Elevating Hourly PM2.5 Forecasting in Istanbul, Türkiye: Leveraging ERA5 Reanalysis and Genetic Algorithms in a Comparative Machine Learning Model Analysis.

Rapid urbanization and industrialization have intensified air pollution, posing severe health risks and necessitating accurate PM2.5 predictions for effective urban air quality management. This study distinguishes itself by utilizing high-resolution ERA5 reanalysis data for a grid-based spatial analysis of Istanbul, Türkiye, a densely populated city with diverse pollutant sources. It assesses the predictive accuracy of advanced machine learning (ML) models-Multiple Linear Regression (MLR), Extreme Gradient Boosting (XGBoost), Light Gradient Boosting (LGB), Random Forest (RF), and Nonlinear Autoregressive with Exogenous Inputs (NARX). Notably, it introduces genetic algorithm optimization for the NARX model to enhance its performance. The models were trained on hourly PM2.5 concentrations from twenty monitoring stations across 2020-2021. Istanbul was divided into seven regions based on ERA5 grid distributions to examine PM2.5 spatial variability. Seventeen input variables from ERA5, including meteorological, land cover, and vegetation parameters, were analyzed using the Neighborhood Component Analysis (NCA) method to identify the most predictive variables. Comparative analysis showed that while all models provided valuable insights (RF>LGB>XGB>MLR), the NARX model outperformed them, particularly with the complex dataset used. The NARX model achieved a high R-value (0.89), low RMSE (5.24 µg/m³), and low MAE (2.94 µg/m³). It performed best in autumn and winter, with the highest accuracy in Region-1 (R-value 0.94) and the lowest in Region-5 (R-value 0.75). This study's success in a complex urban setting with limited monitoring underscores the robustness of the NARX model and the methodology's potential for global application in similar urban contexts. By addressing temporal and spatial variability in air quality predictions, this research sets a new benchmark and highlights the importance of advanced data analysis techniques for developing targeted pollution control strategies and public health policies.

Frequency of Human Leukocyte Antigen-B*57:01 Allele Carriers in People Living with HIV/AIDS in Türkiye.

INTRODUCTION: Abacavir is among the first-line initial antiretroviral regimens for most patients living with HIV/AIDS (PLWHA). Although well tolerated, it is associated with hypersensitivity reaction (HSR), which is treatment-limiting and potentially life-threatening. HSR was shown to be associated with the class I MHC allele, HLA-B*57:01. In this study, we aimed to evaluate the prevalence of HLA-B*57:01 in PLWHA in Istanbul, Türkiye. MATERIAL AND METHODS: Five HIV treatment centers in Istanbul included all sequential treatment-- naïve, ≥ 18 years adult PLWHA, between December 2017- December 2021. Demographic, clinical, and laboratory data were collected at baseline and during treatment. HLA-B* 57:01 genotyping was determined with PCR-SSP. RESULTS: Eight hundred sixty-seven PLWHA were included (male:91%, mean age 39.6±11.1 years). 1.6% of patients were found to be HLA-B*57:01 positive. Among HLA-B*57:01 positive patients, 4 were initially given abacavir-containing treatment; they were switched to non-abacavir treatment upon the allele found to be positive. CONCLUSION: Although previous studies reported the HLA-B*57:01 prevalence of PLWHA in Türkiye as 3-3.6%, we have found the prevalence to be 1.6%. The current study includes higher numbers of patients than the previous studies. Furthermore, patients from all over the country apply to the centers in Istanbul; compared to the other studies, which involve patients limited to the relevant regions, it can be assumed that the number in our cohort is more representative of the country. In conclusion, the prevalence of the HLA-B*57:01 allele in PLWHA in this study is relatively low. With evident benefit in preventing abacavir HSR, HLA-B*57:01 should be screened in planning antiretroviral therapy.

Suggestions and Comparisons of Two Algorithms for the Simplification of Bluetooth Sensor Data in Traffic Cordons.

