Job quality in Europe

Promoting job quality and gender equality are objectives of the European Employment Strategy (EES) in spite of a downgrading of the attention given to both in the revised employment guidelines and the re-launch of the Lisbon Process. However, advances on both of these objectives may be important complements to the employment rate targets of the EES, as access to good quality jobs for both sexes is likely to help sustain higher employment rates. While the European Commission has a broad view of the concept of job quality in practice, it relies on a selection of labour market type indicators that say little about the quality of the actual jobs people do. Using data from the 2005 European Working Conditions survey, we analyse job quality along three dimensions: job content, autonomy and working conditions. We conclude that gender and occupational status, along with other job characteristics such as working time and sector, have more influence on an individual’s job quality than the country or ‘national model’ they are situated in. Our results also demonstrate the value of developing indicators of job quality that are both gender sensitive and derived at the level of the job rather than the labour market in order to advance EU policy and academic debate on this topic

Upper-Level Courses: Three Exemplars

This Article presents three exemplars of upper-level law school classes, and is divided into three parts. Part I discusses Securitization and Asset-Backed Securities ; Part II discusses Using Transactions to Teach Secured Transactions ; and Part III discusses Teaching Deals Through a Focus on the Entertainment Industry

Call for amendment of Declaration of Geneva of the World Medical Association

The Declaration of Geneva serves as a guide to ethical medical practice. It primarily addresses the duties of the physician in relation to an individual physician–patient relationship and implicitly advocates a ‘first come, first served’ model. It assumes the availability of adequate resources to treat all patients. However, no health system can meet all the requirements of its intended beneficiaries, and resource allocation, priority-setting and triaging are inevitable. Yet the Declaration of Geneva ‘does not permit considerations of age, disease or disability, gender …, social standing or any other factor’ to be considered. Neither does it permit consideration of ‘financial toxicity of treatment’ on patients, families and struggling healthcare systems. Making resource allocation, priority-setting, and triaging decisions is ethically complex. Yet in many resource-limited settings, such difficult and ethical judgement calls are left to individual physicians to make; this applies especially in low- and middle-income countries where practitioners are often faced with overwhelming burdens of disease and simply cannot treat everyone requiring care. The Declaration of Geneva should be amended to recognise limitations of physicians to deliver care because of health system constraints and should speak not only of a physician’s duty towards the individual patient but also to broader society. It should provide ethical guidance to those practising in limited resource settings about triaging, protecting elective care, ensuring training of well-rounded physicians, ensuring financial wellness of patients and healthcare systems and ensuring accountability for health and wellness of patients and healthcare systems

Upper-Level Courses: Three Examplars

I\u27m Mark Fagan, and I co-teach a course on securitization with Tamar Frankel at Boston University School of Law. We have come together to teach several interdisciplinary courses that combine law, business and public policy. Our course on securitization is a wonderful exemplar because it touches so many aspects of law as well as business and public policy. We spent quite a bit of time wrestling with how to teach it. Do you teach it in a process fashion? Do you teach it by legal topic? Do you take examples and examine them? After much debate and discussion, we actually went with the linear, process path. We begin with the borrower and show the students how the originator of the loan fits in, how they take and create a Special Purpose Vehicle ( SPV ), and the SPV in turn takes the assets and turns them into securities. We walk through this process and explain how the assets can move in one direction, and the cash in the other, and then the repayment. On the surface, this seems quite straightforward. Basically, we\u27re taking the illiquid assets and turning them into tradable securities. But, when you unbundle it, you find a level of complexity, because in addition to our primarily players, many of whom they\u27ve already had some exposure to, we get our additional players: the rating agencies, the appraisers, the security brokers, and the servicers, which layer on a very interesting dynamic into this process, because they\u27re actually not part of the core process yet have a significant impact on the outcome of the securitization process

