When Things Go Wrong in the Clinic: How to Prevent and Respond to Serious Student Misconduct

This article documents the types of misconduct that students commit, explores why serious misconduct occurs, examines whether such conduct can be anticipated and reduced by prescreening and monitoring potentially problematic students, and suggests how misconduct might be addressed once it occurs. The authors\u27 analysis thus encompasses both legal obligations and pedagogical considerations, and it takes account of the differing perspectives of clinical professors, law school administrators, and bar examiners. The authors operate from a student centered perspective that emphasizes the support and development of law students. This article is prescriptive, therefore, in the extent to which it emphasizes preventive actions and constructive responses. The purpose of this article is not to prescribe how a clinical professor should deal with any particular instance of misconduct, but rather to empower clinical professors to deal thoughtfully with such situations by providing them with helpful information and an analytic framework

When Things Go Wrong in the Clinic: How to Prevent and Respond to Serious Student Misconduct

This article documents the types of misconduct that students commit, explores why serious misconduct occurs, examines whether such conduct can be anticipated and reduced by prescreening and monitoring potentially problematic students, and suggests how misconduct might be addressed once it occurs. The authors\u27 analysis thus encompasses both legal obligations and pedagogical considerations, and it takes account of the differing perspectives of clinical professors, law school administrators, and bar examiners. The authors operate from a student centered perspective that emphasizes the support and development of law students. This article is prescriptive, therefore, in the extent to which it emphasizes preventive actions and constructive responses. The purpose of this article is not to prescribe how a clinical professor should deal with any particular instance of misconduct, but rather to empower clinical professors to deal thoughtfully with such situations by providing them with helpful information and an analytic framework

Blood-Based Protein Changes in Childhood Are Associated With increased risk for later psychotic disorder: evidence from a nested case–control study of the ALSPAC Longitudinal Birth Cohort

The identification of early biological changes associated with the psychotic disorder (PD) is important as it may provide clues to the underlying pathophysiological mechanisms. We undertook the first proteomic profiling of blood plasma samples of children who later develop a PD. Participants were recruited from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who also participated in psychiatric assessment interviews at age 18. Protein expression levels at age 11 were compared between individuals who developed PD at age 18 (n = 37) with population-based age-matched controls (n = 38). Sixty out of 181 plasma proteins profiled were found to be differentially expressed (P < .05) in children with an outcome of the PD. Thirty-four of these proteins were found to be differentially expressed following correction for multiple comparisons. Pathway analysis implicated the complement and coagulation cascade. A second, targeted proteomic approach was used to verify these findings in age 11 plasma from subjects who reported psychotic experiences at age 18 (n = 40) in comparison to age-matched controls (n = 66). Our findings indicate that the complement and coagulation system is dysregulated in the blood during childhood before the development of the PD

Episodic Therapy for Genital Herpes in Sub-Saharan Africa: A Pooled Analysis from Three Randomized Controlled Trials

BACKGROUND: A randomized controlled trial in South Africa found a beneficial effect of acyclovir on genital ulcer healing, but no effect was seen in trials in Ghana, Central African Republic and Malawi. The aim of this paper is to assess whether the variation in impact of acyclovir on ulcer healing in these trials can be explained by differences in the characteristics of the study populations. METHODOLOGY/PRINCIPAL FINDINGS: Pooled data were analysed to estimate the impact of acyclovir on the proportion of ulcers healed seven days after randomisation by HIV/CD4 status, ulcer aetiology, size and duration before presentation; and impact on lesional HIV-1. Risk ratios (RR) were estimated using Poisson regression with robust standard errors. Of 1478 patients with genital ulcer, most (63%) had herpetic ulcers (16% first episode HSV-2 ulcers), and a further 3% chancroid, 2% syphilis, 0.7% lymphogranuloma venereum and 31% undetermined aetiology. Over half (58%) of patients were HIV-1 seropositive. The median duration of symptoms before presentation was 6 days. Patients on acyclovir were more likely to have a healed ulcer on day 7 (63% vs 57%, RR = 1.08, 95% CI 0.98-1.18), shorter time to healing (p = 0.04) and less lesional HIV-1 RNA (p = 0.03). Small ulcers (<50 mm(2)), HSV-2 ulcers, first episode HSV-2 ulcers, and ulcers in HIV-1 seropositive individuals responded best but the better effectiveness in South Africa was not explained by differences in these factors. CONCLUSIONS/SIGNIFICANCE: There may be slight benefit in adding acyclovir to syndromic management in settings where most ulcers are genital herpes. The stronger effect among HIV-1 infected individuals suggests that acyclovir may be beneficial for GUD/HIV-1 co-infected patients. The high prevalence in this population highlights that genital ulceration in patients with unknown HIV status provides a potential entry point for provider-initiated HIV testing

