The Deborah Jones Merritt Center for the Advancement of Justice

When invited to write an essay on clinical legal education honoring our friend, we were struck by the importance of a focus on clinical legal education in any collection of work paying tribute to Professor Deborah Jones Merritt. Legal education has benefited from a fifty-year movement for clinical education. This movement necessarily interrogates and seeks to overcome the anachronistic, inherited Langdellian paradigm that dominates and continues to define the curricula and policies of our law schools. But the movement for clinical education has been exponentially confounded by contemporary legal education’s shape as a pyramid of statuses and privileges accumulated over time and embedded in the straight, white, male, ableist, classist structures of American universities, our legal system, and our laws.Progress has been made. Thousands of lawyers now enter the profession with the advantage of having practiced under the supervision of faculty who choose to live in the fray of the reality of clients’ lives, the ambiguity of the real world, and the politics of the profession. Thousands of lawyers have learned through clinical education the habits of planning, doing, and reflecting that are otherwise invisible in the academy.But clinical faculty typically work at lower pay in smaller offices on cases that don’t run on an academic timetable, in physical and ideological structures that are ill-suited for law practice, and in statuses that deprive them of the ability to build a better-suited environment. Perhaps most cruelly in an academic environment, clinical faculty have faced the pervasive stigma of the foolish but well-entrenched notion that classroom teaching far removed from practice demands a higher order of intellect. Professor Merritt understood this to be untrue, unjust, bad for students, and potentially disastrous for their future clients.With the ambition to undertake her best work and motivated to hew her efforts to their highest calling, Professor Merritt unflinchingly and joyfully crossed the divide to become a clinician. At the height of an exceptional professorial career, Professor Merritt cheerfully changed course. She had learned from her students that she should become a different kind of professor so they could become the lawyers they wanted to be, the lawyers their future clients deserved. We are humbled to write in honor of such a clear-eyed colleague

Working as a Healthcare Professional and Wellbeing During the COVID-19 Pandemic: Work Recovery Experiences and Need for Recovery as Mediators

Considering the high impact strain that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has put on medical personnel worldwide, identifying means to alleviate stress on healthcare professionals and to boost their subjective and psychological wellbeing is more relevant than ever. This study investigates the extent to which the relationships between the status of working in healthcare and the subjective and psychological wellbeing are serially mediated by work recovery experiences and the need for recovery. Data were collected from 217 Romanian employees (44 health professionals and 173 employees from other domains) using a cross-sectional design with self-report instruments, during the first stage of the nationwide lockdown. The results of the serial mediation analyses revealed that working in the medical field is indirectly related to subjective and psychological wellbeing through the following: (i) mastery experiences and (ii) mastery experiences as an antecedent of the need for recovery. As such, our findings indicate that (i) working in the medical field is, in fact, linked to healthcare professionals' subjective and psychological wellbeing, and they provide some input on (ii) how recovery experiences and the need for recovery intervene in these relationships. Based on these findings, theoretical, methodological, and practical implications were suggested, and future research directions were proposed to maximize healthcare professionals' wellbeing

On the accuracy of DFT exchange-correlation functionals for H bonds in small water clusters II: The water hexamer and van der Waals interactions

Second order Moeller-Plesset perturbation theory (MP2) at the complete basis set (CBS) limit and diffusion quantum Monte Carlo (DMC) are used to examine several low energy isomers of the water hexamer. Both approaches predict the so-called "prism" to be the lowest energy isomer, followed by "cage", "book", and "cyclic" isomers. The energies of the four isomers are very similar, all being within 10-15 meV/H2O. This reference data is then used to evaluate the performance of several density-functional theory (DFT) exchange-correlation (xc) functionals. A subset of the xc functionals tested for smaller water clusters [I: Santra et al., J. Chem. Phys. 127, 184104 (2007)] has been considered. Whilst certain functionals do a reasonable job at predicting the absolute dissociation energies of the various isomers (coming within 10-20 meV/H2O), none predict the correct energetic ordering of the four isomers, nor does any predict the correct low total energy isomer. All xc functionals tested either predict the book or cyclic isomers to have the largest dissociation energies. A many-body decomposition of the total interaction energies within the hexamers leads to the conclusion that the failure lies in the poor description of van der Waals (dispersion) forces in the xc functionals considered. It is shown that the addition of an empirical pairwise (attractive) C6/R6 correction to certain functionals allows for an improved energetic ordering of the hexamers. The relevance of these results to density-functional simulations of liquid water is also briefly discussed.Comment: 15 pages including 4 figures; related publications can be found at http://www.fhi-berlin.mpg.de/th/th.htm

