Foreign Attorneys in U.S. LL.M. Programs: Who\u27s In, Who\u27s Out, and Who They Are

In recent decades, there has been a remarkable growth in the number of foreign attorneys enrolled at U.S. law schools and particularly in LL.M. programs. To learn more about these students and how they fare, we conducted research in two law schools, one in the Midwest and the second on the East Coast. We examine the admissions process for foreign attorneys from the perspectives and experiences of both the administrators who make admissions decisions and the students who seek admission. We consider the layered international, national, state, and local laws that complicate the selection process, as well as the standards set by the schools themselves. To understand who gets in and who does not, we interviewed nine administrators who admit and support the international students during their studies. We observed how accounting practices and techniques of audit culture color administrative decision-making, but also the conditions under which discretion comes into play. We collected quantitative data about the students at the two schools and analyzed their personal statements using the anthropological and linguistic concept of genre, a stylized narrative, that revealed students\u27 life histories, education, work experiences, motives for attending the programs, and future goals. The narratives, and our interviews with fifty students who attended the programs, demonstrate that internationalizationh as changed the terms for inclusion in U.S. law schools. The structures of privilege play by different rules at the international level. They include a wider politics of interstate relations, the vicissitudes of international and national law, the operation of audit cultures, a certain proficiency in English as the lingua franca of international law, and the ability to muster economic and other symbolic resources, even under great hardship. As sites of globalization, law schools are creating new legal experts who will reinvent the future meaning of being a lawyer and doing a lawyer\u27s work

Arthroscopic transosseous rotator cuff repair: A prospective study on cost savings, surgical time, and outcomes

Objectives: Health expenditures in the United States are outpacing national income, and affordability has become a major policy issue. Over 500,000 rotator cuff repairs (RCR) are performed annually in the United States making RCR a potential source of cost savings. Arthroscopic trans-osseous equivalent (TOE) repair using a double row of anchors has shown superior biomechanical strength compared to other techniques, but at a higher cost. The arthroscopic transosseous (TO) repair is a novel technique allowing arthroscopic rotator cuff repair to be performed without suture anchors. Arthroscopic TO repair may be a means to provide similarly excellent patient outcomes while lowering the cost of care. The primary purpose is to compare the price differential and time of surgery for an arthroscopic rotator cuff repair using anchorless TO repair verses an anchor trans-osseous equivalent (TOE) repair. A secondary purpose of the study was to evaluate outcomes at 6 months postoperatively. Methods: A prospective, case-controlled study evaluating arthroscopic rotator cuff repair using two techniques was performed. The study group consisting of 21 patients undergoing TO repair was compared to a control group consisting of 22 patients undergoing TOE repair. The groups were controlled for size of tear, biceps treatment, acromioplasty, distal clavicle excision, and labral pathology. The primary outcome measures were surgical time as well as total cost of implants and equipment for each surgery, determined by an independent third party, Atlanticare Hospital. Secondary outcomes were changes in the SST, VAS, and SANE scores. Results: Mean total surgical implant/equipment cost per procedure for TOE repair was $2348.03 (SD 490.30) and for TO repair was$1204.97 (SD 330.69; p\u3c0.0001). Mean cut to close time for TOE repair was 85 minutes (95% CI is 77-90) verses 74 (95% CI = 71-98) for TO repair. A log rank test revealed no difference in time (p =0.95). A linear regression model was developed to evaluate the change in SST, VAS, and SANE scores from pre-op to 6 months follow-up. Our study was underpowered but no difference in outcome was observed. Conclusion: Arthroscopic TO rotator cuff repair is a cost savings and time neutral technique compared to TOE repair. A mean of $1100 can be saved in surgical cost per case. In a country that performs over 500,000 RCRs annually, utilizing a TO repair technique can provide substantial cost savings to the healthcare system. © The Author(s) 2015

‘You Before Me’: A qualitative study of Health Care Professionals’ and students’ understanding and experiences of compassion in the workplace, self-compassion, self-care and health behaviours

Background: The importance of compassionate care within health care services is at the forefront of training and workplace policy and practice. The challenges for Health Care Professionals (HCPs) in delivering compassionate care are wide-ranging. Aims: This study explored the experiences of HCPs in delivering compassionate care and examined the impact of working in the health profession on their own health and wellbeing in order to increase knowledge around how to support HCPs in the workplace. Methods: A phenomenological approach was adopted, and individual semi-structured interviews were carried out with a sample of twenty-three qualified and student HCPs. The data was analysed using thematic analysis using Braun and Clarke’s (2006) procedural steps. Results: Four major themes were constructed: (a) Keeping it real: The need for authentic compassion, (b) Compassion takes time: Barriers to delivering compassionate care, (c) There’s no time to think about myself: Self compassion, self-care and health behaviours, and (d) Does anybody care? Accessing support. Participants talked of the occupational difficulties of providing high quality compassionate care and described a deficit of self-care in both their working and non-working lives. Conclusions: This study suggests an ethical and pragmatic imperative to enhance the care and support for HCPs, particularly given the current and projected shortage of HCPs alongside a suggested model of compassionate self-care for improving health and wellbeing Keywords: Health Care Professionals, Compassion, Self-compassion, Self-care, Health behaviour

