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The article reports the need of the U.S. Supreme Court to provide direction to navigating choice-of-law questions in maritime-lien cases. Topics discussed include enactment of Federal Maritime Lien Act in the U.S.; maritime lien concerning contract or tort claims, and the U.S. court case "World Fuel Services Trading, DMCC v. Hebei Prince Shipping Co." on choice-of-law provisions in determining whether to enforce a maritime lien.

The article discusses the U.S. Department of Health and Human Services regulation that requires employers to offer contraception coverage to their employees without cost-sharing. It analyzes legal challenges to the mandate with regard to the Religious Freedom Restoration Act which prohibits laws burdening a person's free exercise of their religion. It highlights the U.S. Court's decision regarding nonprofit organizations and for-profit corporation's litigations seeking relief from the mandate.

An essay is presented on how Asian-American Catholics redefine and nuance Marian devotions to articulate new senses of empowerment and efficacy in the socio-cultural context of the U.S. It explores the implications of Marian devotions as ritual practice for Asian-American Catholics. It highlights the different shrines and pilgrimages of the Blessed Virgin Mary including Our Lady of Antipolo, Our Lady of Velankanni and Our Lady of China.

The article discusses the issues and challenges faced in doing pastoral and ministerial work with American young adults. It reveals that young adults are difficult to encourage to participate in chuch activities because of technological innovations and prevalence of social networking sites. It notes that pastoral ministers are required to learn and engage in advance technologies to sustain mutuality and to collaborate with younger people to obtain active participation.

Introduction: Postgraduate medical education in Singapore underwent a major transition recently, from a British-style system and accreditation to a competency-based residency programme modelled after the American system. We aimed to identify the relative importance of factors influencing the choice of sponsoring institution (SI) for residency among medical students during this transition period., Methods: A questionnaire-based cross-sectional study of Singapore undergraduate medical students across all years of study was performed in 2011. Participants rated the degree of importance of 45 factors (including research, academia and education, marketing, reputation of faculty, working conditions, posting experience and influence by peers/seniors) to their choice of SIs on a five-point Likert scale. Differences in gender and seniority were compared., Results: 705 out of 1,274 students completed the survey (response rate 55.3%). The top five influencing factors were guidance by mentor (4.48 ± 0.74), reputation for good teaching (4.46 ± 0.76), personal overall experience in SI (4.41 ± 0.88), quality of mentorship and supervision (4.41 ± 0.75), and quality and quantity of teaching (4.37 ± 0.78). The five lowest-rated factors were social networking (2.91 ± 1.00), SI security (3.01 ± 1.07), open house impact (3.15 ± 0.96), advertising paraphernalia (3.17 ± 0.95) and research publications (3.21 ± 1.00). Female students attributed more importance to security and a positive working environment. Preclinical students rated research and marketing aspects more highly, while clinical students valued a positive working environment more., Conclusion: Quality of education, mentorship, experiences during clerkship and a positive working environment were the most important factors influencing the choice of SI., (Copyright: © Singapore Medical Association.)

Background: External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation., Methods: A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness., Results: The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean., Conclusions: From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.