Bluetooth sensors in intelligent transportation systems possess extensive coverage and access to a large number of identity (ID) data, but they cannot distinguish between vehicles and persons. This study aims to classify and differentiate raw data collected from Bluetooth sensors positioned between various origin-destination (i-j) points into vehicles and persons and to determine their distribution ratios. To reduce data noise, two different filtering algorithms are proposed. The first algorithm employs time series simplification based on Simple Moving Average (SMA) and threshold models, which are tools of statistical analysis. The second algorithm is rule-based, using speed data of Bluetooth devices derived from sensor data to provide a simplification algorithm. The study area was the Historic Peninsula Traffic Cord Region of Istanbul, utilizing data from 39 sensors in the region. As a result of time-based filtering, the ratio of person ID addresses for Bluetooth devices participating in circulation in the region was found to be 65.57% (397,799 person IDs), while the ratio of vehicle ID addresses was 34.43% (208,941 vehicle IDs). In contrast, the rule-based algorithm based on speed data found that the ratio of vehicle ID addresses was 35.82% (389,392 vehicle IDs), while the ratio of person ID addresses was 64.17% (217,348 person IDs). The Jaccard similarity coefficient was utilized to identify similarities in the data obtained from the applied filtering approaches, yielding a coefficient (J) of 0.628. The identity addresses of the vehicles common throughout the two date sets which are obtained represent the sampling size for traffic measurements.

Increase in measles cases in a City hospital, Istanbul, Turkey.

OBJECTIVES: Measles cases are increasing remarkably in our country as well as all over the world. In this study, it was aimed to examine the epidemiological and clinical characteristics of measles cases detected in our hospital, as well as the measles seroprevalence in our region. METHODS: A total of 7,452 individuals whose measles IgG and/or IgM antibodies were studied between December 2021 and March 2023 in the Medical Virology Laboratory in Basaksehir Çam and Sakura City Hospital were included in this retrospective study. Measles IgG and IgM antibodies were analysed by enzyme-linked immunosorbent assay. Demographic information, clinical symptoms and laboratory data of the participants were obtained from the hospital's electronic medical records. RESULTS: A total of 102 measles cases were identified between December 2021 and March 2023. Of these cases, 77 (75.5%) patients were ≤ 18 years old. Of the 73 measles cases with vaccination information, 90% were unvaccinated. The measles seroprevalence rate was 72.8%. The lowest seroprevalence rate (4.8%) among the age groups was found in 8-11-month-old babies, the highest cases rate (35.7%) was detected in this age group. It was determined that measles immunity increased with age (r = 0.276, p < 0.001) and was over 89.3% over the age of 30. CONCLUSIONS: Measles immunity is insufficient in our region and measles remains an important public health problem until the age of 18. The recent increase in measles cases in our country and around the world shows that current vaccination programmes need to be implemented more decisively and strictly.

The politics of electricity use and non-use in late Ottoman Istanbul.

This article focuses on the earlier encounters and uses of electricity, its technology, and its infrastructure to understand how electricity formed a contested terrain of politics among the city's varying actors, such as state officials, financial investors, and consumers, in late Ottoman Istanbul, roughly between the 1870s and early 1920s. I contend that people used electricity as a political tool in their everyday lives even before they could access it physically. Electricity skepticism during the reign of Sultan Abdülhamid II (1876-1909) increased Istanbul residents' inclination for an electrified future; the longer the sultan's prohibitions lasted, the more they fueled this inclination, causing problems about the use of electricity. In contrast to the previous regime's skepticism about electricity use, the Committee of Union and Progress (1909-18) administrators considered electricity a public service that a larger population could use rather than a source of energy for a small, privileged elite. The first urban-scale power plant was completed in 1914. However, the inability to import technical equipment and raw materials due to political and financial troubles caused by World War I (1914-18) and the Occupation Period (1918-23) hampered electricity production and consumption, causing serious problems in electricity use on public and private scales. Amid the wave of challenges, the city inhabitants witnessed numerous unpleasant encounters with electricity use; some perished in tram accidents, while others became criminals. At a time when much of society viewed electricity as a vital element for progress and economic growth, the prevalence of crowded trams, tram accidents, blackouts, and instances of electricity theft within the Ottoman capital called into question the notion of electricity as a technological promise and public good. Consequently, the initial enthusiasm for electricity's transformative potential waned due to tensions between expectations and daily realities, resulting in a cautious approach toward technological modernity.

