which指代什么？

The evolution of concepts about the relationship between pain and worker’s compensation reflect not just careful observation, as in describing pain and depression, but rather how social bias powerfully influences clinical thought. Mendelson (31) recounts how over the last century socioeconomic factors and science interacted in the evolution of psychiatric diagnosis in injured patients, leading to the use of stigmatizing labels such as compensation neurosis, psychogenic pain, and secondary gain that are medically convenient but without scientific or clinical merit (32–34). We now take for granted the scientific advances made in imaging and electrophysiological technology (35,36) and in the science of epidemiology , which introduced measures of prediction such as validity into clinical science. However, only 20 years ago, physicians relied on physical examination and conventional x-rays (which do not reveal soft-tissue pathology) to demonstrate pathology; patients without any demonstrable cause for the intensity and persistence of pain and impairments were assumed to be seeking personal gain and were thought to have a variant of psychogenic pain. The notion of psychological causation was buttressed by studies using psychological tests, for example the Minnesota Multiphasic Personality Inventory , which showed an abnormal profile in chronic low back pain, the “conversion V” (elevations on the hysteria, depression, and hypochondriasis scales) (37). However, later studies showed that this profile indicated no specific disorder but chronic illnesses.

关于疼痛和工人赔偿之间关系的概念演变不仅反映了对疼痛和抑郁等的仔细观察，还反映了社会偏见如何强烈地影响了临床思维。Mendelson（31）讲述了在上个世纪里，社会经济因素和科学在受伤患者的精神病学诊断演变中的相互作用，导致使用诸如补偿性神经症、心因性疼痛和再度获益等污辱性标签，这些标签方便在医学上使用，但没有科学或临床价值（32-34）。我们现在理所当然地认为影像、电生理技术（35，36）和流行病学取得的科学进步是理所当然的，这些科学进步将效度等预测指标引入临床医学。然而，就在20年前，医生们依靠体检和常规X线（不能显示软组织病变）来证明病理；那些疼痛和损伤的强度和持续性没有任何明显原因的患者被认为是在寻求个人利益，并被认为患有独特的心因性疼痛。心理因果关系的概念得到了心理测试研究的支持，例如明尼苏达多相人格问卷显示了慢性下腰痛的异常特征，即“转换V”（歇斯底里、抑郁和疑病量表上的升高）（37）。然而，后来的研究表明，这一特征并不表明有特定的疾病而是慢性疾病的特征。

按理说which应指代影像、电生理技术（35，36）和流行病学所取得的科学进步，但是感觉只有流行病学的科学进步才和效度等预测指标联系在一起。