31 research outputs found

    Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

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    BACKGROUND: Medical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India. METHODS: This analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6). RESULTS: From the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care. CONCLUSIONS: This analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India

    The Influence of Law and Economics Scholarship on Contract Law: Impressions Twenty-Five Years Later

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    Unbundling Freedom in the Sharing Economy

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    Courts and scholars point to the sharing economy as the most recent proof that our labor amp employment infrastructure is obsolete because it rests on a narrow and outmoded idea ”namely that only workers subjected to direct personalized control by their employers need workrelated protections and benefits Since they diagnose the problem as being our system\u27s emphasis on control these critics have long called for reducing or eliminating the primacy of the control test in classifying workers as either protected employees or unprotected independent contractors Despite these persistent criticisms however the concept of control has been remarkably sticky in scholarly and judicial circlesbrbrThis Article argues that critics have misdiagnosed the reason why the control test is an unsatisfying method of classifying workers and dispensing workrelated safeguards Controlbased analysis is faulty because it only captures one of the two conflicting ways in which workers scholars and decisionmakers think about freedom at work One of these ways freedom as noninterference is adequately captured by the control test The other freedom as nondomination is not The tension between these two conceptions of freedom both deeply entrenched in American culture explains why the concept of control has been both faulty and sticky when it comes to worker classification brbrDrawing on a firstofitskind body of ethnographic fieldwork among workers and policymakers across several sharing economy industries this Article begins by showing how workers themselves conceptualize freedom as both noninterference and nondomination It then goes on to show that both these conceptualizations of freedom also exist in case law and statutory law pertaining to work In doing so the Article demonstrates that there is no great divide between work law and work practices and that if anything the problem is that classification doctrine reflects and reinforces an irresolvable tension in the way lay and legal actors think about freedom at wor

    Family Leave and the Gender Wage Gap

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    In this article, I argue that the key to achieving greater gender equality in the workplace is finding a way to change the behavior of men with respect to the care of children. Until now, most suggestions have focused on changing the behavior of women or employers, but women continue to face significant disadvantages in the workplace despite substantial changes in their labor force behavior. In the first part of the article, I analyze the latest data and conclude that the gender pay gap reflects both women\u27s actual labor market behavior, which still differs from men\u27s, and employers\u27 exaggerated responses to the expectation that women will leave the workforce to have and to raise children. Through a short empirical analysis, I then demonstrate that the Family and Medical Leave Act (FMLA) falls far short of providing the kind of relief that might improve gender inequality, and in the last section I propose that the leave law be amended with an eye on equality. In particular, I propose that we create a contract set-aside program tied to employers establishing generous and successful leave policies
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