Manifestations of cruel, inhuman types of behavior and torture of Ukrainian military who died in captivity.

The given information and forensic medical characteristics of injuries found on the bodies of Ukrainian soldiers who were in Russian captivity and died as a result of cruel, inhuman treatment and torture in 2022-2023. According to their nature and morphological features, the damage could be the result of high temperature action using hot metal objects, but more likely, the result of the use of electric current conductors (bare end of the wire). In other cases, after the exhumation of the occupied territory of the Kharkiv region, the manifestations of torture were brain injuries and fractures of the bones of the body caused by blunt hard objects with a limited surface. All the injuries described by us correspond both to the list of physical evidence of torture of the "Istanbul Protocol" and to the list of war crimes of the "Rome Statute".

The effects of technological developments in transportation vehicles on air pollution mitigation of metropolitan cities: A case study of Istanbul.

This study investigates the impact of transportation vehicles on air pollution emissions in Istanbul, a metropolitan city in Türkiye. The TIMES (The Integrated MARKAL-EFOM System) Model has been used to determine the current level of air pollutants coming from the transportation sector, make future estimates, and assess the impact of various scenarios on air pollution emissions. Air pollutants such as carbon monoxide, nitrogen oxides, sulfur oxides, particulate matter, and non-methane volatile organic compounds are included in the model. The amount of air pollution emissions discussed in this research were 74, 68, 13, 5, and 2 kt for NOx, CO, VOC, SO2, and PM, respectively, in the base year of 2016. In 2055, these emissions have shifted to 190, 98, 26, 8, and 5 kt, respectively. This means that emissions are predicted to increase between 1.4 and 2.6 times. According to model results, individual measures could decrease potential air pollution emissions for 2055 by up to 13 %. When all of the actions done within the pollutants of the study are combined, the total amount of emissions has decreased by 30.2 %, 24.3 %, 18.8 %, 5.3 % and 21.4 % for NOx, CO, VOC, SO2, and PM, respectively. This research emphasizes how critical it is to address metropolitan areas' transportation-related air pollution. The number of such studies dealing with air pollution parameters using the TIMES Model is very few, and it is expected that this study will create important outputs for similar studies.

The Prevalence of Headache Disorders in Children and Adolescents in Istanbul: A School-Based Study.

BACKGROUND: Headache among children and adolescents is an important health problem. In this school-based epidemiological study conducted in Istanbul, we aimed to reveal the frequency of headaches in this population, define the risk factors associated with headaches, and establish the effect of headaches on the quality of life in this population. METHODS: The child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation structured questionnaire were conducted in 30 schools in Istanbul. The diagnosis was made based on the International Classification of Headache Disorders III-(ICHD-3) beta version. Risk factors associated with headaches were analyzed in a binary logistic regression model. RESULTS: Among the 5944 students (boys = 3011 [50.7%], girls 2933 [49.3%]) who completed the survey and were enrolled in this study, 3354 (56.4%) reported a headache ever. The prevalence of headaches was significantly higher in girls (62.6% vs. 50.4%, P < 0.001). Migraine prevalence was found to be 5.2%, whereas tension-type headache (TTH) prevalence was 26.1%. Being a female, age, living on the European side, and headache history in the family were found to be associated with an increased risk of having a headache. Pupils with headaches reported that they missed an average of 0.5 ± 1.5 school days due to headaches. CONCLUSION: TTH was found to be the most common headache syndrome in Istanbul metropolitan area. Considering the effect of headaches on school success and quality of life in childhood, it is clear that the correct diagnosis of headaches and careful handling of risk factors are crucial for this population.

