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Context: Pain is a poorly managed aspect in fibrous dysplasia/McCune-Albright syndrome (FD/MAS) because of uncertainties regarding the clinical, behavioral, and neurobiological underpinnings that contribute to pain in these patients. Objective: Identify neuropsychological and neurobiological factors associated with pain severity in FD/MAS. Design: Prospective, single-site study. Patients: Twenty patients with FD/MAS and 16 age-sex matched healthy controls. Intervention: Assessments of pain severity, neuropathic pain, pain catastrophizing (pain rumination, magnification, and helplessness), emotional health, and pain sensitivity with thermal quantitative sensory testing. Central nervous system (CNS) properties were measured with diffusion tensor imaging, structural magnetic resonance imaging, and functional magnetic resonance imaging. Main outcome measures: Questionnaire responses, detection thresholds and tolerances to thermal stimuli, and structural and functional CNS properties. Results: Pain severity in patients with FD/MAS was associated with more neuropathic pain quality, higher levels of pain catastrophizing, and depression. Quantitative sensory testing revealed normal detection of nonnoxious stimuli in patients. Individuals with FD/MAS had higher pain tolerances relative to healthy controls. From neuroimaging studies, greater pain severity, neuropathic pain quality, and psychological status of the patient were associated with reduced structural integrity of white matter pathways (superior thalamic radiation and uncinate fasciculus), reduced gray matter thickness (pre-/paracentral gyri), and heightened responses to pain (precentral, temporal, and frontal gyri). Thus, properties of CNS circuits involved in processing sensorimotor and emotional aspects of pain were altered in FD/MAS. Conclusion: These results offer insights into pain mechanisms in FD/MAS, while providing a basis for implementation of comprehensive pain management treatment approaches that addresses neuropsychological aspects of pain. [ABSTRACT FROM AUTHOR]

Objective To explore the impact of common gastrointestinal (GI) symptoms on psychological symptoms, sleep quality, and quality of life in patients with inflammatory bowel disease (IBD). Methods A unified questionnaire was developed to collect clinical data on the mental psychology and quality of life of IBD patients from 42 hospitals in 22 provinces in P. R. China from September 2021 to May 2022. The general clinical characteristics, psychological symptoms, sleep quality, and quality of life of IBD patients with different numbers of GI symptoms were analyzed by descriptive statistical analysis. Results A total of 2,478 IBD patients were finally analysed in this study, including 365 without GI symptoms (14.7%), 752 with single symptoms (30.4%), 841 with double symptoms (33.9%), and 520 with three symptoms (21.0%). Compared with patients without GI symptoms, patients with only simple abdominalgia or diarrhea or hematochezia showed significantly higher levels of anxiety and depression and worse quality of life (all P  <   0.05). Compared with asymptomatic patients, patients with double symptoms (e.g. abdominalgia plus hematochezia, diarrhea plus hematochezia, abdominalgia plus diarrhea) and patients with three symptoms (abdominalgia, diarrhea, and hematochezia) showed significantly higher levels of anxiety and depression and worse sleep quality and quality of life (all P  <   0.05). Conclusion Compared with IBD patients without gastrointestinal symptoms, patients with gastrointestinal symptoms were more likely to experience anxiety, depression, sleep disturbances, and poorer quality of life. [ABSTRACT FROM AUTHOR]

Aim The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health. Subject and Methods To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n  = 3 802). Results Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning—with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude. Conclusion We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded. [ABSTRACT FROM AUTHOR]