A National Survey of Undergraduate Clinical Education in Internal Medicine

BACKGROUND: In the present milieu of rapid innovation in undergraduate medical education at US medical schools, the current structure and composition of clinical education in Internal Medicine (IM) is not clear. OBJECTIVE: To describe the current composition of undergraduate clinical education structure in IM. DESIGN: National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. PARTICIPANTS: One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. MAIN MEASURES: IM core clerkship and post-core clerkship structure descriptions, including duration, educational models, inpatient experiences, ambulatory experiences, and requirements. KEY RESULTS: The survey response rate was 83% (107/ 129). The majority of schools utilized one core IM clerkshipmodel (67%) and continued to use a traditional block model for a majority of their students (84%). Overall 26% employed a Longitudinal Integrated Clerkship model and 14% employed a shared block model for some students. The mean inpatient duration was 7.0 ± 1.7 weeks (range 3–11 weeks) and 94% of clerkships stipulated that students spend some inpatient time on general medicine. IM-specific ambulatory experiences were not required for students in 65% of IM core clerkship models. Overall 75% of schools did not require an advanced IM clinical experience after the core clerkship; however, 66% of schools reported a high percentage of students (> 40%) electing to take an IM sub-internship. About half of schools (48%) did not require overnight call or night float during the clinical IM sub-internship. CONCLUSIONS: Although there are diverse core IM clerkship models, the majority of IM core clerkships are still traditional block models. The mean inpatient duration is 7 weeks and 65% of IM core clerkship models did not require IM-specific ambulatory education

Cost effectiveness of recombinant factor VIIa for treatment of intracerebral hemorrhage

<p>Abstract</p> <p>Background</p> <p>Phase I/II placebo-controlled clinical trials of recombinant Factor VIIa (rFVIIa) suggested that administration of rFVIIa within 4 hours after onset of intracerebral hemorrhage (ICH) is safe, limits ICH growth, and improves outcomes. We sought to determine the cost-effectiveness of rFVIIa for acute ICH treatment, using published Phase II data. We hypothesized that rFVIIa would have a low marginal cost-effectiveness ratio (mCER) given the poor neurologic outcomes after ICH with conventional management.</p> <p>Methods</p> <p>We performed an incremental cost-effectiveness analysis from the societal perspective, considering conventional management vs. 80 ug/kg rFVIIa treatment for acute ICH cases meeting Phase II inclusion criteria. The time frame for the analysis was 1. 25 years: data from the Phase II trial was used for 90 day outcomes and rFVIIa complications – arterial thromboembolic events (ATE). We assumed no substantial cost differences in care between the two strategies except: 1) cost of rFVIIa (for an 80 mcg/kg dose in an 80 kg patient, assumed cost of $6,408); 2) cost of ATE side effects from rFVIIa (which also decrease quality of life and increase the chance of death); and 3) differential monetary costs of outcomes and their impact on quality of life, including disposition (home vs. nursing home), and outpatient vs. inpatient rehabilitation. Sensitivity analyses were performed to explore uncertainty in parameter estimates, impact of rFVIIa cost, direct cost of neurologic outcomes, probability of ATE, and outcomes after ATE.</p> <p>Results</p> <p>In the "base case", treating ICH with rFVIIa dominates the usual care strategy by being more effective and less costly. rFVIIa maintained a mCER <$50,000/QALY over a wide range of sensitivity analyses. Sensitivity analyses showed that the cost of rFVIIa must exceed $14,500, or the frequency of ATE exceed 29$50,000/QALY. Varying the cost and/or reducing the utility of health states following ATE did not impact results.</p> <p>Conclusion</p> <p>Based on data from preliminary trials, treating selected ICH patients with rFVIIa results in lower cost and improved clinical outcomes. This potential cost-effectiveness must be considered in light of the Phase III trial results.</p