The impact of the covid-19 outbreak on unmet health care needs in istanbul.

Background & aim: COVID-19 pandemic caused significant barriers to maintain health services. Our study determines the frequency and significant determinants of unmet health needs in Istanbul both in 2019, a pre-pandemic year, and in 2021, a pandemic year and compares the results COVID-19 era to a prior to pandemic year. Methods: As our study is the first questing Istanbul experience, we estimate the frequencies and determinants of unmet healthcare need among +15 population using TurkStat's Income and Living Conditions Survey Data via Generalized Linear Models (GLMs). Results: We found that the most prominent barriers were late appointment dates and financial difficulty both before and during the pandemic. According to our findings, women and those having any chronic disease become significantly more likely to have unmet health needs during the pandemic compared to pre-pandemic period. Indeed, the ones belonging to the lowest income group and having lower level perceived health were disadvantaged with higher change of unmet needs both prior to and during the pandemic. Furthermore, the frequency of the Istanbulers who had unmet healthcare needs increased more than 1.5 time during the COVID-19 pandemic. Conclusions: As unmet healthcare needs due to COVID-19 jeopardizing the healthcare systems, it is important to comprehend the causes of unmet healthcare demands during infectious disease outbreaks in order to prioritize the right policies and protection strategies for the most vulnerable ones.

Spatio-temporal distribution of microplastic pollution in surface sediments along the coastal areas of Istanbul, Turkey.

Microplastics (MPs) have become prevalent in various environmental compartments, including air, water, and soil, attracting attention as significant pollutant parameters. This study investigated the prevalence of MP pollution in surface sediments along Istanbul's Marmara Sea, encompassing the megacity and the Bosphorus. A comprehensive sampling approach was employed, covering 43 stations across four seasons and depths ranging from 5 to 70 m. The objective was to assess the impact of terrestrial, social, and industrial activities on MPs. The average concentrations varied per season, with fall, winter, spring, and summer values recorded as 2000 ± 4100, 1600 ± 3900, 4300 ± 12,000, and 9500 ± 20,300 particles/kg-DW. The study identified river stations in the Golden Horn and sea discharge locations as hotspots for high concentrations. Notably, the dominant shape shifted from fibers in fall, winter, and spring to fragments during summer, coinciding with mucilage occurrences. The study identified 11 different polymers, with polyethylene (44 %) and polypropylene (31 %) being the most common.

Ecotoxicological evaluation of organic contamination in the world's two significant gateways to the Black Sea using GIS techniques: Turkish Straits.

This study was carried out to determine the spatial-temporal distributions of limnological parameters of Çanakkale Strait (ÇS) and Istanbul Strait (IS), Turkiye. Fluvial (n = 11) and lacustrine (n = 4) habitats water samples were collected in the dry and rainy seasons of 2022-2023. Among limnological parameters, the highest mean electrical conductivity values of 6063 µS/cm were noted in the IS basin during the rainy season and the lowest was 0.04 mg/L for nitrite in the ÇS basin. Generally, the levels of organic contaminants and ecological risk indices were as follows: rivers of IS > rivers of ÇS > Alibey Dam Lake (IS) > Atikhisar Dam Lake (ÇS). The highest non-carcinogenic health risks of 0.88 were noted for children in the ÇS basin during the dry season and the lowest of <0.01 in Atikhisar Dam Lake during the rainy season. Multivariate statistical techniques were applied to data to categorize investigated ecosystems and sources apportionment of contaminants and geospatial distribution.

Detection of the Crimean-Congo Hemorrhagic Fever Virus Genome in Questing Ixodes spp. and Haemaphysalis spp. in the Periurban Forestry Areas of Istanbul: Has a New Biorisk Emerged?