Background Past research on the association between sexual desire and the menstrual cycle has provided inconclusive results and has not considered the potential influence of psychological and physical changes that are frequently associated with the menstrual cycle. Aim To test the strength of association between the menstrual cycle (and associated symptoms) and changes in sexual desire. Methods Prospective daily reports across 2 full menstrual cycles (2 months) from a sample of female university students (n = 213), were analysed. Analyses tested for average effects of the menstrual cycle on sexual desire, individual differences in these effects, and cyclical and noncyclical associations between sexual desire and the 9 menstrual cycle–related changes. Note that data presented in the current article come from a larger study from which other reports have been published. Outcomes Target variables were (1) daily change in sexual desire and (2) daily reports of 5 psychological changes and 4 physical changes that are commonly associated with the menstrual cycle. Results Results showed that when considering average effects across participants, the menstrual cycle was associated with a small midcycle increase in sexual desire. However, multilevel analyses showed large individual differences in how the menstrual cycle influences sexual desire. Specifically, some participants showed a midcycle increase, others a perimenstrual increase, and others no change across the menstrual cycle. Moreover, results demonstrated that psychological changes were more important for predicting sexual desire as compared with physical changes. Clinical Implications These results suggest that daily measurement of sexual desire across multiple menstrual cycles may be an important tool in the assessment of sexual desire among some females. Strengths and Limitations Strengths of this study are the daily assessment of sexual desire and all symptoms for 2 menstrual cycles and multilevel analyses that allow the study of individual differences. Limitations include limited measurement of sexual desire based on only 2 questions and the lack of measures of relationship status and sexual orientation. Conclusion Emphasis is placed on the need to apply more rigorous research methods and to abandon simplistic average-effects models that are based on outdated theories and stereotypes. [ABSTRACT FROM AUTHOR]

Background Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. Methods Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018 and 2020. Itching, sleep problems and psychological symptoms were assessed with the Dialysis Symptom Index (DSI) and HRQOL with the 12-item Short Form Health Survey. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally using linear regression and linear mixed models. Results Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL {−3.35 [95% confidence interval (CI) −4.12 to −2.59) and −3.79 [95% CI −4.56 to −3.03]}. HRQOL remained stable during 2 years and trajectories did not differ between patients with or without itching. Sleep problems (70% versus 52%) and psychological symptoms (36% versus 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL but did not interact with itching. Conclusions The persistence of itching, its impact on HRQOL over time and the additional effect on HRQOL of sleep problems and psychological symptoms emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL. [ABSTRACT FROM AUTHOR]

Introduction: Many service members experiencing symptoms of mental health conditions do not receive mental health care for these symptoms. The stigma associated with having a mental health condition or seeking treatment is often cited as a specific barrier to mental health care. However, study results bearing on the question of whether and how stigma may reduce treatment-seeking have been inconsistent.Methods: We searched 10 databases for sources published between 2004 and 2014 that prospectively linked stigma to treatment-related outcomes (such as treatment seeking, retention, and reports of symptoms) using longitudinal data and predictive models. The searches yielded 2,409 sources. After reviewing titles and abstracts for relevance, we retained 15 sources to undergo full-text review.Results: Overall, this review illustrates that evidence exploring the direct effect of stigma on treatment-related outcomes is still scant. We identified two studies whose outcomes conflict when it comes to stigma and treatment-initiation and utilization, and three studies found no relationship between stigma and treatment-initiation and utilization. One study suggested that the relationship between stigma and experience of symptoms is nuanced and may depend on the type of stigma and types of symptoms considered. Meager evidence was available to inform the relationship between stigma and treatment duration, attrition, and quality of life/functioning. The evidence was not sufficient to draw conclusions about the state of these relationships. No conclusions could be made about the direct impact of stigma on treatment-related outcomes among military service members given that only two studies explored this relationship among military service members.Conclusion: Current research does not provide a true understanding of the degree to which mental illness stigma affects treatment-related outcomes for service members experiencing mental health challenges. This understanding could only be developed through a longitudinal study assessing prospectively whether stigma affects treatment-utilization in the military. Should such a study show that stigma reduces treatment-utilization, the military would need to consider whether changes to their current approaches to stigma reduction are warranted. [ABSTRACT FROM AUTHOR]