Menthol Cigarette Smoking and Obesity in Young Adult Daily Smokers in Hawaii

This study investigates 1) the relationship between menthol cigarette smoking and obesity and 2) the association of body mass index with the nicotine metabolite ratio among menthol and non-menthol daily smokers aged 18–35 (n = 175). A brief survey on smoking and measures of height and weight, carbon monoxide, and saliva samples were collected from participants from May to December 2013 in Honolulu, Hawaii. Multiple regression was used to estimate differences in body mass index among menthol and non-menthol smokers and the association of menthol smoking with obesity. We calculated the log of the nicotine metabolite ratio to examine differences in the nicotine metabolite ratio among normal, overweight, and obese smokers. Sixty-eight percent of smokers used menthol cigarettes. Results showed that 62% of normal, 54% of overweight, and 91% of obese smokers used menthol cigarettes (p = .000). The mean body mass index was significantly higher among menthol compared with non-menthol smokers (29.4 versus 24.5, p = .000). After controlling for gender, marital status, educational attainment, employment status, and race/ethnicity, menthol smokers were more than 3 times as likely as non-menthol smokers to be obese (p = .04). The nicotine metabolite ratio was significantly lower for overweight menthol smokers compared with non-menthol smokers (.16 versus .26, p = .02) in the unadjusted model, but was not significant after adjusting for the covariates. Consistent with prior studies, our data show that menthol smokers are more likely to be obese compared with non-menthol smokers. Future studies are needed to determine how flavored tobacco products influence obesity among smokers

Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students.

BACKGROUND: Recent data do not exist regarding fourth-year medical students\u27 performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students\u27. METHOD: Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S. medical schools, compared with their responses in summer 2005. Students estimated their cumulative performance of 22 skills and reported self-confidence and perceived importance using a five-point Likert-type scale. RESULTS: The response rate was 79% (96/122). A majority reported never having performed cardioversion, thoracentesis, cardiopulmonary resuscitation, blood culture, purified protein derivative placement, or paracentesis. One fifth of students had never performed peripheral intravenous catheter insertion, phlebotomy, or arterial blood sampling. Students reported increased cumulative performance of 17 skills, increased self-confidence in five skills, and decreased perceived importance in three skills (two-sided P \u3c .05). CONCLUSIONS: A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures

Plasma amyloid‐beta levels in a pre‐symptomatic dutch‐type hereditary cerebral amyloid angiopathy pedigree: A cross‐sectional and longitudinal investigation

Plasma amyloid‐beta (Aβ) has long been investigated as a blood biomarker candidate for Cerebral Amyloid Angiopathy (CAA), however previous findings have been inconsistent which could be attributed to the use of less sensitive assays. This study investigates plasma Aβ alterations between pre‐symptomatic Dutch‐type hereditary CAA (D‐CAA) mutation‐carriers (MC) and non-carriers (NC) using two Aβ measurement platforms. Seventeen pre‐symptomatic members of a D‐ CAA pedigree were assembled and followed up 3–4 years later (NC = 8;MC = 9). Plasma Aβ1‐40 and Aβ1‐42 were cross‐sectionally and longitudinally analysed at baseline (T1) and follow‐up (T2) and were found to be lower in MCs compared to NCs, cross‐sectionally after adjusting for covari-ates, at both T1(Aβ1‐40: p = 0.001; Aβ1‐42: p = 0.0004) and T2 (Aβ1‐40: p = 0.001; Aβ1‐42: p = 0.016) employing the Single Molecule Array (Simoa) platform, however no significant differences were observed using the xMAP platform. Further, pairwise longitudinal analyses of plasma Aβ1‐40 revealed decreased levels in MCs using data from the Simoa platform (p = 0.041) and pairwise longitudinal analyses of plasma Aβ1‐42 revealed decreased levels in MCs using data from the xMAP platform (p = 0.041). Findings from the Simoa platform suggest that plasma Aβ may add value to a panel of biomarkers for the diagnosis of pre‐symptomatic CAA, however, further validation studies in larger sample sets are required