Background: Istanbul is one of the world's most densely populated metropolitan cities, with various geographical areas that possess distinct characteristics. These areas have different climates, vegetation, and host populations that can support the survival of diverse tick species. Turkey is a region with a high risk of Crimean-Congo hemorrhagic fever (CCHF) disease, making it crucial to screen for this risk, especially in densely populated regions such as Istanbul and its surrounding areas. However, the presence of potential vectors for CCHF virus (CCHFV) in these areas has not been studied in the past 12 years. Materials and Methods: In this study, a total of 676 ticks were collected from 6 centers using the flagging and dragging method. Ticks were identified as Ixodes ricinus (7.85%), Ixodes spp. immature form (73.22%), Haemaphysalis parva (0.89%), Haemaphysalis inermis (0.15%), and Haemaphysalis spp. immature form (17.89%). Pooled samples were screened for the CCHFV genome (S segment) by RT-nested PCR. Results: A total of 14.28% of the samples were found as positive. Phylogenetic analysis revealed that all the CCHFV sequences obtained from the positive samples were clustered in clade V: Europe/Turkey genogroup. Conclusion: This study suggests that ixodes spp. and Haemaphysalis spp. may have the potential to pose a biorisk for Crimean-Congo hemorrhagic fever.

The effects of urban growth on natural areas: the three metropolitan areas in Türkiye.

Today, more than half of the world's population of 7.6 billion lives in cities, and by 2030, it is estimated that the population of urban residents will exceed 5 billion worldwide. Since growth in cities destroys agriculture, forests, and wetlands, an increasing carbon footprint brings many environmental problems, such as global climate change. Among the developing countries, Türkiye's largest cities have been experiencing a rapid urbanization process. The study aims to analyze the adverse effects of urban growth in Türkiye's largest metropolises on natural areas such as agriculture, forests, and wetlands. In this context, the Istanbul, Ankara, and Izmir metropolitan areas have been determined as case areas. The correlation between the changes in the land cover and the urban expansion processes of the three big cities from 1990 to 2018 has been systematically analyzed in the GIS environment using Corine land cover program data. The study indicates the devastating effect of urban growth on agricultural areas in all three case areas. In addition, the urbanization pressure in Istanbul continues to destroy northern forests.

Beyond Crisis: Understandings of Vulnerability and Its Consequences in Relation to Intimate Partner Violence.

This article takes a closer look at intimate partner violence (IPV) and its semantical, political, and legal interactions with crisis and crisis discourse. Starting from the fact that IPV has been called a "shadow pandemic" and a "hidden crisis", the article conceptualizes two parallel phenomena: how the COVID-19 pandemic - and crises in general - impact on IPV by exacerbating vulnerabilities and how crisis discourse has been mobilized to argue for a responsive state and strong positive obligations to combat and reduce IPV. The article then draws a parallel between crisis discourse and vulnerability reasoning, analyzing how vulnerability has played a similar role within the case law of the European Court of Human Rights (ECtHR) and led the latter to develop a consistent strand of case law concretizing states' positive obligations. The article also takes a critical stance, examining the risks of crisis discourse and vulnerability when viewed through a crisis lens. To counter these risks, it argues for a nuanced, structural, and dynamic understanding of vulnerability and a focus on resilience-building institutions and mechanisms. Within the ECtHR case law, this signifies elaborating upon the already existing positive obligations, including by taking inspiration from the Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention). Such an approach is necessary to leave behind the emergency time usually associated with crises and work toward lasting structural change.

Assessing diagnostic certainty for scurvy and rickets in human skeletal remains.