Background Recently, the etiology of sexual dysfunctions in women has been approached from different angles. In clinical practice and in previous studies, it has been observed that women with sexual problems experience anxiety problems and express more rigid and perfectionistic personality traits than women without these problems. Aim To investigate whether personality disorder characteristics according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and psychological symptoms are associated with sexual problems in women. Methods 188 women 18 to 25 years old participated in this cross-sectional study. Questionnaires measuring sexual functioning (Female Sexual Function Index), personality disorder characteristics (Assessment of DSM-IV-TR Personality Disorders Questionnaire), and psychological symptoms (Brief Symptom Inventory and Center for Epidemiological Studies Depression Scale) were used. Outcome The main outcome measure used was sexual functioning assessed by self-report. Results Results, using analysis of variance, indicated that women with sexual problems report significantly more cluster A (specifically schizoid) and C (specifically avoidant and obsessive-compulsive) personality disorder characteristics than women without sexual problems. Furthermore, using multiple regression analyses, higher cluster A (specifically schizoid) and lower cluster B (specifically borderline and antisocial) personality disorder characteristics indicated lower levels of sexual functioning. Psychological symptoms partly mediated the effect of cluster A personality disorder characteristics on sexual functioning. Clinical Implications The results of this study indicate that clinical practice should extend its scope by focusing more on improving adaptive personality characteristics, such as extraversion and individualism seen in cluster B personality characteristics, and decreasing the perfectionistic, introvert, and self-doubting characteristics seen in cluster C personality characteristics. Strengths and Limitations Because of the correlational design and use of self-report measures, causal relations cannot be established between personality disorder characteristics and sexual functioning. Conclusion Overall, the results indicate that personality disorder characteristics can play an important associative role in the development and maintenance of sexual functioning problems in women. Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2018;15:192–200. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of work characteristics on the psychological symptoms of general practitioners' (GPs) and community nurses.Design, Setting and Participants: A stratified sampling cross-sectional survey was performed at the 12 community health services centres involved 233 GPs and 202 community nurses in three cities of Hubei Province in central China. The independent variables were career prospects, superior recognition, salary fairness, professional-patient relationship and self-perceived workload. The dependent variables were the General Health Questionnaire.Results: The generalized linear regression showed the career prospects had a significant association with GPs' psychological health, whereas career prospects, self-perceived workload and superior recognition had significant association on the psychological health of community nurses. However, salary fairness and professional-patient relationship were not statistically significant for GPs or community nurses.Conclusions: A better understanding of the effects of career prospects on the psychological health of GPs and community nurses, and improvements in superior recognition and workload on the psychological health of community nurses, would improve psychological symptoms of primary-level medical staff. [ABSTRACT FROM AUTHOR]

Objective To explore psychological symptoms in emerging adults with spina bifida (SB) and their association with self-management and satisfaction with family functioning. Methods Longitudinal data were collected at 2 time points, 15 months apart, in 48 individuals with SB. Reliable change indices and paired samples t-tests assessed change in anxiety and depressive symptoms. Hierarchical regression models explored the contributions of SB severity, family satisfaction, and self-management in explaining change in psychological symptoms. Results No significant group level differences in psychological symptoms were found across time in participants (Mean age 22 years), but significant individual-level change in anxiety symptoms (n = 13) and depressive symptoms (n = 9) was observed. Improved satisfaction with family functioning was associated with decreased anxiety symptoms (b = −0.30, p = .02), and increased SB self-management was related to reduced depressive symptoms (b = −0.63, p = .01). Conclusions Changes in self-management and satisfaction with family functioning may influence the course of psychological symptoms. [ABSTRACT FROM AUTHOR]

The protection of witnesses occupies a prominent place in 10 years of practice of the International Criminal Tribunal for Rwanda (ICTR). This paper sketches certain elements of the ICTR law on this matter. Among other things, it demonstrates that this law is flexible and has resulted in the provision of protective measures as a matter of routine, without much regard for the principles of public trial. It is furthermore critical as to the practical effect of protective measures, arguing that enforcement mechanisms in the form of contempt procedures are highly unattractive, and the continuing expansion of protective measures is undesirable from the perspective of the rights of the accused. A final point of criticism addressed in this paper concerns the apparent lack of interest of the ICTR in the protection of a particular category of witnesses, namely witnesses detained in Rwanda. [ABSTRACT FROM PUBLISHER]

