The Future of Emotional Harm

Why should tort law treat claims for emotional harm as a second-class citizen? Judicial skepticism about these claims is long entrenched, justified by an amalgam of perceived problems ranging from proof difficulties for causation and the need to constrain fraudulent claims, to the ubiquity of the injury, and a concern about open-ended liability. To address this jumble of justifications, the law has developed a series of duty limitations to curb the claims and preclude them from reaching the jury for individualized analysis. The limited duty approach to emotional harm is maintained by the latest iteration of the Restatement (Third) of Torts. This Article argues that many of the justifications for curtailing this tort have been discredited by scientific developments. In particular, the rapid advances in neuroscience give greater insight into the changes that occur in the brain from emotional harm. Limited duty tests should no longer be used as proxies for validity or justified by the presumed untrustworthiness of the claim. Instead, validity evidence for emotional harm claims—like evidence of physical harm—should be entrusted to juries. This approach will reassert the jury’s role as the traditional factfinder, promote corrective justice and deterrence values, and lead to greater equity for negligent infliction of emotional distress (NIED) claimants. The traditional limitations on tort recovery, including the rules of evidence and causation, are more than adequate to avoid opening the floodgates to emotional distress claims

The Future of Emotional Harm

Why should tort law treat claims for emotional harm as a second-class citizen? Judicial skepticism about these claims is long entrenched, justified by an amalgam of perceived problems ranging from proof difficulties for causation and the need to constrain fraudulent claims, to the ubiquity of the injury, and a concern about open-ended liability. To address this jumble of justifications, the law has developed a series of duty limitations to curb the claims and preclude them from reaching the jury for individualized analysis. The limited duty approach to emotional harm is maintained by the latest iteration of the Restatement (Third) of Torts. This Article argues that many of the justifications for curtailing this tort have been discredited by scientific developments. In particular, the rapid advances in neuroscience give greater insight into the changes that occur in the brain from emotional harm. Limited duty tests should no longer be used as proxies for validity or justified by the presumed untrustworthiness of the claim. Instead, validity evidence for emotional harm claims—like evidence of physical harm—should be entrusted to juries. This approach will reassert the jury’s role as the traditional factfinder, promote corrective justice and deterrence values, and lead to greater equity for negligent infliction of emotional distress (NIED) claimants. The traditional limitations on tort recovery, including the rules of evidence and causation, are more than adequate to avoid opening the floodgates to emotional distress claims

Evidence for the use of exercise in patients with breast cancer to reduce cancer-related fatigue

Background & Purpose: Cancer-related fatigue is the most commonly reported side effect of cancer treatment and affects 70-100% of patients. According to the 2013 National Comprehensive Cancer Network Guidelines on Cancer-Related Fatigue, institutions should assess the quality of fatigue management in their continuous quality improvement projects. In addition, the Guidelines also state that Medicare contracts should reimburse for fatigue management and disability insurance should include coverage for the continuing effects of fatigue. Exercise has been suggested for breast cancer survivors as an intervention to reduce cancer-related fatigue both during and after cancer treatment. However, it has been reported that only 68% of patients receive information about fatigue during their cancer treatment and the information they receive is not specific enough to initiate an exercise program. The objective of this systematic literature review was to summarize the effects of exercise to reduce cancer-related fatigue in patients with breast cancer and discuss the exercise dosage in terms of mode, frequency, duration and intensity. Number of Subjects: Five studies met the inclusion/exclusion criteria for this review. Materials/Methods: The literature search included key word searches in the databases, Medline and CINHAL, and a hand-search of studies included in a Cochrane review. The search was limited to females only, published in 2008-2013 and English language. Of the 23 studies that met the search criteria, five were chosen based on inclusion of an aerobic component, measurement of fatigue levels and high PEDro scores. Types of studies reviewed included clinical trials comparing an exercise intervention group to a control group and one cross sectional survey of an exercise intervention. Outcomes: Four out of five studies showed an improvement in cancer treatment related fatigue in individuals with breast cancer following the exercise intervention. Three different outcome tools were used to measure fatigue. The length of exercise intervention varied among each study and there was inconsistent duration, type of exercise, or supervision reported. The range included 8 weeks aquatic aerobic and resistance exercise, 12 weeks of aerobic, resistance and stretching, a home based walking program of 6 weeks or 14 weeks, in addition to a yearlong combined home-based aerobic exercise program. Intensity was measured using both RPE and/or heart rate. No study reported negative impacts of exercise implementation. General study limitations included group contamination when the control group began an exercise program on their own or there was decreased adherence to the exercise intervention by the study subjects. Systemic bias may have occurred when the control group received little/no attention and the Hawthorne effect of study participants. Discussion: Physical therapists should be aware not only of the important role of exercise intervention for the management of cancer-related fatigue in individuals with breast cancer but the mode, frequency and duration that is most effective. Additional research is needed in this population to clarify optimal exercise dosage and to compare outcomes of total daily physical activity versus only formal exercise. Despite these limitations, the available evidence supports the value of exercise for individuals with breast cancer-related fatigue and the active role physical therapists can play to initiate exercise programs