OBJECTIVES: Identifying scurvy and rickets has important implications for understanding adaptations and variability among past communities, and bioarchaeologists now regularly evaluate these conditions. Due to the increased number of studies, cases with less clear-cut lesions and variable preservation are now frequently reported. Despite an improved understanding of the biological mechanisms for disease expression, there is a lack of consensus on the language used to express diagnostic certainty, limiting comparability. This article aims to address these issues and provide recommendations on more consistent diagnostic terminology using widely accepted diagnostic methodology based on biological mechanisms. MATERIALS AND METHODS: We review diagnostic terms used in bioarchaeology by considering published cases of rickets, scurvy and co-occurrence alongside M.B.B.'s past project notes. We also consider differences in the diagnosis of rickets and scurvy in living and archeological individuals. RESULTS: We provide recommendations on a framework that can be used to show diagnostic certainty in cases of rickets, scurvy, and co-occurrence. Core lesions of rickets and scurvy are used alongside a limited lexicon of diagnostic terminology based on the Istanbul protocol. DISCUSSION: It is not the number of lesions that determines whether an individual is assigned to a particular diagnosis category, but rather the range and expression of lesions present. Avoiding a "tick-list" approach to core lesions of these diseases will be critical to ensure that identifying rickets and scurvy continues to contribute to understanding adaptations and variability among past communities. The framework allows more consistency in diagnostic certainty, facilitating greater comparability in research.

What constitutes a high-quality, comprehensive medico-legal asylum affidavit in the United States immigration context? A multi-sectoral consensus-building modified Delphi.

In the United States, clinicians are often called upon to provide their expertise to generate expert evidence in cases of individuals seeking asylum or other forms of international protection. Due to a lack of validated guidelines specific to the U.S. immigration context, clinical evaluations produced for immigration proceedings in the United States vary in their format, structure, and content, which can be confusing for practitioners and for adjudicators assessing the weight these evaluations should be afforded in asylum proceedings. We sought to review critical components of a medico-legal asylum evaluation from an interdisciplinary perspective of key stakeholders, by collecting and synthesizing expert opinions to reach consensus on what constitutes a high-quality, comprehensive medical or psychological affidavit for U.S. immigration cases. The consensus process incorporated a three-step modified Delphi method, which took place between September and December 2021 and consisted of two rounds of online questionnaires and a synchronous video conference meeting. The areas most experts agreed on included, by order of highest agreement (combining answers of "strongly agree" and "agree"): A narrative form or checklist is preferable to a predetermined template (95%); Primary care physicians should describe their qualifications to diagnose mental health conditions (81%); Use of citation is helpful, with caveats (77%); Clinicians should include an assessment of malingering (72%); Clinicians should include an executive summary/summary of conclusions at the top of the affidavit (72%); Clinicians should reference the Istanbul Protocol and explain its relevance (66%); It may be beneficial for clinicians to describe the anticipated process of healing (57%); Clinicians may include treatment recommendations (52%). Results of this and future consensus-building efforts and resulting guidance should be used to enhance overall quality of medico-legal reports and incorporated in training programs developed for clinicians, attorneys and adjudicators.

Impact of mixing on water quality in the Bosphorus - Implications on sustainable management of wastewater marine discharges.

The study established the water quality modelling of the Bosphorus system, based on hydrodynamic data as well as the results of the water quality survey carried out in the last five years. The model revealed significant decrease in the magnitude of pollutant loads in the upper layer at the exit into The Marmara Sea providing numerical proof that no pollutant transport would take place from sewage discharges to the upper layer. A similar modelling approach was implemented at the Bosphorus/Marmara interface, a significant hotspot as it included two major deep marine outfalls. The results asserted that the entire sewage flow would enter the lower flow in The Bosphorus through the interface without an appreciable mixing with the upper flow. This way, the study provided a significant scientific support for the sustainable management of marine discharges in this area, since they have no physical interference with The Marmara Sea.

Comparison of the quality of clinical forensic examination of victims of physical violence conducted by clinicians and forensic examiners.