This article aims to assess the contribution of the Outreach Programme at the International Criminal Tribunal for Rwanda (ICTR). The author introduces and discusses two general approaches or models of outreach that international criminal tribunals may pursue. The transparency model of outreach seeks to make a tribunal's opaque legal process more visible by disseminating basic information about the court to communities recovering from human rights abuses. The engagement model goes beyond only informing these communities by facilitating frequent and extensive tribunal interaction and dialogue through seminars, town hall presentations, and training of legal professionals. Despite some progress with limited resources, the efforts of the Outreach Programme of the ICTR to engage the Rwandan population and to make the Tribunal more transparent have been ineffective. The article recommends that the ICTR bolster its outreach efforts by helping to train Rwanda's judiciary, appointing more Rwandans to serve in positions of authority at the Tribunal, and engaging domestic and international non-governmental organizations in outreach programme partnerships. [ABSTRACT FROM PUBLISHER]

Drawing upon a book by J.M. Lecomte on the genocide of the Jews by the Nazi Germans, the author examines the seven stages in the genocide of the Tutsi in Rwanda. These stages, which do not necessarily follow one another in time but may overlap, can be classified in the following way: (i) definition of the target group on the basis of some criteria; (ii) registration of the victims; (iii) designation or outward identification of the victims; (iv) restriction and confiscation of goods; (v) exclusion from professions, working activities and means of transportation, among other things; (vi) systematic isolation; (vii) mass extermination. [ABSTRACT FROM PUBLISHER]

Faced with an overflowing caseload and imperatives of national reconciliation, Rwandan authorities have established a system of justice, meted out through gacaca courts under the legal framework created by organic laws. The following contribution analyses this framework, within the context of national and international legal systems, and pinpoints the shortcomings of the proposed form of justice. These include legal issues such as the problem of retroactivity, as well as the definition of crimes and concerns over due process and the right to a fair trial for defendants. Practical and material obstacles arise in implementing the organic laws, alongside broader implications owing to the traditional nature of such courts and possible interference by political authorities. In this respect, the gacaca courts may be victims of their own ambitions, by seeking to respond to judicial, societal and philosophical concerns alike. [ABSTRACT FROM PUBLISHER]

Since trials began in 1997, the International Criminal Tribunal for Rwanda (ICTR) has conducted cases involving 50 accused, involving a prime minister and several ministers, prefects, bourgmestres and other leaders, who would otherwise not have been brought to justice. Judgments have been rendered in respect of 25 accused, with three acquittals. During the first mandate (1995–1999), the Tribunal delivered ground-breaking judgments concerning genocide, such as Akayesu and Kambanda. In the second mandate (1999–2003), the judicial output doubled and included the Media judgment. Halfway into the third mandate (2003–2007), trials involving 25 accused are ongoing. The ICTR is an efficient judicial institution which has conducted fair trials, created important jurisprudence, and made a significant contribution to the development of international criminal justice. [ABSTRACT FROM PUBLISHER]

Since his appointment in 2003, the Prosecutor of the International Criminal Tribunal for Rwanda (ICTR) remains silent on the issue of prosecuting officials of the victorious Rwandan Patriotic Front (RPF). There is certainly no lack of credible reports about massive violations of human rights and international humanitarian law by the RPF both in Rwanda and in neighbouring countries, in 1994 and thereafter. The Prosecutor and the UN Security Council, despite lip service to the contrary, seem less than eager to confront the government in Kigali. It is therefore to be feared that prosecutorial practice at the ICTR will follow the Nuremberg paradigm. This one-sided policy may, however, have far-reaching consequences. [ABSTRACT FROM PUBLISHER]

