiplash Injury

Rehabilitation clinicians routinely make judgments about the capacity of individuals to return to work following whiplash injury, which can have serious implications for individuals’ continued access to salary indemnity benefits. The present study examined the validity and determinants of these judgments. During a standardized rehabilitation intervention, data regarding demographic factors, crash characteristics, pain severity, range of motion, pain-related psychological functioning, as well as change in the latter three factors over the course of treatment were collected for 104 whiplash-injured individuals (73 women, 31 men). Upon completion of the intervention, clinicians rated the number of hours each individual was capable of working per day. Follow-up data regarding the actual number of hours worked were collected 1 year later. Hierarchical regression analyses revealed that clinicians’ judgments added significant unique variance to the return to work prediction beyond other predictive factors, and that clinicians were particularly influenced by patients’ pain severity and treatment-related change in pain severity in making these judgments. Although clinicians were significantly able to predict return to work, the limited variance accounted for by their judgments (12%) warrants caution in the use of these judgments in decisions related to access to services or indemnity. Factors predictive of clinician judgment and actual return to work are compared, and recommendations to enhance the utility of these judgments are made.     

Causality and Causation in Law, Medicine, Psychiatry, and Psychology: Progression or Regression?

In this article, I review recent developments in the areas of law, medicine, psychiatry, and psychology concerning causality and causation. I analyze the validity of the 2008 edition of the American Medical Association (AMA)’s guides to the evaluation of permanent impairment and its accompanying volume on causation. I conclude with recommendations for a synthetic approach to causality in the legal field and a more consistent model of impairment in the mental health one. The AMA’s book on medical causation needs careful revision.