Supporting Breastfeeding Moms at Work: How a Doctor's Note Can Make the Difference.

One of the most critical junctures for community support of breastfeeding is the mother's return to work. When breastfeeding workers have access to both time and space for expressing breast milk, they are more likely to breastfeed for the recommended term, yet many mothers still struggle to access these simple accommodations in their workplace. Healthcare providers can and should aid nursing mothers in accessing these accommodations.

Health impact of human rights testimony: harming the most vulnerable?

Background: Current legal efforts to document human rights violations typically include interviews in which survivors are asked to provide detailed descriptions of their traumatic experiences during a single meeting. Research on similar interview techniques used as part of a mental health treatment (eg, debriefing) has raised concerns that they might worsen mental health-more than doubling the risk of post-traumatic stress disorder in some studies. While controversy over the mental health impact of debriefing continues, debriefing treatments have been discontinued in most clinics nearly 2 decades ago.

Development of an adaptive, personalized, and scalable dementia care program: Early findings from the Care Ecosystem.

Katherine Possin and colleagues report on the implementation, development, and early findings of the Care Ecosystem, an adaptive, personalized, and scalable dementia care program.

Universities and Patent Demands.

Research universities have made enormous contributions to the field of medicine and the treatment of human disease. Alone or in collaboration with pharmaceutical companies, academic researchers have added to the store of knowledge that has led to numerous life science breakthroughs. A new chapter may be opening for academic researchers, however, that could lead to a darker tale.

Informed Consent, Body Property, and Self-Sovereignty.

Recent cases involving biosamples taken from indigenous tribes and newborn babies reveal the emptiness of informed consent. This venerable doctrine often functions as a charade, a collective fiction which thinly masks the uncomfortable fact that the subjects of human research are not actually afforded full information regarding the types of research that may be contemplated, nor do they provide meaningful consent. But if informed consent fails to provide adequate protection to the donors of biological materials, why not turn to principles of property law? Property is power, yet current law permits everyone except for those who donate biological materials to possess property rights.

Pregnant at work: time for prenatal care providers to act.

Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary.

Whole-Genome Screening of Newborns? The Constitutional Boundaries of State Newborn Screening Programs.

State newborn screening (NBS) programs routinely screen nearly all of the 4 million newborns in the United States each year for ∼30 primary conditions and a number of secondary conditions. NBS could be on the cusp of an unprecedented expansion as a result of advances in whole-genome sequencing (WGS). As WGS becomes cheaper and easier and as our knowledge and understanding of human genetics expand, the question of whether WGS has a role to play in state NBS programs becomes increasingly relevant and complex.

Funding the Costs of Disease Outbreaks Caused by Non-Vaccination.

While vaccination rates in the United States are high - generally over 90 percent - rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include.

Beyond Work-Life "Integration".

Research on the work-family interface began in the 1960s and has grown exponentially ever since. This vast amount of research, however, has had relatively little impact on workplace practice, and work-family conflict is at an all-time high. We review the work-family research to date and propose that a shift of attention is required, away from the individual experience of work and family and toward understanding how identity and status are defined at work.

Selective Reduction: "A Soft Cover for Hard Choices" or Another Name for Abortion?

Selective reduction and abortion both involve the termination of fetal life, but they are classified by different designations to underscore the notion that they are regarded as fundamentally different medical procedures: the two are performed using distinct techniques by different types of physicians, upon women under very different circumstances, in order to further dramatically different objectives. Hence, the two procedures appear to call for a distinct moral calculus, and they have traditionally evoked contradictory reactions from society. This essay posits that despite their different appellations, selective reduction and abortion are essentially equivalent.

My Obstetrician Got Me Fired: How Work Notes Can Harm Pregnant Patients and What to Do About It.

Prenatal care providers are frequently asked to provide employment notes for their patients requesting medical leave or changes to work duties. Writing employment notes correctly can help patients negotiate for and obtain medically indicated workplace accommodations, allowing them to continue to work and earn an income. However, a poorly written or poorly timed note can jeopardize a patient's employment and salary.

Compensating the victims of failure to vaccinate: what are the options?

This Article asks whether parents who choose not to vaccinate their child should be liable if that child, at higher risk of infectious disease than vaccinated children, transmits a vaccine-preventable disease to another. The Article argues that a tort remedy in this situation is both desirable and appropriate. It is desirable to assure compensation to the injured child and the family, who should not have to face the insult of financial ruin on top of the injury from the disease.

Promises, promises for neuroscience and law.

Stunning technical advances in the ability to image the human brain have provoked excited speculation about the application of neuroscience to other fields. The 'promise' of neuroscience for law has been touted with particular enthusiasm. Here, we contend that this promise elides fundamental conceptual issues that limit the usefulness of neuroscience for law.

Women's empowerment and fertility: a review of the literature.

Women's empowerment has become a focal point for development efforts worldwide and there is a need for an updated, critical assessment of the existing evidence on women's empowerment and fertility. We conducted a literature review on studies examining the relationships between women's empowerment and several fertility-related topics. Among the 60 studies identified for this review, the majority were conducted in South Asia (n = 35) and used household decision-making as a measure of empowerment (n = 37).

Copyright at the Bedside: Should We Stop the Spread?

We recently published an article in the New England Journal of Medicine describing a crisis in cognitive testing, as doctors and medical researchers increasingly face copyright claims in sets of questions used for testing mental state. We encouraged the creation of a cultural norm in medicine, in which medical researchers would ensure continued availability of their tests through open source licensing for any copyrights that might exist. In this piece, we consider the legal side of the question.

Outing the costs of civil deference to the military.

Placing the costs and process of repeal into the framework of U.S. civil governance and military power reveals the faltering state of civilian control over, and understanding of, contemporary military institutions.

Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change.

In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009-11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement.

Bending the health cost curve: the promise and peril of the Independent Payment Advisory Board.

Underlying today's and the future's health-care reform debate is a consensus that America's health-care financing system is in a slow-moving but deep crisis: care appears substandard in comparison with other advanced industrial countries, and relative costs are exploding beyond all reasonable measures. The Obama Administration's Patient Protection and Affordable Care Act (ACA) attempts to grapple with both of these problems. One of ACA's key instrumentalities is the Independent Payment Advisory Board-the IPAB, designed to discover and authorize ways to reduce the rate of growth of Medicare and other categories of health spending.

Whose body is it anyway? Human cells and the strange effects of property and intellectual property law.

Whatever else I might own in this world, it would seem intuitively obvious that I own the cells of my body. Where else could the notion of ownership begin, other than with the components of the tangible corpus that all would recognize as "me"? The law, however, does not view the issue so neatly and clearly, particularly when cells are no longer in my body. As so often happens in law, we have reached this point, not by design, but by the piecemeal development of disparate notions that, when gathered together, form a strange and disconcerting picture.

He Says, She Says: Gender and Cohabitation.

Cohabitation has become the modal path to marriage in the United States. However, little is known about what cohabitation means to young adults today. Drawing on data from 18 focus groups (N=138) and 54 in-depth interviews with young adults, this exploratory study investigates motivations to cohabit, and examines potential gender differences in those motivations and the meanings attached to them.