Over a decade after the establishment of the International Criminal Tribunal for Rwanda (ICTR), an assessment of its achievements with regard to its role in fostering reconciliation among Rwandans must be undertaken. The ICTR's activities have provided a setting for witnesses and victims of the genocide to testify before judicial authorities. However, persisting obstacles involving the nature of the conflict and ongoing instability in the country have hindered progress in efforts at national reconciliation, and addressing the issue of compensation for victims remains inadequate. The ICTR continues to play a crucial role in shedding light on the atrocities and endeavouring to raise awareness for victims’ issues at the international level. [ABSTRACT FROM PUBLISHER]

The Judgment of the International Criminal Tribunal for Rwanda in the Media case focuses on the responsibility of three individuals charged on the basis of their control of a radio channel and a newspaper in Rwanda. Due to overt freedom of speech issues relating to this Judgment, it was immediately mass-mediatized. This article analyses the case from a purely legal perspective, focusing on the issue of ‘how’ the Judges determined the culpability of individuals for crimes concerning the media's influence in the preparation and execution of mass crimes. Some critical elements appear in this perspective, including: the (il)legitimacy of the extension of jurisdiction ratione temporis; the (in)opportunity to establish the mens rea of an inchoate offence via the actus reus of a non-inchoate offence; the (un)certain distinction between forms of direct and indirect participation; and the (in)determination of the criteria applied to reduce the sentence against one of the accused (as a form of reparation for the violation of procedure by the Prosecutor). [ABSTRACT FROM PUBLISHER]

The genocide in Rwanda will define for our generation the failure to intervene in the face of mass human rights abuses. The UN Security Council (the Council) was intimately involved in this terrible event, with the decisions it took from October 1993, when a peacekeeping mission was created for Rwanda, having a decisive effect on what happened. This article details the crucial meetings held by the Council in secret and informal sessions and describes how a serious assessment of the situation in Rwanda was simply missing. It shows how the peacekeepers of the Council's mission to Rwanda were abandoned during the genocide and how the efforts of these UN personnel to ease the suffering of the Rwandan people were ignored by the Great Powers. [ABSTRACT FROM PUBLISHER]

Faced with incontrovertible evidence of the most clear-cut case of genocide possible, the international community failed to denounce the evil and to take action to stop the killings taking place in Rwanda in 1994. Under the influence of three major powers—France, the United States and the United Kingdom—the United Nations was disabled from taking the necessary action because the mass slaughter of the Tutsi people did not impinge on these powers' narrowly defined national interests. In the specific case of France, there is evidence to show that this power arguably aided and abetted the genocide. Yet, in contrast, these three powers were able to take decisive and quick action when faced with an outraged domestic public in response to the humanitarian crisis which unfolded from the genocide. There are many reasons why individuals and governments cannot bring themselves to use the word ‘genocide’. In the case of Rwanda, perhaps the enormity of the concept prevented those who were in the midst of it from recognizing it for what it actually was. [ABSTRACT FROM PUBLISHER]

After many decades of impunity, Rwanda has embarked upon a course of transitional justice committed to prosecuting all who are suspected of involvement in the 1994 genocide. The first phase, which began in 1997 and is still continuing, targets the most serious offenders. Some 10,000 have been tried under the system. Confronted with its limitations, Rwanda has devised a second approach, known as gacaca, which focuses on a lower and less heinous level of participation in genocide, and which is inspired by traditional models of local justice. Acting upon legislation adopted in 2001, a pilot phase convinced Rwandan justice officials of the viability of the process throughout the country. The institutions have been fine-tuned, and become fully operational in the course of 2005. Because the pilot phase encouraged denunciation, instead of offering ‘closure’, the process has actually revealed a much broader popular participation in the atrocities of 1994. Rwandan authorities now say the gacaca process will prosecute more than 1,000,000 suspects. [ABSTRACT FROM PUBLISHER]