Preemption of Bivens Claims: How Clearly Must Congress Speak?

Part I of this Article demonstrates that the Court\u27s approach to congressional remedial schemes has changed significantly since Bivens. Part II of the Article investigates whether this change in approach is warranted by the principle that, when filling gaps in federal legislation (i.e., creating federal common law), the Court should exercise caution because it is acting in an area primarily entrusted to Congress. In Part III, the Article contrasts the Court\u27s approach in the Bivens line of cases to its approach in the federal-state preemption area, where the Court is faced with a similar problem of determining whether one remedial scheme (that of a state) may coexist with another remedial scheme (that of Congress)

Evaluation of a Student-Centered Digital Education Project in Health Science Education

Student-centered learning is essential and evidence shows higher levels of achievement when students are engaged with educational activities that include critical thinking and effective communication in addition to creativity. The aim of this prospective cohort study was to evaluate a student-centered digital education project during a course about physical therapy (PT) management of chronic diseases. The objectives of this student project were to apply content through a well thought-out digital project and critically analyze information considering multiple points of view. Each project was evaluated by faculty using a rubric, and students completed a self- and peer-assessment. All projects were shared at the end of the semester. Students self-selected the topic (and deadline), whether to work individually or in groups and the digital format of their project (infographic, screencast or PechaKucha/Ignite). Data analyzed from three cohorts (n=137) show this student project was well-received with 69% agreeing the time it took to complete the project was appropriate for the percentage of the final grade, 76% reported having a better understanding of the topic and 80% reported a new understanding of presenting information to health professions audience. The studentcentered components of the project were also highly favored with the ability to self-select the digital project format (86%), due date (85%) and topic (87%). Most students choose to work in groups (96%) and the infographic digital format was selected most (88%), followed by screencast (7%) and Pecha Kucha/Ignite (5%). Faculty noted an excitement by students about their completed projects and eagerness to share with others. These results support the use of a student-centered digital educational project allowing students to make connections between course material and PT with an individualized project plan to present information digitally. The millennial generation of students are comfortable with technology and this project introduced new platforms for presenting healthcare information

Sex-Based Brain Differences and Emotional Harm

Technological advances have allowed neuroscientists to identify brain differences between women and men, which may lead to explanations for sex-biased population differences in behavior and brain-based disorders. Although the research is at its early stages, this is an appropriate time to examine some of the potential legal implications of these findings. This Article examines that question in the context of tort law, especially how scientific findings may affect the use of the reasonable person standard in emotional injury claims. Specifically, studies suggest that there may be distinct sex-based mechanisms involved in reactions to extreme stress, raising the question of whether women experience and process stress and trauma differently than men. This Article argues that these studies may eventually inform the use of the reasonableness standard for freestanding emotional harm claims. As science further develops, courts may either apply a reasonable woman standard in limited contexts or at least allow jurors to consider evidence of sex-based differences in applying a reasonable person standard. Recognizing these differences, courts have already begun to apply the reasonable woman standard to hostile workplace environment claims, and science may support broader use of that standard, especially for negligent and intentional infliction of emotional harm claims

Repetition

Artist Statement My work is about memory, and my awareness of the repetition of large and small events in my life. In my paintings, drawings, and mixed media I create rhythmic patterns with images and colors to imply a sense of recurrence. I often repeat imagery such as paper dolls or geometric and organic shapes in my work. I choose and repeat shapes and colors that remind me of events in my childhood and in my life as an adult. I see these multiple images as symbolic self-portraits which prompt memories of recurring events, such as waking up each morning or remaking a mistake or running into an old friend. By incorporating personally familiar and repeated imagery, I want to trigger a déjà vu experience. I want the presentation of my memories to evoke the same in the viewer