Johnny\u27s in the Basement/Mixing up His Medicine: Therapeutic Jurisprudence and Clinical Teaching

Clinical legal education is both more exhilarating and more stressful than traditional legal education. It forces students to confront their pre-existing assumptions about the practice of law and the representation of clients (frequently, indigent and marginalized individuals), and it similarly forces them to integrate new doctrine, theory, and practice in a very different way than regular law classes demand. Therapeutic jurisprudence considers the role of the law as a therapeutic agent, and examines all aspects of the legal system in an effort to determine whether it is operating therapeutically or anti-therapeutically, and suggests that legal decision-makers consider the potential impact that legal judgments may have on individuals\u27 well-being. Therapeutic jurisprudence has several applications to clinical teaching: It (1) improves the teaching of skills, (2) gives clinical teachers a better understanding of the dynamics of clinical relationships, (3) investigates ethical concerns and the effect on lawyering roles, and (4) invigorates the way teachers and students question accepted legal practice

Positron Emission Tomography 18F-Fluorodeoxyglucose Uptake and Prognosis in Patients with Surgically Treated, Stage I Non-small Cell Lung Cancer: A Systematic Review

Background18F-fluorodeoxyglucose (FDG) uptake holds potential as a noninvasive biomarker in patients with non-small cell lung cancer (NSCLC). We aimed to investigate the association between tumor FDG uptake and survival in patients with surgically resected, stage I NSCLC.MethodsWe used systematic methods to identify studies for inclusion, assess methodological quality, and abstract relevant data about study design and results.ResultsOur literature search identified 1578 citations, of which nine retrospective, cross-sectional studies met eligibility criteria. In all studies, higher degrees of FDG uptake in the primary tumor were associated with worse overall or disease free survival after 2 to 5 years of follow-up, but these differences were statistically significant in only five studies. Across studies, the median overall or disease free survival was 70% for patients with higher FDG uptake compared with 88% for patients with lower FDG uptake. In three studies that performed multivariable analysis, the adjusted hazard of death or recurrence was 1.9 to 8.6 times greater in patients with higher FDG uptake.ConclusionCurrent evidence suggests that increasing tumor FDG uptake is associated with worse survival in patients with stage I NSCLC. FDG uptake has the potential to be used as a biomarker for identifying stage I patients who are at increased risk of death or recurrence and therefore could identify candidates for participation in future trials of adjuvant therapy

Patients' perspectives on how idiopathic pulmonary fibrosis affects the quality of their lives

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a debilitating lung disease with a survival of only three to five years from the time of diagnosis. Due to a paucity of studies, large gaps remain in our understanding of how IPF affects the quality of patients' lives. In only one other study did investigators ask patients directly for their perspectives on this topic. Further, currently there is no disease-specific instrument to measure health-related quality of life (HRQL) in patients with IPF. A carefully constructed measurement instrument, sensitive to underlying change, is needed for use in clinical trials and longitudinal studies of patients with IPF. Before developing such an instrument, researchers must improve their understanding of the relevant effects of IPF on patients' lives. On a broader scale, to provide the best care for people with IPF, clinicians must appreciate – from patients' perspectives – how this disease affects various aspects of their lives. METHODS: We used focus groups and individual in-depth interviews with 20 IPF patients to collect their perspectives on how IPF affects their lives (with a focus on the quality of their lives). We then analyzed these perspectives and organized them into a conceptual framework for describing HRQL in patients with IPF. Next, we examined how well certain existing measurement instruments – which have been administered to IPF patients in prior studies – covered the domains and topics our patients identified. RESULTS: In our framework, we identified 12 primary domains: symptoms, IPF therapy, sleep, exhaustion, forethought, employment and finances, dependence, family, sexual relations, social participation, mental and spiritual well-being, mortality. Each domain is composed of several topics, which describe how IPF affects patients' lives. When we compared the content of our conceptual framework with the existing instruments, we found the coverage of the existing instruments to be inadequate for several reasons, including they may tap general areas of QOL or HRQL but not some areas that appear to be most directly affected by IPF, and they include items that are relevant to symptoms and effects of other respiratory diseases but not IPF. CONCLUSION: Collecting patients' perspectives and developing an organized inventory of the relevant effects of IPF on patients' lives provides valuable information for improving our understanding of the impact of this disease on patients and their loved ones. We believe our findings will help alert clinicians and researchers to IPF patients' experiences and concerns. Based on the comparison or our conceptual framework with the content of four existing instruments, it would appear that developing an IPF-specific measurement instrument is justified. Our conceptual framework for describing health-related quality of life in patients with IPF lays a solid foundation for constructing such an instrument

NASA ExoPAG Study Analysis Group 11: Preparing for the WFIRST Microlensing Survey

NASA's proposed WFIRST-AFTA mission will discover thousands of exoplanets with separations from the habitable zone out to unbound planets, using the technique of gravitational microlensing. The Study Analysis Group 11 of the NASA Exoplanet Program Analysis Group was convened to explore scientific programs that can be undertaken now, and in the years leading up to WFIRST's launch, in order to maximize the mission's scientific return and to reduce technical and scientific risk. This report presents those findings, which include suggested precursor Hubble Space Telescope observations, a ground-based, NIR microlensing survey, and other programs to develop and deepen community scientific expertise prior to the mission.Comment: 35 pages, 5 Figures. A brief overview of the findings is presented in the Executive Summary (2 pages

Call Me Caitlyn: Making and making over the 'authentic' transgender body in Anglo-American popular culture

A conception of transgender identity as an ‘authentic’ gendered core ‘trapped’ within a mismatched corporeality, and made tangible through corporeal transformations, has attained unprecedented legibility in contemporary Anglo-American media. Whilst pop-cultural articulations of this discourse have received some scholarly attention, the question of why this 'wrong body' paradigm has solidified as the normative explanation for gender transition within the popular media remains underexplored. This paper argues that this discourse has attained cultural pre-eminence through its convergence with a broader media and commercial zeitgeist, in which corporeal alteration and maintenance are perceived as means of accessing one’s ‘authentic’ self. I analyse the media representations of two transgender celebrities: Caitlyn Jenner and Nadia Almada, alongside the reality TV show TRANSform Me, exploring how these women’s gender transitions have been discursively aligned with a cultural imperative for all women, cisgender or trans, to display their authentic femininity through bodily work. This demonstrates how established tropes of authenticity-via-bodily transformation, have enabled transgender to become culturally legible through the wrong body trope. Problematically, I argue, this process has worked to demarcate ideals of ‘acceptable’ transgender subjectivity: self-sufficient, normatively feminine, and eager to embrace the possibilities for happiness and social integration provided by the commercial domain