Beyond Lawyer Assistance Programs: Applying the United States Marine Corps\u27 Concepts and Principles of Spiritual Fitness as a Means Towards Increasing the Health, Resiliency, and Well-Being of Lawyers—While Restoring the Soul of the Profession

(Excerpt) Lawyer Assistance Programs (“LAPs”) are recognized as an invaluable tool for increasing well-being by assisting lawyers to secure confidential treatment in order to overcome various addictions and mental health issues. The 2017 report by the National Task Force on Lawyer Well-Being underscores this notion by asserting that LAPs “play a pivotal role in lawyer wellbeing.” While this is true, the legal profession would do well to look beyond LAPs and broaden its discussion regarding wellness. In particular, the American Bar Association (“ABA”) should more robustly recognize and encourage spirituality as a means towards health, resiliency, and well-being, much like the United States Marine Corps (“USMC”) has done. Spirituality, as viewed by the USMC, is another valuable resource, among others, that is an important means to increase the health and resiliency of its members. Indeed, spiritual fitness is prominently referenced and has its own section in the official website of the USMC maintained by Headquarters Marine Corps. Along with this, General Robert B. Neller, then Commandant of the USMC, recognizing the importance of spiritual fitness in a 2016 ALMAR message to all Marines, stated that “[r]esearch indicates that spiritual fitness plays a key role in resiliency, in our ability to grow, develop, recover, heal, and adapt. Regardless of individual philosophy or beliefs, spiritual well-being makes us better warriors and people of character capable of making good choices on and off duty.” Setting aside the significant differences in the demands, work, and lifestyles of Marines as warriors compared to that of lawyers as white-collar professionals, there are enough similarities between the professions as they relate to wellness to link the concept of spirituality as a means towards increasing well-being among lawyers. For example, both professions often involve great difficulties and test the breaking point of its members; additionally, both professions often involve highly stressful work with long hours, considerable responsibility, and the need for excellence and results-generated productivity. Perhaps most importantly, both professions often involve weighty responsibilities and heavy burdens that entail enormous consequences and impact on other people. Certainly, the stress associated with these factors does not, in and of itself, cause addiction or mental health issues. But it undoubtedly often serves as a catalyst or trigger in some individuals for addictive behavior or certain mental health conditions, such as depression, which can spiral into destructive behavior or poor life choices

Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?

OBJECTIVE: Disease-modifying osteoarthritis drugs (DMOADs) are under development. Our goal was to determine efficacy, toxicity, and cost thresholds under which DMOADs would be a cost-effective knee OA treatment. DESIGN: We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare guideline-concordant care to strategies that insert DMOADs into the care sequence. The guideline-concordant care sequence included conservative pain management, corticosteroid injections, total knee replacement (TKR), and revision TKR. Base case DMOAD characteristics included: 50% chance of suspending progression in the first year (resumption rate of 10% thereafter) and 30% pain relief among those with suspended progression; 0.5%/year risk of major toxicity; and costs of $1,000/year. In sensitivity analyses, we varied suspended progression (20-100$1,000-$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization. RESULTS: Base case DMOADs added 4.00 quality-adjusted life years (QALYs) and$230,000 per 100 persons, with an ICER of $57,500/QALY. DMOADs reduced need for TKR by 15$3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20$5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%. CONCLUSIONS: Cost, suspended progression, and pain relief are key drivers of value for DMOADs. Plausible combinations of these factors could reduce need for TKR and satisfy commonly cited cost-effectiveness criteri

Lifetime risk and age of diagnosis of symptomatic knee osteoarthritis in the US

OBJECTIVE: To estimate the incidence and lifetime risk of diagnosed symptomatic knee osteoarthritis (OA) and the age at diagnosis of knee OA based on self-reports in the US population. METHODS: We estimated the incidence of diagnosed symptomatic knee OA in the US by combining data on age-, sex-, and obesity-specific prevalence from the 2007-2008 National Health Interview Survey, with disease duration estimates derived from the Osteoarthritis Policy (OAPol) Model, a validated computer simulation model of knee OA. We used the OAPol Model to estimate the mean and median ages at diagnosis and lifetime risk. RESULTS: The estimated incidence of diagnosed symptomatic knee OA was highest among adults ages 55-64 years, ranging from 0.37% per year for nonobese men to 1.02% per year for obese women. The estimated median age at knee OA diagnosis was 55 years. The estimated lifetime risk was 13.83%, ranging from 9.60% for nonobese men to 23.87% in obese women. Approximately 9.29% of the US population is diagnosed with symptomatic knee OA by age 60 years. CONCLUSION: The diagnosis of symptomatic knee OA occurs relatively early in life, suggesting that prevention programs should be offered relatively early in the life course. Further research is needed to understand the future burden of health care utilization resulting from earlier diagnosis of knee OA. Copyright 2013 by the American College of Rheumatology