INTRODUCTION: The Istanbul Convention calls for comprehensive care for victims of violence while maintaining forensic standards. After violent crimes, court usable documentation of injuries and securing of evidence is essential to avoid disadvantages for those affected in criminal prosecution. MATERIAL AND METHODS: This retrospective study compares forensic relevant aspects in clinical forensic examination of victims of physical and sexual violence conducted by clinicians and forensic examiners. Forensic medical reports based on clinical documentation of individuals of all ages in the period from 2015 to 2018 (n = 132) were evaluated in comparison to a control group of examinations conducted by forensic specialists. A comparative statistical evaluation was performed. RESULTS: The study revealed statistically significant differences in forensically relevant aspects. In the clinical examinations, full-body examination was performed in only 37.9%, and concealed body sites were examined in 9.8%. Photo documentation was often incomplete (62.4%), without scale (59.1%), blurred (39.7%), or poorly exposed (31.2%). Information on size, color, shape, and texture of injuries was often missing. In about every third examination, the findings were not described purely objective. A body scheme was used only in 8.3% of the clinical cases. DISCUSSION: In order to establish nationwide care structures and the forensic standard required in criminal proceedings, intensive involvement of forensic medicine is essential. Standardized examination materials, regular training of medical staff, and telemedical approaches can improve the care for victims of violence regarding criminal prosecution.

Physical assessment of tortures: Interobserver analysis of medico-legal degrees of consistency based on the Istanbul protocol.

The Istanbul Protocol section on medicolegal evaluation delineates the guidelines for the correct management of the physical examination and the methods of assigning the degrees of consistency. Considering that most cases exhibit highly heterogeneous lesions, the examiner is forced to rely on his own experience, and their evaluation may be very subjective. The purpose of this work is to understand how subjective such an evaluation may be and whether the "experience" factor, interpreted as years dedicated to this profession and the number of cases evaluated, is statistically significant. To this end, a survey containing eleven cases of pre-evaluated asylum seekers was sent to thirty Italian clinical forensic practitioners. The participants were invited to assign a degree of consistency to each case according to the Istanbul Protocol guidelines, besides answering a few questions regarding their professional record. The doctors were divided into groups based on the number of cases evaluated and the experience collected expressed in years, and then interobserver analysis was performed. Results showed that the Fleiss' Kappa coefficient acquired significant values when attention was turned to the sub-samples composed of more experienced participants. Therefore, the introduction of appropriately trained health professionals - "experts in migrations and torture" - could lower the risks of misinterpretation and make the assessment as reproducible as possible.

Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany-results and insights of the in:Fo-project.

As part of a third-party funded project, expert opinions according to the Istanbul Protocol (IP) standards were compiled in Germany on a larger scale for the first time. The assessment process was initiated for 130 project participants. Statistical analysis on numerous variables was performed to test the impact of the expert opinions, foremost of the forensic medical expert opinions, on the individuals' asylum proceedings. The variables were drawn from forensic medical expert opinions and reports of findings, questionnaires for the study participants' counsellors in the project and a query on the asylum status of the study participants. Regression analysis and bivariate analysis on two dependent variables-subjective impact on the asylum procedure from the counsellors' point of view and objective change in the asylum status-were performed to test for an influence on asylum procedures. No statistically significant results were obtained for the objective change of the study participants' asylum status. For the subjective dependent variable, a positive prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and highest IP grade; a negative prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and use of IP grading. Apart from the statistical analysis, a positive effect of the assessment on the psychosocial well-being of the study participants could be demonstrated. The results differed from other European studies which demonstrated a correlation between the objective outcome of an asylum procedure (asylum status) and, for example, specific types of violence or the number of documented injuries. Differences also occurred in the use of the plausibility grades proposed by the IP, which questions their use in cases in which the reported torture happened a relevant time ago. Therefore, compiling individually worded evaluations instead of using the IP grading system-if possible, by an experienced forensic physician-is recommended in this scenario. Still, the assessment of alleged torture experiences should follow the IP guidelines, since psychological assessments are of especially high importance in cases with healed physical injuries and since the results also demonstrated a positive effect on the psychosocial well-being of the study participants.