The jurisprudence of the International Criminal Tribunal for Rwanda (ICTR) has properly focused on the special intent (dolus specialis) to destroy a group as the distinguishing characteristic of genocide and differentiated it from result-oriented crimes. Although the ICTR has crowned genocide as ‘the crime of crimes’, it has simultaneously dethroned it by holding that it attracts the same sentence as other humanitarian law violations. Nonetheless, ICTR jurisprudence attaches considerable importance to characterizing the destruction of the Tutsi as genocide as distinct from crimes against humanity. Because the Tutsi cannot be readily distinguished as one of the protected groups under the Genocide Convention, Trial Chambers have gone to great lengths to characterize them as an ‘ethnic’ group in order to justify the label of genocide. [ABSTRACT FROM PUBLISHER]

Considering the magnitude of rape and other sexual crimes perpetrated during the Rwandan genocide, gender crimes prosecutions at the International Criminal Tribunal for Rwanda (ICTR) have been inadequate so far. Nonetheless, the ICTR case law must be commended for the impulse given, with and after Akayesu, to the criminalization and punishment of gender-related violence. This paper points to the achievements of the ICTR case law in this respect. [ABSTRACT FROM PUBLISHER]

This article begins with an account of significant events and socio-political relationships in the history of Rwanda, leading to mass murder and genocide in 1994. An explanation is then offered of these crimes, based on an analysis of certain ecological, economic, cultural and political factors specific to Rwanda, but shared to an important extent by much of East Africa. [ABSTRACT FROM PUBLISHER]

The author describes the results of the UN Independent Inquiry on the Genocide in Rwanda, which he headed. The international community's reluctance to commit itself and its resources to the UN Assistance Mission for Rwanda (UNAMIR or UN Mission), coupled with the inadequacy of UNAMIR's initial mandate, are identified as the crucial reasons for the Mission's failings. These weaknesses led to the failure of the UN forces on the ground to respond effectively to the genocide and inhibited their ability to protect civilians and UN staffers. The author details the failures both of the UN Mission in Rwanda and of the leadership in New York, with unflinching exactitude, drawing important lessons to help ensure that another such breakdown of the UN system during a time of crisis does not happen again. [ABSTRACT FROM PUBLISHER]

Background: It is a recurrent finding that adolescent girls report psychological symptoms in a higher degree compared with boys. The explanations for this difference vary, but the psychosocial school environment has never been a focus in these explanations. The aim of this study was to analyse whether psychosocial factors at school were associated with a high degree of psychological symptoms among boys and girls in grade nine, with a special focus on sexual harassment. Methods: The study was based on a cross-sectional study including 336 pupils (175 girls and 161 boys) in grade nine (about 15 years old), who answered an extensive questionnaire. The non-response rate was negligible (< 1%). Logistic regression analysis was used to analyse whether school-related factors (teacher support, classmate support, sexual harassment), body image, and parental support were associated with a high degree of psychological symptoms. Results: Sexual harassment at school was associated with a high degree of psychological symptoms among girls. Conclusions: Sexual harassment must be acknowledged as a negative psychosocial school environmental factor of importance for the high degree of psychological ill-health symptoms among girls compared with boys. [ABSTRACT FROM AUTHOR]

This article reviews findings on the maternal stress and health effects of lactation. Several significant associations have emerged. Compared with not breastfeeding, breastfeeding is associated with increased parasympathetic nervous system modulation, greater vascular stress response, lower perceived stress levels, and fewer depressive symptoms. Breastfeeding exclusively is associated with an attenuated initial sympathetic cardiac nervous system response to some laboratory stressors. Bottle-feeding is associated with increased sympathetic and decreased parasympathetic cardiac control. The act of breastfeeding is associated with decreased neuroendocrine response to stressors and decreased negative mood. Finally, breastfeeding is associated with enhanced physical and mental health compared with non-breastfeeding. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses an article on the failure of the international committee to stop the genocide in Rwanda, the need of justice after genocide, and the strenuous search for individual accountability for genocide in Rwanda.