Diploma Privilege and the Constitution

The COVID-19 pandemic and resulting shutdowns are affecting every aspect of society. The legal profession and the justice system have been profoundly disrupted at precisely the time when there is an unprecedented need for legal services to deal with a host of legal issues generated by the pandemic, including disaster relief, health law, insurance, labor law, criminal justice, domestic violence, and civil rights. The need for lawyers to address these issues is great but the prospect of licensing new lawyers is challenging due to the serious health consequences of administering the bar examination during the pandemic. State Supreme Courts are actively considering alternative paths to licensure. One such alternative is the diploma privilege, a path to licensure currently used only in Wisconsin. Wisconsin\u27s privilege, limited to graduates of its two in-state schools, has triggered constitutional challenges never fully resolved by the lower courts. As states consider emergency diploma privileges to address the pandemic, they will face these unresolved constitutional issues. This Article explores those constitutional challenges and concludes that a diploma privilege limited to graduates of in-state schools raises serious Dormant Commerce Clause questions that will require the state to tie the privilege to the particular competencies in-state students develop and avenues they have to demonstrate those competencies to the state\u27s practicing bar over three years. Meeting that standard will be particularly difficult if a state adopts an in-state privilege on an emergency basis. States should consider other options, including privileges that do not prefer in-state schools. The analysis is important both for states considering emergency measures and for those that might restructure their licensing after the pandemic

The Bar Exam and the COVID-19 Pandemic: The Need for Immediate Action

The novel coronavirus COVID-19 has profoundly disrupted life in the United States. Among other challenges, jurisdictions are unlikely to be able to administer the July 2020 bar exam in the usual manner. It is essential, however, to continue licensing new lawyers. Those lawyers are necessary to meet current needs in the legal system. Equally important, the demand for legal services will skyrocket during and after this pandemic. We cannot close doors to the profession at a time when client demand will reach an all-time high.In this brief policy paper, we outline six licensing options for jurisdictions to consider for the Class of 2020. Circumstances will vary from jurisdiction to jurisdiction, but we hope that these options will help courts and regulators make this complex decision. These are unprecedented times: We must work together to ensure we do not leave the talented members of Class of 2020 on the sidelines when we need every qualified professional on the field to keep our justice system moving

Prevalence of Drug-Resistant HIV-1 Variants in Untreated Individuals in Europe: Implications for Clinical Management

BackgroundInfection with drug-resistant human immunodeficiency virus type 1 (HIV-1) can impair the response to combination therapy. Widespread transmission of drug-resistant variants has the disturbing potential of limiting future therapy options and affecting the efficacy of postexposure prophylaxis penta increase-spacing 1>MethodsWe determined the baseline rate of drug resistance in 2208 therapy-naive patients recently and chronically infected with HIV-1 from 19 European countries during 1996-2002 ResultsIn Europe, 1 of 10 antiretroviral-naive patients carried viruses with ⩾1 drug-resistance mutation. Recently infected patients harbored resistant variants more often than did chronically infected patients (13.5% vs. 8.7%; P=.006). Non-B viruses (30%) less frequently carried resistance mutations than did subtype B viruses (4.8% vs. 12.9%; P<.01). Baseline resistance increased over time in newly diagnosed cases of non-B infection: from 2.0% (1/49) in 1996-1998 to 8.2% (16/194) in 2000-2001 ConclusionsDrug-resistant variants are frequently present in both recently and chronically infected therapy-naive patients. Drug-resistant variants are most commonly seen in patients infected with subtype B virus, probably because of longer exposure of these viruses to drugs. However, an increase in baseline resistance in non-B viruses is observed. These data argue for testing all drug-naive patients and are of relevance when guidelines for management of postexposure prophylaxis and first-line therapy are update

Assessment of the sensitivity of model responses to urban emission changes in support of emission reduction strategies

© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/The sensitivity of air quality model responses to modifications in input data (e.g. emissions, meteorology and boundary conditions) or model configurations is recognized as an important issue for air quality modelling applications in support of air quality plans. In the framework of FAIRMODE (Forum of Air Quality Modelling in Europe, https://fairmode.jrc.ec.europa.eu/) a dedicated air quality modelling exercise has been designed to address this issue. The main goal was to evaluate the magnitude and variability of air quality model responses when studying emission scenarios/projections by assessing the changes of model output in response to emission changes. This work is based on several air quality models that are used to support model users and developers, and, consequently, policy makers. We present the FAIRMODE exercise and the participating models, and provide an analysis of the variability of O3 and PM concentrations due to emission reduction scenarios. The key novel feature, in comparison with other exercises, is that emission reduction strategies in the present work are applied and evaluated at urban scale over a large number of cities using new indicators such as the absolute potential, the relative potential and the absolute potency. The results show that there is a larger variability of concentration changes between models, when the emission reduction scenarios are applied, than for their respective baseline absolute concentrations. For ozone, the variability between models of absolute baseline concentrations is below 10%, while the variability of concentration changes (when emissions are similarly perturbed) exceeds, in some instances 100% or higher during episodes. Combined emission reductions are usually more efficient than the sum of single precursor emission reductions both for O3 and PM. In particular for ozone, model responses, in terms of linearity and additivity, show a clear impact of non-linear chemistry processes. This analysis gives an insight into the impact of model’ sensitivity to emission reductions that may be considered when designing air quality plans and paves the way of more in-depth analysis to disentangle the role of emissions from model formulation for present and future air quality assessments.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London