The Legal Profession: Client Interests, Professional Roles, and Social Hierarchies

There is a natural urge to study the extreme. The extreme case is likely to be conspicuous and dramatic. Sociological research on the American legal profession has not, for the most part, resisted the urge. The best-known studies examine lawyers at the extremes of the profession\u27s prestige hierarchy-e.g., Carlin\u27s study of solo practitioners and Smigel\u27s study of the Wall Street lawyer. The profession\u27s center has more often been neglected and few data are available on the bar\u27s overall social structure. Ladinsky\u27s study .of Detroit lawyers covers all types and specialities, and contributes substantially to our understanding of the profession\u27s general social structure, but it rests on a limited data base. Rueschemeyer\u27s commentary on the legal profession has a broader, comparative viewpoint and includes useful theoretical propositions, but it presents no original data on American lawyers. This Article attempts to supply some of that data by systematically describing and analyzing the social structure of the legal profession in a major city. The Article first describes the types of differentiation that might be expected within the profession, and then examines the extent to which those differences in fact occur within the Chicago bar. It concludes that the most important determinant of the profession\u27s social organization is the impact on the bar of client interests rather than of forces generated within the profession or compelled by the logic of the law. Finally, the Article compares law with medicine to demonstrate why the characteristics of the persons served more significantly determine the profession\u27s structure in law than in medicine

Women do have an improved long-term outcome after non–ST-elevation acute coronary syndromes treated very early and predominantly with percutaneous coronary intervention A prospective study in 1,450 consecutive patients

AbstractObjectivesThis study sought to assess gender-based differences in long-term outcome after very early aggressive revascularization for non–ST-elevation acute coronary syndromes (NSTACS).BackgroundThe Fragmin and fast Revascularization during InStability in Coronary artery disease (FRISC) II study suggested that women have less to gain from an early invasive strategy.MethodsWe conducted a prospective cohort study in 1,450 consecutive patients with NSTACS undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularization strategy within 24 h of admission. The combined primary end point was defined as death or nonfatal myocardial infarction (MI) and recorded for a mean of 20 months.ResultsPercutaneous coronary intervention was performed in more than 50% of patients in women and men and accompanied with stenting in 80%. The percutaneous coronary intervention:coronary artery bypass grafting ratio was 4:1 in men and 5:1 in women. The primary end point occurred in 29 (7.0%) women as compared with 108 (10.5%) men (hazard ratio for women, 0.65; 95% confidence interval [CI] 0.42 to 0.99; p = 0.045). Backward-stepwise multivariate Cox regression analysis identified female gender as an independent predictor of death or MI (hazard ratio for female gender, 0.51; 95% CI, 0.28 to 0.92; p = 0.024). Kaplan-Meier analysis showed that women had consistently lower event rates during the entire follow-up period (p = 0.037 by log-rank for death or MI).ConclusionsWomen treated with very early aggressive revascularization with coronary stenting of the culprit lesion as the primary revascularization strategy have a better long-term outcome as compared with men