When Things Go Wrong in the Clinic: How to Prevent and Respond to Serious Student Misconduct

This article documents the types of misconduct that students commit, explores why serious misconduct occurs, examines whether such conduct can be anticipated and reduced by prescreening and monitoring potentially problematic students, and suggests how misconduct might be addressed once it occurs. The authors\u27 analysis thus encompasses both legal obligations and pedagogical considerations, and it takes account of the differing perspectives of clinical professors, law school administrators, and bar examiners. The authors operate from a student centered perspective that emphasizes the support and development of law students. This article is prescriptive, therefore, in the extent to which it emphasizes preventive actions and constructive responses. The purpose of this article is not to prescribe how a clinical professor should deal with any particular instance of misconduct, but rather to empower clinical professors to deal thoughtfully with such situations by providing them with helpful information and an analytic framework

Integrated environmental modeling : a vision and roadmap for the future

Integrated environmental modeling (IEM) is inspired by modern environmental problems, decisions, and policies and enabled by transdisciplinary science and computer capabilities that allow the environment to be considered in a holistic way. The problems are characterized by the extent of the environmental system involved, dynamic and interdependent nature of stressors and their impacts, diversity of stakeholders, and integration of social, economic, and environmental considerations. IEM provides a science-based structure to develop and organize relevant knowledge and information and apply it to explain, explore, and predict the behavior of environmental systems in response to human and natural sources of stress. During the past several years a number of workshops were held that brought IEM practitioners together to share experiences and discuss future needs and directions. In this paper we organize and present the results of these discussions. IEM is presented as a landscape containing four interdependent elements: applications, science, technology, and community. The elements are described from the perspective of their role in the landscape, current practices, and challenges that must be addressed. Workshop participants envision a global scale IEM community that leverages modern technologies to streamline the movement of science-based knowledge from its sources in research, through its organization into databases and models, to its integration and application for problem solving purposes. Achieving this vision will require that the global community of IEM stakeholders transcend social, and organizational boundaries and pursue greater levels of collaboration. Among the highest priorities for community action are the development of standards for publishing IEM data and models in forms suitable for automated discovery, access, and integration; education of the next generation of environmental stakeholders, with a focus on transdisciplinary research, development, and decision making; and providing a web-based platform for community interactions (e.g., continuous virtual workshops)

Blood-based protein changes in childhood are associated with increased risk for later psychotic disorder: evidence from a nested case-control study of the ALSPAC longitudinal birth cohort

The identification of early biological changes associated with the psychotic disorder (PD) is important as it may provide clues to the underlying pathophysiological mechanisms. We undertook the first proteomic profiling of blood plasma samples of children who later develop a PD. Participants were recruited from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who also participated in psychiatric assessment interviews at age 18. Protein expression levels at age 11 were compared between individuals who developed PD at age 18 (n = 37) with population-based age-matched controls (n = 38). Sixty out of 181 plasma proteins profiled were found to be differentially expressed (P < .05) in children with an outcome of the PD. Thirty-four of these proteins were found to be differentially expressed following correction for multiple comparisons. Pathway analysis implicated the complement and coagulation cascade. A second, targeted proteomic approach was used to verify these findings in age 11 plasma from subjects who reported psychotic experiences at age 18 (n = 40) in comparison to age-matched controls (n = 66). Our findings indicate that the complement and coagulation system is dysregulated in the blood during childhood before the development of the PD. </p