The Supreme Court that Stole…Christmas? Measuring the Fallout from Lynch and Allegheny: A Critique of the Establishment Clause and Religious Displays

Lynch v. Donnelly in 1984 and County of Allegheny v. ACLU in 1989, the only holiday themed religious display cases decided by the Court on the grounds on Establishment Clause violations, demonstrate the inadequacies of the Court’s Establishment Clause jurisprudence. The precedent set out by the Supreme Court in Lynch v. Donnelly and Allegheny v. ACLU compromise lower courts’ decision making process. Discrepancy in methods, results, and opinions threatens the credibility of the Court. This not only confuses the idea of religious freedom, but it also threatens its very core. Lynch and Allegheny were intended to clarify Establishment Clause jurisprudence and provide a standard for interpretation for lower courts to follow. However, the Court failed to agree upon a legal doctrine that would achieve these goals. This stems from a deeper conflict over the fundamental principles underlying the Establishment Clause, which prevents the Court from providing the guidance necessary to lower court decision-making. This study examined Circuit Court cases to determine the effect that Lynch and Allegheny had on lower courts. Compiling circuit court cases involving disputes of religious symbols displayed in the holiday context and analyzing the rulings provides a manageable case set that will accurately depict the way lower courts have responded to the Lynch and Allegheny decisions. Empirical data shows that cohesiveness within a higher court results in fewer reversals of the lower court’s decisions. Therefore, circuit courts’ rulings on religious displays lack uniformity because of the Supreme Court’s inability to provide consistent guidelines. Evaluation of Circuit Court decisions will provide an accurate representation of the problems that exist within the appellate court system. I examined the methodology used by courts and the outcome reached. Cases that involved similar displays but resulted in different rulings or cases that employed different doctrines to come to the same ruling supported the claim that the Supreme Court has failed to produce guidelines that the lower courts can effectively apply to a wide range of cases. The 20 cases evaluated in this study were classified according to the type of display. Two categories of cases emerged: displays of a single, unattended religious symbol, such as a solitary crèche or menorah and displays with one or more symbols, such as a menorah and Christmas tree, included as part of a larger display with clearly secular symbols, such as a reindeer, candy cane, or banner. For combined displays, the inclusion of secular objects mitigated the religious tones of the message perceived by the reasonable observer and were almost always allowed. For unattended displays, the judges are not equipped with a clear rule and case outcomes were inconsistent. The overarching issue still remains that the Court needs to provide better guidance for lower courts

Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BackgroundDocumenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record.MethodsKotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed.ResultsKotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element.ConclusionChange strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care.Practical implicationsA practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture

An International Working Definition for Quality of Oral Healthcare.

KNOWLEDGE TRANSFER STATEMENT: This special communication describes the development of a working definition for quality of oral healthcare. The findings of this study are intended to raise awareness of the relevance of quality improvement initiatives in oral healthcare. The working definition described here has the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare

Developing a Standard Set of Patient-centred Outcomes for Adult Oral Health - An International, Cross-disciplinary Consensus.

OBJECTIVE: To develop a minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health. MATERIALS AND METHODS: An international oral health working group (OHWG) was established, of patient advocates, researchers, clinicians and public health experts to develop an AOHSS. PubMed was searched for oral health clinical and patient-reported measures and case-mix variables related to caries and periodontal disease. The selected patient-reported outcome measures focused on general oral health, and oral health-related quality of life tools. A consensus was reached via Delphi with parallel consultation of subject matter content experts. Finally, comments and input were elicited from oral health stakeholders globally, including patients/consumers. RESULTS: The literature search yielded 1,453 results. After inclusion/exclusion criteria, 959 abstracts generated potential outcomes and case-mix variables. Delphi rounds resulted in a consensus-based selection of 80 individual items capturing 31 outcome and case-mix concepts. Global reviews generated 347 responses from 87 countries, and the patient/consumer validation survey elicited 129 responses. This AOHSS includes 25 items directed towards patients (including demographics, the impact of their oral health on oral function, a record of pain and oral hygiene practices, and financial implications of care) and items for clinicians to complete, including medical history, a record of caries and periodontal disease activity, and types of dental treatment delivered. CONCLUSION: In conclusion, utilising a robust methodology, a standardised core set of oral health outcome measures for adults, with a particular emphasis on caries and periodontal disease, was developed