Lifetime risk and age of diagnosis of symptomatic knee osteoarthritis in the US

The definitive version is available at www3.interscience.wiley.comOBJECTIVE: To estimate the incidence and lifetime risk of diagnosed symptomatic knee osteoarthritis (OA) and the age at diagnosis of knee OA based on self-reports in the US population. METHODS: We estimated the incidence of diagnosed symptomatic knee OA in the US by combining data on age-, sex-, and obesity-specific prevalence from the 2007-2008 National Health Interview Survey, with disease duration estimates derived from the Osteoarthritis Policy (OAPol) Model, a validated computer simulation model of knee OA. We used the OAPol Model to estimate the mean and median ages at diagnosis and lifetime risk. RESULTS: The estimated incidence of diagnosed symptomatic knee OA was highest among adults ages 55-64 years, ranging from 0.37% per year for nonobese men to 1.02% per year for obese women. The estimated median age at knee OA diagnosis was 55 years. The estimated lifetime risk was 13.83%, ranging from 9.60% for nonobese men to 23.87% in obese women. Approximately 9.29% of the US population is diagnosed with symptomatic knee OA by age 60 years. CONCLUSION: The diagnosis of symptomatic knee OA occurs relatively early in life, suggesting that prevention programs should be offered relatively early in the life course. Further research is needed to understand the future burden of health care utilization resulting from earlier diagnosis of knee OA. Copyright 2013 by the American College of Rheumatology

To arm or to ally? The patron's dilemma and the strategic logic of arms transfers and alliances

How do great powers decide whether to provide arms to or form alliances with client states? This “patron's dilemma” revolves around a decision about how to best provide security to clients without becoming entrapped in unwanted conflicts. Strong commitments worsen the risk of entrapment, whereas weak commitments intensify fears of abandonment. This traditional alliance dilemma can be addressed through the provision of arms and alliances. Great power patrons primarily make such decisions on the basis of two factors: first, the extent to which the patron believes it and its client have common security interests; and second, whether the patron believes that its client has sufficient military capabilities to deter its main adversary without the patron's assistance. Patrons assess the degree of shared threat and the local balances of capabilities in determining whether to support their clients with arms, alliances, or both. As demonstrated in the U.S. provision of security goods to Taiwan and Israel during the Cold War, this strategic logic explains how great powers manage the patron's dilemma

Comparative Proteomic Analysis of the PhoP Regulon in Salmonella enterica Serovar Typhi Versus Typhimurium

Background: S. Typhi, a human-restricted Salmonella enterica serovar, causes a systemic intracellular infection in humans (typhoid fever). In comparison, S. Typhimurium causes gastroenteritis in humans, but causes a systemic typhoidal illness in mice. The PhoP regulon is a well studied two component (PhoP/Q) coordinately regulated network of genes whose expression is required for intracellular survival of S. enterica. Methodology/Principal Findings: Using high performance liquid chromatography mass spectrometry (HPLC-MS/MS), we examined the protein expression profiles of three sequenced S. enterica strains: S. Typhimurium LT2, S. Typhi CT18, and S. Typhi Ty2 in PhoP-inducing and non-inducing conditions in vitro and compared these results to profiles of $phoP^−/Q^−$ mutants derived from S. Typhimurium LT2 and S. Typhi Ty2. Our analysis identified 53 proteins in S. Typhimurium LT2 and 56 proteins in S. Typhi that were regulated in a PhoP-dependent manner. As expected, many proteins identified in S. Typhi demonstrated concordant differential expression with a homologous protein in S. Typhimurium. However, three proteins (HlyE, STY1499, and CdtB) had no homolog in S. Typhimurium. HlyE is a pore-forming toxin. STY1499 encodes a stably expressed protein of unknown function transcribed in the same operon as HlyE. CdtB is a cytolethal distending toxin associated with DNA damage, cell cycle arrest, and cellular distension. Gene expression studies confirmed up-regulation of mRNA of HlyE, STY1499, and CdtB in S. Typhi in PhoP-inducing conditions. Conclusions/Significance: This study is the first protein expression study of the PhoP virulence associated regulon using strains of Salmonella mutant in PhoP, has identified three Typhi-unique proteins (CdtB, HlyE and STY1499) that are not present in the genome of the wide host-range Typhimurium, and includes the first protein expression profiling of a live attenuated bacterial vaccine studied in humans (Ty800)