Genetic Discrimination: Overview of the Issue and Proposed Legislation

[Excerpt] A key policy issue before Congress is whether the potential for genetic discrimination by employers and insurers merits protections for genetic information that are more extensive than those already in place for health information. For the stated purpose of prohibiting discrimination on the basis of genetic information with respect to health insurance and employment, the Genetic Information Nondiscrimination Act of 2007 (H.R. 493) was introduced in the House on January 16, 2007. On January 22, 2007, the act was introduced in the Senate (S. 358). The act is identical to the Genetic Information Nondiscrimination Act of 2005, which passed the Senate by a vote of 98-0 (S. 306, 109th). An identical House bill (H.R. 1227, 109th), never came to a vote. S. 306 was very similar to S. 1053 (108th), which the Senate passed in 2003 by a vote of 95-0. A distinct House bill, H.R. 1910 (108th), never came to a vote. This report focuses on the key points in the ongoing debate about genetic discrimination legislation

Diagnosis isn\u27t enough: Understanding the connections between high health care utilization, chronic conditions and disabilities among U.S. working age adults

Background Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among people with chronic conditions, disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. Objectives Our aims were to (1) identify high utilizers of health care in the U.S. working age (18–64) population, (2) examine the overlap between this group and people with chronic conditions and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. Methods Using pooled national data from the Medical Expenditure Panel Survey (2006–2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with chronic conditions and/or disabilities. Results While the large majority of persons with high use/cost had chronic conditions, the minority of persons with chronic conditions had high health care utilization. However, among persons with chronic conditions, disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among people with disabilities, particularly when activities of daily living were limited. Conclusions We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports

Experimentations with Mindfulness and Gratitude Practice in My Legal Writing Classroom

Three years ago, I attended my first Western Regional Legal Writing Conference at Santa Clara University School of Law. I was brand new to teaching legal writing, only about a month into my first year of classes, and I was inspired by the creativity and focus on student learning that seemed to drive my new colleagues. One presentation stood out to me: “Making Mindfulness a Part of the Legal Writing Curriculum: ‘If a Lawyer Isn’t Happy, What’s the Point?’” by Professors Katherine Brem and Lauren Simpson at the University of Houston Law Center. The presenters demonstrated how they start their legal writing classes with a mindfulness activity, and they explained some of the benefits of a mindfulness practice, including reduced anxiety and heightened wellness within their classrooms. Although I am not a mindfulness expert, I do have anxiety myself and after a month of being in the classroom I was keenly aware of the tremendous pressure my first-year law students were under. So, I decided to take these professors’ advice and try a “mindfulness minute” in my classroom once a week. The response from my students was overwhelmingly positive. Since then, I have continued the mindfulness practice in my classroom each year, and I have also experimented with adding a gratitude practice to my classroo

Exploring Anti-racism in the First Year Legal Writing Classroom

The Legal Writing Institute hosted a series of one-day workshops at various law schools, including at SU, where the theme of the workshops was Teaching Values in the Legal Writing Classroom. This presentation explores assignments and activities that legal writing professors can use to introduce and reinforce ant-racism as a critical professional value

Using a Mindfulness and Gratitude Practice to Improve Student Wellness

The University of Oregon School of Law hosted the annual, two-day conference for legal writing professors to share ideas and research on topics related to legal writing and legal writing instruction. This presentation described two experimental semester-long mindfulness activities—mindfulness minutes and gratitude journaling—and student reactions to them

Practice patterns and outcomes of equivocal bone scans for patients with castration-resistant prostate cancer: Results from SEARCH.

ObjectiveTo review follow-up imaging after equivocal bone scans in men with castration resistant prostate cancer (CRPC) and examine the characteristics of equivocal bone scans that are associated with positive follow-up imaging.MethodsWe identified 639 men from five Veterans Affairs Hospitals with a technetium-99m bone scan after CRPC diagnosis, of whom 99 (15%) had equivocal scans. Men with equivocal scans were segregated into "high-risk" and "low-risk" subcategories based upon wording in the bone scan report. All follow-up imaging (bone scans, computed tomography [CT], magnetic resonance imaging [MRI], and X-rays) in the 3 months after the equivocal scan were reviewed. Variables were compared between patients with a positive vs. negative follow-up imaging after an equivocal bone scan.ResultsOf 99 men with an equivocal bone scan, 43 (43%) received at least one follow-up imaging test, including 32/82 (39%) with low-risk scans and 11/17 (65%) with high-risk scans (p = 0.052). Of follow-up tests, 67% were negative, 14% were equivocal, and 19% were positive. Among those who underwent follow-up imaging, 3/32 (9%) low-risk men had metastases vs. 5/11 (45%) high-risk men (p = 0.015).ConclusionWhile 19% of all men who received follow-up imaging had positive follow-up imaging, only 9% of those with a low-risk equivocal bone scan had metastases versus 45% of those with high-risk. These preliminary findings, if confirmed in larger studies, suggest follow-up imaging tests for low-risk equivocal scans can be delayed while high-risk equivocal scans should receive follow-up imaging