Pilot study of a cluster randomised trial of a guided e-learning health promotion intervention for managers based on management standards for the improvement of employee well-being and reduction of sickness absence: GEM Study

Objectives To investigate the feasibility of recruitment, adherence and likely effectiveness of an e-learning intervention for managers to improve employees’ well-being and reduce sickness absence. Methods The GEM Study (guided e-learning for managers) was a mixed methods pilot cluster randomised trial. Employees were recruited from four mental health services prior to randomising three services to the intervention and one to no-intervention control. Intervention managers received a facilitated e-learning programme on work-related stress. Main outcomes were Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), 12-item GHQ and sickness absence <21 days from human resources. 35 in-depth interviews were undertaken with key informants, managers and employees, and additional observational data collected. Results 424 of 649 (65%) employees approached consented, of whom 350 provided WEMWBS at baseline and 284 at follow-up; 41 managers out of 49 were recruited from the three intervention clusters and 21 adhered to the intervention. WEMWBS scores fell from 50.4–49.0 in the control (n=59) and 51.0–49.9 in the intervention (n=225), giving an intervention effect of 0.5 (95% CI −3.2 to 4.2). 120/225 intervention employees had a manager who was adherent to the intervention. HR data on sickness absence (n=393) showed no evidence of effect. There were no effects on GHQ score or work characteristics. Online quiz knowledge scores increased across the study in adherent managers. Qualitative data provided a rich picture of the context within which the intervention took place and managers’ and employees’ experiences of it. Conclusions A small benefit from the intervention on well-being was explained by the mixed methods approach, implicating a low intervention uptake by managers and suggesting that education alone may be insufficient. A full trial of the guided e-learning intervention and economic evaluation is feasible. Future research should include more active encouragement of manager motivation, reflection and behaviour change

Cryptosporidium Priming Is More Effective than Vaccine for Protection against Cryptosporidiosis in a Murine Protein Malnutrition Model

Cryptosporidium is a major cause of severe diarrhea, especially in malnourished children. Using a murine model of C. parvum oocyst challenge that recapitulates clinical features of severe cryptosporidiosis during malnutrition, we interrogated the effect of protein malnutrition (PM) on primary and secondary responses to C. parvum challenge, and tested the differential ability of mucosal priming strategies to overcome the PM-induced susceptibility. We determined that while PM fundamentally alters systemic and mucosal primary immune responses to Cryptosporidium, priming with C. parvum (106 oocysts) provides robust protective immunity against re-challenge despite ongoing PM. C. parvum priming restores mucosal Th1-type effectors (CD3+CD8+CD103+ T-cells) and cytokines (IFNγ, and IL12p40) that otherwise decrease with ongoing PM. Vaccination strategies with Cryptosporidium antigens expressed in the S. Typhi vector 908htr, however, do not enhance Th1-type responses to C. parvum challenge during PM, even though vaccination strongly boosts immunity in challenged fully nourished hosts. Remote non-specific exposures to the attenuated S. Typhi vector alone or the TLR9 agonist CpG ODN-1668 can partially attenuate C. parvum severity during PM, but neither as effectively as viable C. parvum priming. We conclude that although PM interferes with basal and vaccine-boosted immune responses to C. parvum, sustained reductions in disease severity are possible through mucosal activators of host defenses, and specifically C. parvum priming can elicit impressively robust Th1-type protective immunity despite ongoing protein malnutrition. These findings add insight into potential correlates of Cryptosporidium immunity and future vaccine strategies in malnourished children

Perceiving and responding to challenges in job crafting at different ranks: When proactivity requires adaptivity

We utilize a qualitative study of 33 employees in for-profit and non-profit organizations to elaborate theory on job crafting. We specifically focus on how employees at different ranks describe perceiving and adapting to challenges in the execution of job crafting. Elaborating the challenges employees perceive in job crafting and their responses to them details the adaptive action that may be necessary for job crafting to occur. Specifically, our findings suggest that higher-rank employees tend to see the challenges they face in job crafting as located in their own expectations of how they and others should spend their time, while lower-rank employees tend to see their challenges as located in their prescribed jobs and others' expectations of them. The nature of each group's perceived challenges is related to the adaptive moves that they make to overcome them, such that higher-rank employees adapt their own expectations and behaviors to make do with perceived opportunities to job craft at work, while lower-rank employees adapt others' expectations and behaviors to create opportunities to job craft. Our elaborated theory presents a socially embedded account of job crafting as a proactive and adaptive process that is shaped by employees' structural location in the organization. Copyright © 2010 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64922/1/645_ftp.pd

The parenting experience of those with borderline personality disorder traits: practitioner and parent perspectives

Background: Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful. Aim: To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them. Methods: Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison. Results: Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents. Conclusion: This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given